Midface Reconstruction

ABSTRACT

In the midface, two polyhedron-shaped maxillary units are separated by the central midportion, which includes the nasal area. The midface includes such facial features as the nose, cheek, and upper lip, and posteriorly it extends to the anterior skull base. In the superoinferior direction, the midface includes the soft and bony tissue from the orbital cavity to the oral cavity. Laterally, the midface extends to the temporal bone. Although most superficial skin defects of the midface can be covered by various standard reconstructive modalities, because of the need to evaluate the nature of the tissues involved and because of structural and also functional considerations, the management of large, full-thickness defects is a challenge for reconstructive surgeons. Advances in microsurgical techniques have permitted reliable wound closure and a substantial decrease in patient morbidity with low complication rates while allowing a variety of reconstructive flap options in a single stage. To create a reconstructive algorithm, several classification systems have been proposed, mostly relating to the extension, location, and tissue involvement of the defect. Defects can be classified as simple soft tissue defects and complex defects. The complex three-dimensional defect is classified under four types: types I to IV. Although maxillary prostheses are nonliving tissues and may cause discomfort for the patient, in special situations they can be reconstructive options requiring special experience. Essentially, the method of reconstruction should be selected on an individual basis, bearing in mind the medical situation; the age and prognosis of the patient; the size, extension, and composition of the defect; and the availability of local or distant tissues.

Midface

REFERENCES

• 1 Muzaffar A R, Adams Jr W P, Hartog J M, Rohrich R J, Byrd H S. Maxillary reconstruction: functional and aesthetic considerations.  Plast Reconstr Surg. 1999;  104 2172-2183 quiz 2184
• 2 Wells M D, Luce E A. Reconstruction of midfacial defects after surgical resection of malignancies.  Clin Plast Surg. 1995;  22 79-89
• 3 Cordeiro P G, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects.  Plast Reconstr Surg. 2000;  105 2331-2346 discussion 2347-2348
• 4 Wei F C, Jain V, Celik N, Chen H C, Chuang D C, Lin C H. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps.  Plast Reconstr Surg. 2002;  109 2219-2226 discussion 2227-2230
• 5 Ozkan O, Coşkunfirat O K, Ozgentaş H E. An ideal and versatile material for soft-tissue coverage: experiences with most modifications of the anterolateral thigh flap.  J Reconstr Microsurg. 2004;  20 377-383
• 6 Coskunfirat O K, Wei F C, Huang W C, Cheng M H, Yang W G, Chang Y M. Microvascular free tissue transfer for treatment of osteoradionecrosis of the maxilla.  Plast Reconstr Surg. 2005;  115 54-60
• 7 Ozkan O, Mardini S, Chen H C, Cigna E, Tang W R, Liu Y T. Repair of buccal defects with anterolateral thigh flaps.  Microsurgery. 2006;  26 182-189
• 8 Yamamoto Y, Minakawa H, Kawashima K, Furukawa H, Sugihara T, Nohira K. Role of buttress reconstruction in zygomaticomaxillary skeletal defects.  Plast Reconstr Surg. 1998;  101 943-950
• 9 Chang Y M, Coskunfirat O K, Wei F C, Tsai C Y, Lin H N. Maxillary reconstruction with a fibula osteoseptocutaneous free flap and simultaneous insertion of osseointegrated dental implants.  Plast Reconstr Surg. 2004;  113 1140-1145