Maxillary reconstruction using
rectus abdominis free flap and
bone grafts.
INDIAN DENTAL ACADEMY
Leader in continuing dent...
INTRODUCTION
The reconstruction of maxilla after massive
excisions has been described using prostheses,soft
tissue,and oss...
ADVANTAGES
Rectus abdominus :
• Reliable
• Versatile
• Easy to harvest
• Has a long pedicle
• Large diameter vessels
• Goo...
PATIENTS & METHOD
Between jan1996 and Nov2003,22 pts underwent
microsurgical reconstrucion using R.A free flaps
and bone g...
• In all the cases orbital floor was resected
and the orbital contents preserved.
• Only two pts were given preoperative
r...
• The bone that was harvested was monocortical
and was used in two or three pieces,fixed to
each other with plates for the...
• Donor site was harvested by a second surgical
team and the length of the pedicle allowed the
vessels to those in the nec...
• Good vascularisation of the flap allowed to
design multiple skin paddels with what
ever shape and orientation required.
...
DISCUSSION
• Reconstruction of defects after
maxillectomy with preservation of orbital
contents is a challenging problem c...
OTHER TECHNIQUES
•
•
•
•
•

Obturators
Alloplastic prostheses
Skin grafts
Temporal and nasal flaps.
Palatal obturators are...
• More recently some authors have
described reconstructions of orbital floor
and maxilla with osseousosteomyocutaneous fre...
• Reconstruction of orbital part requires
more cephalic portion of the flap and need
for the vessels to reach vessels in t...
• When resection of zygoma results in the need
for malar reconstruction we usually harvest a
composite rectus abdominis
os...
• The longterm aesthetic results are good even
after radiotherapy.Despite muscular atrophy ,the
subcutaneous fat maintains...
THANK YOU
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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Maxillary reconstruction using rectus abdominis free flap and bone grafts /certified fixed orthodontic courses by Indian dental academy

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Maxillary reconstruction using rectus abdominis free flap and bone grafts /certified fixed orthodontic courses by Indian dental academy

  1. 1. Maxillary reconstruction using rectus abdominis free flap and bone grafts. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION The reconstruction of maxilla after massive excisions has been described using prostheses,soft tissue,and osseous pedicled flaps,etc Clinically and radiologically when no infiltration of orbital fat and extrinsic muscles by tumor ,it is essential to preserve the orbital contents . A comb. Of nonvascularised bone graft and rectus abdominus free flap is safe and relaiable. Free flaps are used only when alveolar ridge is to be reconstructed to add stability to the prostheses. www.indiandentalacademy.com
  3. 3. ADVANTAGES Rectus abdominus : • Reliable • Versatile • Easy to harvest • Has a long pedicle • Large diameter vessels • Good blood supply • Possibility of shaping the skin paddle to the required form • Two surgical teams can work simultaniously coz of remote donor site. www.indiandentalacademy.com
  4. 4. PATIENTS & METHOD Between jan1996 and Nov2003,22 pts underwent microsurgical reconstrucion using R.A free flaps and bone grafts after total or extended total maxiilectomy. 14-squamous cell carcinoma 1-Anaplastic carcinoma 4-Anaplastic carcinoma 4-Adenoid cystic carcinoma 1-Mets from renal carcinoma 1-Melanoma 1-Condrosarcoma www.indiandentalacademy.com
  5. 5. • In all the cases orbital floor was resected and the orbital contents preserved. • Only two pts were given preoperative radiotherapy • Reconstruction was with iliac bone grafts and rectus abdominis myocutaneous free flaps in 19 cases, and rectus abdominus osteomyocutaneous free flaps in 3. www.indiandentalacademy.com
  6. 6. • The bone that was harvested was monocortical and was used in two or three pieces,fixed to each other with plates for the floor and resected orbital walls. • Care was taken to envelop the bone with in the vascularised muscle,as bone muscle contact promotes vascularisation and protects the healing bone. • The graft ,even though was largely resorbed ,maintained the globe in proper position even after radiation. www.indiandentalacademy.com
  7. 7. • Donor site was harvested by a second surgical team and the length of the pedicle allowed the vessels to those in the neck for anastamosis. • Pedicle of the flap was taken to the neck through the tunnel in the cheek. • Anastamosis was done with facial vessels but the length of the pedicle would allow anastamosis with Jugular vein and Thyroid artery. www.indiandentalacademy.com
  8. 8. • Good vascularisation of the flap allowed to design multiple skin paddels with what ever shape and orientation required. • In19 pts –Two skin paddles were used ,one for the palate and one for lining the nose. • 3pts –required paddles for replacement of facial skin but the inability to match color and texture resulted in poor aesthetic. www.indiandentalacademy.com
  9. 9. DISCUSSION • Reconstruction of defects after maxillectomy with preservation of orbital contents is a challenging problem coz of the key role of the orbital floor in suspension of the globe and binocular vision www.indiandentalacademy.com
  10. 10. OTHER TECHNIQUES • • • • • Obturators Alloplastic prostheses Skin grafts Temporal and nasal flaps. Palatal obturators are bulky and cannot be possible to support eyeball resulting in poor functional results. • Use of alloplastic materials is contraindicated in irradiated pts.Temporal flaps is not ideal for orbital suspension. www.indiandentalacademy.com
  11. 11. • More recently some authors have described reconstructions of orbital floor and maxilla with osseousosteomyocutaneous free flaps {scapula,fibula,iliac crest }. • But the disadvantage is the morbidity of the donor site and difficulty in inserting the flap,shaping. www.indiandentalacademy.com
  12. 12. • Reconstruction of orbital part requires more cephalic portion of the flap and need for the vessels to reach vessels in the neck,with a high risk of thrombosis. • In our experience ,bone grafts for the iliac crest for reconstruction of orbital floor have good long term results ,even after postoperative radiotherapy. www.indiandentalacademy.com
  13. 13. • When resection of zygoma results in the need for malar reconstruction we usually harvest a composite rectus abdominis osseomyocutaneous free flap. • In these 3pts ,bone grafts were used for reconstruction of orbital floor and vascularised costocondral component was positioned from nasal to zygomatic areas,reestablishing the normal facial contour. • In our experience ,malar reconstruction with nonvascularised bone grafts associated with a vascularised soft tissue flapsresulted in total or subtotal resorption ,particularly after radiotherapy. www.indiandentalacademy.com
  14. 14. • The longterm aesthetic results are good even after radiotherapy.Despite muscular atrophy ,the subcutaneous fat maintains enough volumes to prevent depression of the cheek and dislocation of nasal alar cartilage. • An important point during reconstruction is to put in an excess of tissue to account for atrophy of denervated muscle,and to suspend the flap to skeletal frame work to prevent ptosis of the cheek,prolapse of the flap into the mouth,resulting in impairment of prosthetic rehabilitation. www.indiandentalacademy.com
  15. 15. THANK YOU www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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