how to reconstruct maxillectomy defects

1. MAXILLECTOMY
PROSTHETIC REHABILITATION
INDICATIONS
BROWN CLASS 1(MAXILLECTOMY NOTCAUSING OAF)
BROWN 2a(MAXILLECTOMY NOT INVOLVING ORBIT WITH PALATAL DEFECT
ONLY AND ALVEOLUS NOT INVOLVED)
BROWN 2b(MAXILLECTOMY NOT INVOLVING THE ORBIT AND≤1/2 OF BILATERAL
OR TRANSVERSE ANTERIOR)
CORDEIRO TYPE 2( SUBTOTAL MAXILLECTOMY,PRESERVATION OF ORBITAL
FLOOR)
TEMPORALIS MUSCLE FLAP INDICATIONS
SMALL TO MEDIUM SIZE PALATE DEFECTS
SMALL VOLUME DEFECTS:
RADIAL FOREARM FASCIOCUTANEOUS FLAPS
RECTUS ABDOMINUS FLAP
LATERAL ARM
SERRATUS ANTERIOR MUSCLE
LARGE VOLUME DEFECTS:
REQUIRE MICROVASCULAR RECONSTRUCTION
BROWN CLASS 3(MAXILLECTOMY INVOLVING ORBITAL ADNEXAE WITH
ORBITAL RETENTION
BROWN 4a( MAXILLECTOMY WITH ORBITAL ENUCLEATION OR EXENTERATION
WITH PALATAL DEFECT ONLY AND NOT DENTAL ALVEOLUS)
4b ( MAXILLECTOMY WITH ORBITAL ENUCLEATION OR EXENTERATION WITH ≤ ½
of the bilateral or transverse anterior)

2. 4c (MAXILLECTOMY WITH ORBITAL ENUCLEATION OR EXENTERATION WITH ≤1/2
OF THE UNILATERAL)
4d( MAXILLECTOMY WITH ORBITAL ENUCLEATION OR EXENETERATION
GREATER THAN HALF OF MAXILLECTOMY)
CORDEIRO TYPE 3b(TOTAL MAXILLECTOMY WITH ORBITAL EXENTERATION)
CORDEIRO TYPE 4 ORBITOMAXILLECTOMY
RECONSTRUCTION WITH SOFT TISSUE ONLY FLAPS
Indicated in 2 settings
1) Small to medium sized lower maxillectomy defects with viable dentition to support the
prosthesis(Brown Class 1 or 2a -2b or Cordeiro type 2 defects)
2) Extensive defects in patients with relatively poor oncologic prognosis(Brown Class 4 or
5a-5d or Cordeiro type 3b defects)
RECONSTRUCTION WITH BONE CONTAINING FLAP(OSTEOCUTANEOUS
FREE FLAP)
Medium sized to large maxillectomy defects
Most used composite free tissue flaps for bone and soft tissue palate and maxillary repair
are Osteocutaneous radial forearm(OCRF),Fibula, Iliac crest, subscapular system of
flaps.
Osteocutaneous radial forearm free flap indications
INFERIOR MAXILLECTOMY WITH PRESERVATION OF ORBITAL RIM
,REQUIRING INTRAORAL LINING WITH SMALL BONE DEFECTS( BROWN
CLASS 2a(not involving orbit and palatal defect only),Class 2b(not involving orbit and≤
½ of the bilateral or transverse anterior) or Cordeiro type 2(subtotal maxillectomy and
preservation of orbital floor)
Fibula flap
Inferior maxillectomy that doesn’t compromise the inferior orbital rim,extend across the
midline ,and necessitate osseointegrated dental implants for oral rehabilitation(brown
class 2a-2d or cordeiro type 2(subtotal maxillectomy and preservation of orbital floor)
ILEAC CREST FREE FLAP
Ileac crest flap based on deep circumflex ileac artery and harvested with internal oblique
muscle indications:
Patients undergoing total maxillectomies with or without involvement of infraorbital rim
but with preservation of orbital contents (BROWN class 3 a<maxillectomy involving the
orbital adnexae with orbital retention and palatal defect only>3b< maxillectomy
involving the orbital adnexae with orbital retention ≤ ½ of bilateral or transverse
anterior> 3c< involving the orbital adnexae with orbital retention ≤ ½ of unilateral>,3d<

3. maxillectomy involving the orbital adnexae with orbital retention and greater than half of
maxillectomy>Cordeiro type 3a(total maxillectomy with orbital preservation)
SUBSCAPULAR SYSTEM OF FLAPS
Patients undergoing total maxillectomy with orbital preservation are best candidates for
this flap(Brown Class 3a-3d or Cordeiro type 3a.
RECONSTRUCTION OF COMPLEX DEFECTS
CLASS 5 OR 6c-6d cordeiro type 3b and 4 (orbitomaxillectomy defect) multiple free
flaps or augmentation of reconstructive flap with grafts,implants or even prosthesis
indicated