Flashcards on Midface Reconstruction: Defects and Techniques
Midface Reconstruction: Defects, Techniques & Outcomes Guide
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Maxillectomy reconstruction
14 cards
Card 1
Question: What are the reconstruction goals for a type IIIA maxillectomy defect (total maxillectomy that spares the orbital contents)?
Answer: Support the globe; obliterate any communication between the orbit and nasopharynx; reconstruct the palatal surface.
Card 2
Question: What bony grafts are commonly used to reconstruct the maxillary prominence and orbital floor in type IIIA defects?
Answer: Split calvarium, iliac crest, and less commonly split ribs.
Card 3
Question: Which free flap is the preferred choice for mucosal and skin lining in type IIIA maxillectomy reconstruction and how is it used?
Answer: Rectus abdominis myocutaneous free flap; may be wrapped around the bone graft to separate orbital contents from the oral cavity, fill antral dead spac
Card 4
Question: What alternative flap can be used when a patient is not a candidate for free tissue transfer in type IIIA defects, and what are its limitations?
Answer: Temporalis flap; can cover orbital floor bone graft and provide midfacial volume but requires simultaneous use of a palatal obturator.
Card 5
Question: What defines a type IIIB maxillectomy defect and what are the main reconstructive goals?
Answer: Resection of the entire maxilla including the orbital contents (extended maxillectomy). Goals: close the palate, restore nasal lining, reconstruct eye
Card 6
Question: Which flap is preferred for type IIIB (extended maxillectomy) defects and why?
Answer: Rectus abdominis myocutaneous free flap with one or more skin islands to recreate palate, lateral nasal wall, and any cutaneous deficits.
Card 7
Question: What is an alternative flap option for type IIIB defects and what is its limitation compared with rectus abdominis?
Answer: Latissimus dorsi flap; provides adequate soft tissue bulk and pedicle length but is less versatile for providing multiple skin islands.
Card 8
Question: What defines a type IV orbitomaxillectomy defect and which structures are usually involved or exposed?
Answer: Resection of the upper five walls of the maxilla, usually includes resection of the orbital contents and leaves dura/brain exposed; the palate is usua
Card 9
Question: What is the flap of choice for type IV orbitomaxillectomy defects and how are skin islands used?
Answer: Rectus abdominis flap with one or more skin islands used for external skin coverage and/or nasal lining.
Card 10
Question: For type IIB palatal defects (>50% transverse palate or significant anterior arch), what reconstructive option is required and why is a prosthesis ina
Answer: An osteocutaneous free flap is required because bone is needed for structural support of the upper lip and for skin lining of neopalate and nasal floo