Surgical reconstruction of maxilla and midface: Clinical outcome and factors relating to postoperative complications

Aim: The aim of this study was to evaluate the success rate of different techniques of repairing maxillary and midfacial defects according to their extent. Patients and methods: In this retrospective study, 47 maxillary reconstructions in 41 patients were reviewed. Evaluation took place an average of 4.5 years postoperatively. The cases were divided into three groups according to the classification of Brown et al. (Br J Oral Maxillofac Surg 40: 183-190, 2002): Group 1: maxillary defects limited to one side (Class 2a); Group 2: bimaxillary defects (Classes 2b and 2c); Group 3: maxillary/midfacial defects (Classes 3 and 4). Most reconstructions were performed with non-vascularized bone grafts in the first patient group, whilst microvascular soft tissue flaps combined with free bone grafts were used in the second group, and re-vascularized osteocutaneous flaps in the third group. Results: Overall flap survival was 79%. Dental reconstruction was successfully completed in 31 cases (66%). Postoperative infection leading to transplant loss was the main reason for failure. This complication was specifically associated with temporal osteomuscular flaps (50%) and free iliac crest grafts (61%) and was related to the extent of the defect. In the reconstructive methods evaluated here, associated radiotherapy had a minor influence on the occurrence of complications. Conclusion: Non-vascularized iliac bone grafts should be used sparingly in Class 2b, even in combination with microvascular flaps. There is a very limited indication for these grafts in Classes 3 and 4. Temporal osteomuscular flaps do not seem to be suitable for maxillary reconstruction. (C) 2004 European Association for Cranio-Maxillofacial Surgery.