Abstract
The facial defect after an extended total maxillectomy is one of the most difficult deformities to reconstruct esthetically, because the defect is not only large but also three-dimensional. Although free-flap reconstruction is useful, the patchwork-like scar, bad color match and poor texture match are major problems. The contracture and displacement of the reconstructed eyelids and eye socket are also serious matters. To resolve these problems, we have performed a three-step reconstruction using a free rectus abdominis myocutaneous (RAM) flap and an expanded cervicofacial flap with cartilage grafts.
To obtain symmetry and natural appearance in the orbitomaxillary reconstruction, there are five areas that should be formed: the eye socket, the groundwork of the eye socket, the orbital floor and malar prominence, the tarsal plates, and the surface of the eyelids and cheek. To reconstruct these five indispensable areas and achieve satisfying results, we propose this three-step reconstruction.
