Abstract
Background: Orbital floor reconstruction is essential for maintaining orbital function after extensive resection of cancers of the head and neck. We report our experience of orbital floor reconstruction with the transfer of free flaps and titanium mesh (TM).
Methods: From July 2000 through January 2013, orbital floor reconstruction was performed immediately after ablation of cancers of the head and neck in 25 patients (17 men and 8 women; mean age: 61 years). A TM plate was transferred simultaneously with a free rectus abdominis musclocutaneous flap, a vascularized fibula osteocutaneous flap, or a vascularized fibula osteocutaneous flap combined with an anterolateral thigh flap.
Results: The transferred vascularized fibula osteocutaneous flap underwent total necrosis in 1 case and necessitated reconstruction with a free rectus abdominis musclocutaneous flap. Three patients had diplopia and 2 patients lost their sight on the affected side because of cancer infiltration or postoperative edema. Lagophthalmos or ectropion of the lower eyelid developed in 13 cases and necessitated secondary revision surgery in 4 of these cases. Delayed TM infection and exposure developed in only 1 patient, who then underwent removal of the TM and secondary reconstruction with a latissimus dorsi muscle flap.
Discussion: Orbital floor reconstruction with a TM is useful for maintaining orbital function because of the ease with which the 3-dimensional structures of the orbital floor can be formed. However, a TM should not be used over a wide area because of the increased risk of infection.
