Hard and soft palate reconstruction.

Palate reconstruction remains one of the most challenging areas for the head and neck reconstructive surgeon. Although small defects in the palate are managed without significant difficulty, larger defects, particularly total maxillectomy defects, require special attention. The lack of a uniform classification for palate defects has limited prospective comparison of reconstructive methods. In most cases, these defects require bone containing microvascular free flaps for reconstruction if preoperative function is to be approached. Promising results have been documented for fibular, scapular, and iliac crest/internal oblique free flaps in the reconstruction of total or near-total maxillectomy defects. Our lack of ability to reconstruct the dynamic function of the soft palate continues to be disappointing. Limited studies have shown promise in soft palate reconstruction without the complications of velopharyngeal insufficiency.