Shawn T Joseph1, Krishnakumar Thankappan2, Jimmy Mathew3, Manju Vijayamohan4, Mohit Sharma5, Subramania Iyer6. 1. Assistant Professor, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India. 2. Associate Professor, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India. Electronic address: drkrishnakumart@yahoo.co.in. 3. Professor, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India. 4. Professor, Department of Prosthodontics, Amrita School of Dental Sciences, Amrita University, Kochi, Kerala, India. 5. Professor and Head, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India. 6. Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
Abstract
PURPOSE: The conventional way of reconstructing an orbital exenteration defect associated with a maxillectomy is to cover it with a soft tissue free flap and camouflage it with a spectacle-mounted orbital prosthesis. Also, there are some reports on the use of bone flaps. The objective of this study was to review the reconstructive options for a defect resulting after orbital exenteration and maxillectomy. MATERIALS AND METHODS: This study concerns a retrospective case series of 20 patients. Electronic medical records, including clinical details, operative notes, and follow-up data, were analyzed. Defects were analyzed for their reconstructive components. The reconstructive methods used were studied by the types of flap used, bony versus soft tissue types of reconstruction, and the prosthetic method used to rehabilitate the eye. Outcomes were analyzed for flap success rate. Descriptive methods for data analysis were used. RESULTS: Fourteen patients underwent a soft tissue reconstruction alone and 6 underwent bony reconstruction. The free rectus abdominis was the commonest soft tissue flap used. This article presents the outcome of reconstruction in such patients and the utility of individual flaps for their ability to replace different components of the defect. CONCLUSIONS: Ideal reconstruction should address all individual defect components of facial contour, orbital, palatal, skull base, and skin defects. The free rectus abdominis flap remains the common choice. When a composite socket reconstruction is to be achieved, the innovative free tensor fascia lata flap with the iliac crest bone and internal oblique muscle is an option.
PURPOSE: The conventional way of reconstructing an orbital exenteration defect associated with a maxillectomy is to cover it with a soft tissue free flap and camouflage it with a spectacle-mounted orbital prosthesis. Also, there are some reports on the use of bone flaps. The objective of this study was to review the reconstructive options for a defect resulting after orbital exenteration and maxillectomy. MATERIALS AND METHODS: This study concerns a retrospective case series of 20 patients. Electronic medical records, including clinical details, operative notes, and follow-up data, were analyzed. Defects were analyzed for their reconstructive components. The reconstructive methods used were studied by the types of flap used, bony versus soft tissue types of reconstruction, and the prosthetic method used to rehabilitate the eye. Outcomes were analyzed for flap success rate. Descriptive methods for data analysis were used. RESULTS: Fourteen patients underwent a soft tissue reconstruction alone and 6 underwent bony reconstruction. The free rectus abdominis was the commonest soft tissue flap used. This article presents the outcome of reconstruction in such patients and the utility of individual flaps for their ability to replace different components of the defect. CONCLUSIONS: Ideal reconstruction should address all individual defect components of facial contour, orbital, palatal, skull base, and skin defects. The free rectus abdominis flap remains the common choice. When a composite socket reconstruction is to be achieved, the innovative free tensor fascia lata flap with the iliac crest bone and internal oblique muscle is an option.