Author(s)
Thomas Houser, MD
Justin Pyne, MD
Eli Gordin, MD
Affiliation(s)
UT Southwestern Medical Center (Houser, Pyne, and Gordin);
Abstract:
Background:
Extensive maxillary tumor resections can present significant reconstructive challenges. Tumors requiring near-total bilateral maxillectomy necessitate reconstruction of significant midface structural support and large soft tissue volume for dead space obliteration to restore form and function.
Learning Objectives:
To date, there have been few descriptions of successful reconstructive techniques following complex bilateral maxillectomy.
Study Objective:
We propose a novel reconstructive approach utilizing chimeric vascularized serratus-rib and scapular tip with and without latissimus dorsi.
Design Type:
Novel Technique, Case Series
Methods:
Three patients at a single institution who underwent near-total bilateral maxillectomy (unilateral total and contralateral infrastructural) for cancer resection and reconstruction with vascularized serratus-rib and scapular tip with and without latissimus dorsi in 2023 and early 2024 were included. The total maxillectomy side used a carved scapular tip to reconstruct the orbital rim, the zygomatic process, and the alveolar ridge, with a custom orbital floor implant. The contralateral, subtotal defect was reconstructed with a vascularized serratus-rib flap, utilizing the serratus to reconstruct the palate and fill the midface soft-tissue defect. In cases of orbital exenteration, latissimus dorsi was elevated with the scapular tip and used to fill the orbital cavity.
Results:
Patients were followed for at least 7 months post-reconstruction without flap failures. All hardware remained intact with appropriate facial contouring. One patient died 8 months post-reconstruction due to complications of pneumonia. Another’s recovery was complicated by recurrent pleural effusion requiring temporary chest tube placement.
Conclusion:
We propose this reconstructive technique as a viable option for bilateral maxillectomy patients.