Clin Exp Otorhinolaryngol.  2012 Mar;5(1):53-56.

One-Stage Reconstruction for Midfacial Defect after Radical Tumor Resection

• Kim HJ
• Lee KH
• Park SY
• Kim HK

Abstract

A serious midface defect involving resection of squamous cell carcinoma originating from the hard palate was treated by an unusual reconstructive strategy. After tumor resection, surgical reconstruction was accomplished in one stage using one free flap with one distant and local flap: a radial forearm flap to reconstruct the upper lip, a forehead flap to reconstruct the external nose, a cantilever calvarial bone graft to replace the nasal skeleton and a nasolabial flap and split thickness skin graft to cover the internal nasal lining. The rationale for this one-stage reconstruction and the problems associated with midfacial reconstruction after wide tumor excision are discussed.

Keyword

Surgical flaps; Midface; Radical tumor resection

MeSH Terms

Carcinoma, Squamous Cell
Forearm
Forehead
Free Tissue Flaps
Lip
Nose
Palate, Hard
Skeleton
Skin
Surgical Flaps
Transplants

Figure

• 

  Fig. 1 Preoperative view and paranasal sinus computed tomography (CT) of the patient with squamous cell carcinoma, originated from hard palate. (A) Endoscopic findings showing the mass destroying the hard palate and protruding into the oral cavity. Axial (B) and coronal CT (C) scans showing the lesion arising from the hard palate, filling the anterior nasal cavity and extending into both maxilla and gingiva.

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  Fig. 2 Intraoperative view of the surgical procedure. (A) Operative view of midfacial defect after composite bilateral infrastructure maxillectomy, total rhinectomy, near total upper lip resection and total hard palatectomy. (B) A photograph showing the specimen, including primary tumor after surgical resection.

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  Fig. 3 Immediate postoperative view of patient. The midface defect was reconstructed with a radial forearm free flap to reconstruct the upper lip, a forehead flap to reconstruct the external nose, a cantilever calvarial bone graft to replace the nasal skeleton and a nasolabial flap and split thickness skin graft to cover the internal nasal lining.

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  Fig. 4 Postoperative views of the patient. (A) Postoperative view at 4 weeks after reconstruction. (B) Postoperative view at 9 weeks after reconstruction.

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