Maxillary and Orbital Floor Reconstruction with Parallel Segments of the Fibula Free Flap: A Technical Note

Abstract

Introduction

The fibula free flap (FFF) is considered a gold standard for maxillary reconstructions, and in the last few decades, this flap has been widely used for mandibular defects, with a range of modifications, which have allowed the improvement and greater success. The reconstructions of the maxilla and midface are less reported than mandibular reconstructions, despite the remarkable evolution over the years. In the reconstruction of type IIIa maxillary defects using FFF, some authors report that it may not provide enough height to support the orbit in class 3 and 4 defects. Others also encountered several difficulties, mainly in modeling fibular bone (FB) for the zygomatic–maxilla complex reconstruction and orbital floor, due to the difficulty in rotating the soft tissues, pedicle, orientation of the (FB) segments.

Objective

To show this new technique presents another option for maxillary reconstruction with a FFF in type IIIa defects.

Methods

After harvesting FFF in the standard fashion, differentiated osteotomies, modeling, and arrangement of the fibular bone segments are performed.

Results and Conclusion

This new technique presented has the advantage of requiring only one flap, promoting the resolution of the technical difficulties previously reported.