Title : A new approach to bilateral Le Fort I/II midface reconstruction with a microvascularized fibular flap
Abstract:
Resection of facial tumors involving the maxilla and mandible often causes significant functional and aesthetic sequelae, affecting speech, mastication, swallowing, and self-esteem. Factors such as advanced staging, aggressive tumor biology, complex anatomical location, and failures in prevention programs contribute to extensive resections. These procedures represent multidisciplinary challenges, especially when anatomical defects exceed the possibility of simple local repairs. The complexity of tissue loss drives the continuous improvement of reconstructive techniques. Reconstructions with microvascular fibular flaps have been routine in our institution since 1995, which motivates us to constantly seek surgical alternatives that provide more comfort to patients. Our focus is to restore function, aesthetics, and facial expression. Unique challenges in each case, promoting quality of life and facilitating the social reintegration of patients.
Objective: To present a technique using a microvascular fibular U-shaped flap (US-MFF).
Method: This technique is indicated for patients who require reconstruction of Le Fort I/II maxillary defects due to tumor resection, necrosis, or trauma. Osteotomy of the fibular bone is performed in three segments. The first and third segments aim to reconstruct the left and right upper alveolar crest and maxillary reinforcement. The middle segment is used to reconstruct the anterosuperior region of the maxilla. The flap is U-shaped. System 2.0 miniplates and screws are used to fix the segments to each other and to the zygomatic complex (ZC) in the posterior region. In the second surgical procedure, approximately 3 months later, a bone graft from the iliac crest is placed, with two buttresses in the canine fossa joined to the fibular segment with the anterior Z-C.
Case Report: Female patient, 20 years old, white, with a history of a boating accident with a Jet Ski, causing bilateral horizontal maxillary avulsion, Le Fort I/II type. The patient sought specialized care for late reconstruction of the defects. Reconstruction was proposed and performed using the US-MFF technique. The procedures did not present vascular complications and showed satisfactory stability between the bone segments. After 5 years, there was satisfactory evolution and installation of dental implants and rehabilitation. Aesthetics and function were restored.
Conclusion: The approach described, using the microvascularized fibular flap reconstruction technique, resulted in satisfactory results in aesthetics and function, and overcomes technical challenges commonly found in this region. It is believed that this US-MFF technique contributes significantly to the restoration of the anatomy of the maxilla and bilateral zygomatic complex, as well as to the rehabilitation of speech and facial expression, promoting new bone formation and improving the quality of life of patients.
