Objective: The purpose of this study is to evaluate the outcome of orbital floor reconstruction
with free flaps after maxillectomy.
Design: Retrospective case series.
Methods: Analysis of 34 consecutive patients who underwent maxillectomy with orbital floor
removal for malignancies and were reconstructed with free flaps. A cross-sectional
survey was conducted to assess the functional and esthetic outcome in 28 patients,
who were alive and disease free, with a minimum of 6 months follow-up.
Results: Twenty-six patients had bony reconstruction, and 8 had soft tissue reconstruction.
Free fibula flap was the most common flap used (n = 14). Visual acuity was normal
in 86%. Eye movements were normal in 92%. Abnormal globe position occurred in nine
patients. Esthetic satisfaction was good in 19 patients (68%). Although there was
no statistically significant difference in outcome of visual acuity, eye movement
and patient esthetic satisfaction differed between patients with bony and soft tissue
reconstruction—more patients without bony reconstruction had abnormal globe position
(P = 0.040).
Conclusion: Free tissue transfer has improved the results of reconstruction of the orbital floor
after total maxillectomy, preserving the eye. Good functional and esthetic outcome
was achieved. A bony reconstruction is ideal. Free fibula flap remains the most common
choice when a bony reconstruction is contemplated.
