Recurrent giant cell lesion of the nasomaxillary region in a child: excision and immediate reconstruction with a free rectus abdominis muscle transfer

Paediatric craniofacial surgery: historical perspectives, recent advancements and refinements

Paediatric craniofacial surgery has evolved since the innovative work of Tessier in the 1960s. The development of the team approach has greatly helped this progress. Technical advances of osteosynthesis and better radiological examinations have further improved the predictability and stability. Microvascular free tissue transfer is playing an increasing role in certain malformations.

Speech function following maxillectomy reconstructed by rectus abdominis myocutaneous flap

Post-surgical maxillary defects have recently been reconstructed by microvascularized free flaps. However, few reports have evaluated the resulting speech function. This study compared the speech intelligibility of four maxillectomy patients who underwent reconstruction by rectus abdominis myocutaneous flaps (RAMCF) with that of four non-reconstructed patients who were treated with split-skin grafts and prostheses, to explore ways of achieving better speech function. Speech function was assessed by a Japanese language speech intelligibility test. Intelligibility scores ranged from 57.3% to 75.8% (mean, 70.4%) in the non-reconstructed group and from 66.2% to 77.2% (mean, 71.0%) in the reconstructed group. An analysis of articulatory manners and sites revealed that speech disorders resulted mainly from poor oronasal separation in the non-reconstructed group and from incorrect linguopalatal contact in the reconstructed group, especially for linguodentoalveolar and linguovelar sounds. Therefore, for higher speech function in the reconstructed group, dentoalveolar and palatal contours of the maxilla must be restored as closely as possible. This must also be done in patients whose maxillae are reconstructed by other types of microvascularized myocutaneous or cutaneous flaps that have similar postoperative palatal contours.

Immediate reconstruction following maxillectomy: a new method

A new method for immediate reconstruction of the maxilla after resection is described. The ipsilateral pedicled temporalis muscle is tunneled into the defect and sagittaly split into two layers. The inner layer is used to line the nasal side. An individually shaped titanium mesh, tightly filled with free autogenous corticocancellous bone, is fixed by titanium screws to the remnant of the zygoma and contralateral maxilla. The outer layer of the split muscle covers the reconstruction, the temporalis fascia forming the oral side. The method resulted in good cosmetic appearance and permitted the re-creation of a maxillary alveolar ridge suitable for endosseous implants or a simple prosthesis.