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Extended Free Fibula Flap and LeFort I Distraction for Maxillary Reconstruction in the Setting of Prior Premaxillary Resection
Cyrus Mirhaidari, BS, Shayda Mirhaidari, MD, Ananth Murthy, MD, Derek Cody, MD.
Plastic and Reconstructive Surgery-Summa Health System & Akron Children's Hospital, Northeast Ohio M
2020-02-15
Presenter: Cyrus Mirhaidari
Affidavit:
Douglas Wagner, MD
Director Name: Douglas Wagner
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
BACKGROUND: Premaxillary resection has been abandoned in the primary treatment of bilateral cleft lip and palate (BLCP) secondary to complications such as incisor loss and severe maxillary retrognathism. We present a case of a 14-year-old female with a history of BLCP who previously underwent premaxillary resection resulting in significant maxillary hypoplasia and class III malocclusion. In order to address both bony and soft tissue maxillary deficits, the patient underwent a LeFort I Osteotomy in conjunction with a free fibula flap (FFF) followed by distraction of the maxilla/flap complex. A perforator to the soleus muscle was utilized to extend the pedicle. The purpose of this study is to examine the feasibility of using this branch to the muscle by performing lower extremity cadaver dissections.
METHODS: Lower extremity cadaver dissections were performed to evaluate the arterial anatomy in the FFF. Standard measurements included perforator distance to both bony landmarks and tibioperoneal trunk. Perforators lengths were also recorded.
RESULTS: Five cadaveric dissections were performed and four were found to have soleus muscle perforators. The average perforator length was 4.6cm. Correction of a negative 24mm overjet was performed by 2-piece LeFort I Osteotomy and extended pedicle FFF. Patient subsequently underwent 14mm distraction advancement. At 18 months postoperatively, the maxilla was found to be in stable position.
CONCLUSION: Use of the soleus artery perforator is a feasible option in extending the pedicle in FFF reconstruction. In rare cases of premaxillary resection, the use of an extended FFF in conjunction with 2-piece Lefort 1 distraction can be a reconstructive option.
