Reconstruction and masticatory rehabilitation of a bilateral maxillary defect with a microvascular free fibula flap

Microvascular free flaps are frequently applied in midfacial reconstruction to restore mastication and functional dentition in addition to aesthetic and contour rehabilitation. Especially bilateral maxillectomy defects are multidimensional and result in quality of life deterioration and long-term impairment if not reconstructed properly. Therefore, computer-aided three- dimensional surgical planning can help to achieve not only an adequate implant-fixed dentition but also proper soft tissue conditions in the palate and alveolar ridge. In this case presentation a 70-year-old lady after multiple cancer resections in the maxilla received a fibula free flap bilateral maxillary reconstruction including palatal coverage via a perforator perfused skin flap and implant-based dental rehabilitation. Additionally, vestibuloplasty was performed to restore proper lip contours and increase lip function. A one-stage, three-dimensional planned microvascular fibula free flap reconstruction after cancer resection in combination with postoperative implant placement and vestibuloplasty is a clinically valuable treatment concept even in older patients to restore function and facial contours. Keywords: fibula grafting, maxilla reconstruction, oscc, vestibulopasty