Microsurgical Reconstruction of Maxillary Defects

The maxilla is the functional and esthetic keystone of the midface, forming part of each of the key midfacial elements; these are the orbits, the zygomatico-maxillary complex, the nasal unit, and the stomatognathic complex. Maxillary reconstruction is a challenging endeavor in functional and esthetic restoration. Given its central location in the midface and its contribu‐ tions to the midface, maxillary defects are inherently complex because they generally involve more than one midfacial component. Maxillary defects are composite in nature, and they often require skin coverage, bony support, and mucosal lining for reconstruction. Reconstruction of maxillary defects secondary to warfare, trauma, ablative tumor surgery, or congenital deformities must meet the following goals namely: (1) obliteration of the defect; (2) restoration of essential functions such as mastication and speech, (3) provision for adequate structural support to each of the midfacial units and (4) esthetic restoration of facial features. This chapter will discuss the anatomic considerations, the historical approaches to maxillary reconstruction as well as state-of-the-art techniques in use today.