Classification of the Midface Defect: A Defect-Oriented Approach to Reconstruction 2024

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#Midface_reconstruction

As the centerpiece of the face, the midfacial region has particular functional and esthetic importance. Midfacial de- fects may be congenital or more commonly acquired in nature, namely from trauma, infection, or neoplastic processes. Although commonly referred to as a maxillectomy, this term is somewhat of a misnomer as tumor extirpation will rarely be confined to only the maxilla proper. The midface is composed of 15 bones, and defects more commonly include adjacent skeletal structures including the palatine, vomer, lacrimal, ethmoid, nasal, zygomatic, and frontal bones to a variable extent.

The midface is composed of vital structures with important functions including the oral cavity, sinonasal tract, nasolacrimal system, and the orbit. The anatomic complexity and functional importance of the midface makes ablative interventions and reconstruction of form and function particularly demanding. Over the past 50 years, advances in microvascular reconstruction, computer-aided design and manufacturing, and dental implantology have transformed reconstructive care improving patient outcomes. Possibly, the most famous maxillectomy was performed on the Grover Cleveland, the 22nd and 24th Presi- dent of the United States. Under a veil of secrecy, the max- illectomy was performed while aboard the yacht Oneida in the East River on July 1, 1893 for what is now thought to be a verrucous carcinoma.1 He was successfully reconstructed using a vulcanized rubber maxillary obturator allowing him to keep his treatment a secret until after his death in 1908.

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