Master Techniques in Otolaryngology - Head and Neck Surgery: Reconstructive Surgery by Genden Eric

Author:Genden, Eric
Language: eng
Format: epub, pdf
Publisher: LWW
Published: 2014-05-12T16:00:00+00:00

FIGURE 22.4 Once raised, the flap can be left pedicled until the time of inset.

The ipsilateral iliac crest is raised so that the pedicle lies posteriorly and the lateral side of the bone is also lateral in the reconstructive site. This ensures that the crest of the ridge replaces the alveolus and the deeper part of the iliac bone can be fashioned to reconstruct the piriform aperture of the nose, lateral nasal bones, and the orbital floor to articulate with the buttress of the zygoma. The muscle then lies in the region of the hard palate, and there is sufficient bulk to obturate the sinus defect, form a neopalate, and reline the nasal cavity (Fig. 22.5). Horizontal placement of the bone means there is insufficient bone to support the alar region and there is little room for the muscle that is best used to reform the palate and obturate the dead space. A miniplate placed at the maxillary alveolus and the zygomatic buttress will provide sufficient fixation. If there is a need for reconstruction of the nasal bones or orbital floor, then nonvascularized bone can be used from the donor site although titanium mesh is often preferred for the orbital floor.

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