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AAPS 85th Annual Meeting
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High-Energy Maxillary Injuries: Classification and Treatment Algorithm with Composite Bone Flaps
Eduardo D. Rodriguez, DDS, MD1, Rachel Bluebond-Langner, MD1, Hugo St-Hilaire, DDS, MD1, Mark Martin, MD, DMD2, Michael P. Grant, MD1, Navin K. Singh, MD1, Paul N. Manson, MD1.
1R Adams Cowley Shock Trauma Center/UMMS/Johns Hopkins School of Medicine, Baltimore, MD, USA, 2Loma Linda University, Loma Linda, CA, USA.

Purpose: High-energy maxillary injuries result in composite tissue loss, functional compromise and cosmetic deformity. Tissue flaps with non-vascularized bone grafts have been the mainstay. However, bony resorption and soft tissue contraction limit long-term success. Previous investigators have described microvascular maxillary reconstruction following tumor resection but few have applied these prinicples to trauma. This study classifies patterns of maxillary injury and defines a microvascular treatment algorithm.
Methods: This is a retrospective review (1998-2005) of 66 patients admitted to R Adams Cowley Shock Trauma Center with high-energy maxillary injuries. CT scans were reviewed and defects classified according to missing maxillary subunits (see algorithm).
Results: Type I defects were predominant (n = 38) followed by Type II (n = 16), III (n = 9), and IV (n = 3). Injuries prior to July 2003 were treated with prosthetic obturation or tissue flaps and non-vascularized bone grafts. Since July 2003 our institution has undergone a paradigm shift; 14 patients with maxillary loss underwent reconstruction with vascularized bone flaps (8 fibula flaps and 6 iliac crest flaps). Flap survival rate was 93% and average follow-up time was 17 months.
Conclusion: Patterns of high-energy maxillary injury have not changed in the past 7 years, however there has been a distinct change in the treatment algorithm. The authors advocate early reconstruction with vascularized bone flaps to achieve superior functional and cosmetic outcomes.

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