Total Maxillary Reconstruction Using a Double-Barreled and Double Skin Paddle Fibular Flap after Total Maxillectomy
We present the case of a 12-year-old girl with a large mass in the maxilla that had grown for the previous six months, was diagnosed as chondroblastoma, and was treated with bilateral class IIIc maxillectomy [] (high maxillectomy) and reconstruction with a double-barreled and double perforator-based skin paddle fibula flap ().\nIn the supine position, starting with the scanning of the two perforator vessels from the peroneal artery, an incision was made along the edge of the fibula and dissection was performed from the flexor hallucis longus and brevis down to the periosteum, preserving the two skin paddles with a perforator vessel in each one.\nSimultaneously, a bilateral class III maxillectomy was carried out, removing the maxilla by performing a Lefort I type osteotomy. The tumor measured 10 cm×12 cm, covering the entire floor of the maxilla, from the soft palate at the back to the upper lip in the front, affecting the vomer and the nasal floor ().\nThe fibula was sectioned into two pieces with one skin paddle in each one, preserving the peroneal artery as the principal pedicle. Both segments were fixed "in situ" with screws, and subsequently the pedicle was sectioned at the proximal end. Each end of the bone was fixed to the ascending ramus of the maxilla with a 2.0-mm mini-plate titanium system (, ).\nThe superior skin paddle was deepithelized in the central zone and sutured to the mucosa of the nasal septum. The lateral edge of the superior skin paddle was sutured to the lateral wall of the nasal mucosa at the level of the piriform aperture to make a place for the nasal floor. The inferior skin paddle was sutured to the soft palate in the posterior edge and to the labial mucosa at the anterior end. The anastomosis of the artery and the vein were made using a saphenous vein graft from the facial to the peroneal vessels passing through the cheek, using simple stitches with 9-0 nylon.\nThe follow-up period was 6 months, and there was no evidence of tumor recurrence. The functional results were excellent with a well-tolerated liquid and soft diet. The patient's speech is satisfactory overall; however, her consonants are slurred. The histological study reported a solid tumor well defined by a pseudo-capsule, limited by the gingival mucosa. Small polyhedral tumor cells were found with scattered osteoclastic giant cells with no atypical mitosis. The diagnosis was chondroblastoma (-).