642 Copyright © 2013 Korean Society of Otorhinolaryngology-Head and Neck Surgery Head and Neck Korean J Otorhinolaryngol-Head Neck Surg 2013;56:642-6 / pISSN 2092-5859 / eISSN 2092-6529 http://dx.doi.org/10.3342/kjorl-hns.2013.56.10.642 Reconstruction of Maxilla and Midface with Microvascular Free Flaps Shin Hye Kim 1 , Dong Wook Kim 1 , Heejin Kim 1 , Dong-Young Kim 1 , Chae-Seo Rhee 2 and J. Hun Hah 1 1 Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; and 2 Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea 상절제술 후 다한 유리 피판을 이용한 상 재건 김신혜 1 ·김동욱 1 ·김희진 1 ·김동영 1 ·이재서 2 ·하정훈 1 서울대학교 의과대학 서울대학교병원 이비인후과학교실, 1 서울대학교 의과대학 분당서울대학교병원 이비인후과학교실 2 Received July 12, 2013 Revised August 6, 2013 Accepted August 19, 2013 Address for correspondence Dong Wook Kim, MD Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Tel +82-2-2072-2441 Fax +82-2-745-2287 E-mail treu24@naver.com Background and ObjectivesZZThe aim of this study is to report the clinical results of max- illary reconstruction with free fap. Subjects and MethodZZPatients who had undergone free fap reconstruction after maxillec- tomy from January 2009 to January 2013 were included in the study. The medical records of the maxillary defect classifcation, the type of fap used for reconstruction, follow-up results includ- ing the survival rate of fap and postoperative complications were analyzed retrospectively. ResultsZZA total of 13 cases underwent maxillary reconstruction after maxillectomy. Maxil- lary resection were classifed from Ia to V according to the Brown classlifcation system, and various composite faps including rectus abdominis, latissimus dorsi, radial forearm and iliac crest were used. One case (class Ia) was reconstructed with a radial forearm free fap while six cases (classes II, III) were reconstructed with the osteomuscular free fap type, such as iliac crest. Another six cases needed orbital exenteration (class IV, V) and were reconstructed with a soft tissue free fap type, such as a rectus abdominis or latissimus dorsi. Of the 13 cases, four patients had postoperative wound dehiscence and two had preoperative radiotherapy. In all 13 cases, the faps survived. ConclusionZZMaxillary reconstructions were performed successfully with various free faps according to the extent of maxillary defect. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:642-6 Key WordsZZFree fapㆍIliac crest ㆍMaxillary defectㆍMaxillectomyㆍReconstruction. 서 론 상의 원발부 성 종이나 주변서 발생 상을 침범는 성 종을 적출 후는 중 면부의 매우  각 미용적, 기능적 후유증이 남게 되므로 상절제술 후 적 극적인 상 재건이 수적이다. 구개 결손의 경우는 상 및 인두 색장치(obturator) 같은 치과 보철물로 재건이 가능다 . 색 보철물을 이용면 상 구개 결손의 쇄를  치의 회복 , 과대 비성의 감소, 구음장의 느 정도 회 복이 가능며, 수술 간이 짧고, 수술 후 재원 기간이 짧으 며, 상절제술 후 재발 부 가가 용이다는 장점이 있다 . 그러나 색장치만으로는 수술 후 과대 비성과 구음장 의 결 계가 있다. 또 색장치 사용 증 , 궤, 출 혈, 취 비강으로의 음누출, 구강으로의 비루 등이 발 생고 장착과 제거, 세척이 불 수 있으며, 결손부가 클 경우 효과적으로 유지기 힘들다 . 1,2) 이처럼 보철물을 이용 online © ML Comm