DISCUSSION
Reconstruction of maxilla due to therapeutic maxillary resection is an
ongoing clinical challenge. Palatal obturators are considered as the
main nonsurgical treatment options for these palatal defects. However,
the long-term use of these obturators is associated with food impaction,
nasal speech, and mucosal irritation, while frequent prosthetic
adjustments are also inevitable (5) (6). Instead, implant-supported
prosthesis along with soft and hard tissue reconstruction using local or
free flaps seem to be the promising options for these reconstructions
(6) (7). This is especially true in young patients with an underlying
systemic condition and no evidence of recurrence. However these
treatments are time-consuming, require several surgeries and are
accompanied by variable failure rates.
Several flaps have been suggested to reconstruct soft tissue in the
literature. The PBFPF is widely used for soft tissue reconstructions of
palatal defects due to its rich blood supply and undifferentiated
mesenchymal stem cell content (8). Mesenchymal stem cells can act as an
endothelial progenitor and promote tissue vascularization (9) (10).
Furthermore, ease of access and manipulation are among other benefits of
PBFPF flap. Moreover, in case of utilizing PBFPF, a proper soft tissue
bed for a bone graft should also be obtained in order to eliminate the
need for microvascular flaps.
Scapular flaps and fibula free grafts, other than iliac crest free
grafts, are also proposed for hard tissue reconstruction. Since scapula
provides a limited volume of bone for several dental implants in our
case, this donor site was not chosen (11).
Although microvascular free grafts of fibula are considered the most
successful treatment options for facial reconstructions (12), the
relatively more complicated surgical procedure compared to iliac crest
grafts led us to use free iliac graft, since anterior iliac crest also
provides sufficient amount of corticocancellous bone to bridge the
defect and place dental implant (13). Furthermore, the PBFPG, which was
placed in the defect prior to bone reconstruction, was a proper soft
tissue bed for free iliac graft (14).