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).