Maxillofacial reconstruction surgery largely relies on the use of microsurgical free transfer techniques. Head and neck cancer surgery and ballistic injuries may lead to significant losses of multitissular substances. Even when the free transfer is successful and the microvascular critical phase is resolved, some functions or anatomic structures may not have been properly restored or have worsened. Any plastic surgery technique may be used to improve an unfavorable functional or aesthetic result after free flap reconstruction. In most cases, performing surgical readjustments using a local flap is needed.
Key points
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The failure of a head and neck reconstruction even after a successful free flap transfer may be life-threatening if a drop in vital function is not restored.
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Simple plastic surgery techniques such as fat or skin autograft and local flaps are used to resolve sometimes complex issues without the need for a new major surgery.
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Inert reconstruction tissues in the oral cavity may impair the ability to swallow and phonation.
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Using surgical cutting guides for osteotomy results in better outcomes when a complex reconstruction of the mandibular or maxillary bone is needed.
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Allograft transplantation allows treating complex multitissular defects without free flap transfer and results in enhanced functional rehabilitation.

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