Endoscopic-assisted Maxillectomy and Fibular Flap Reconstruction: A Scarless Facial Approach With Novel Reconstruction and Operative Techniques Avoiding Facial Skin Incision

The facial approach remains a challenge in maxillectomy and reconstruction. Various surgical approaches have been developed to improve cosmetic outcomes. The authors herein present a novel approach for endoscopic-assisted maxillectomy with minimal facial incision and endoscopic-assisted vascularized fibular osteomyocutaneous flap (VFOF) reconstruction. Between February 2023 and June 2024, 6 patients who underwent endoscopic-assisted subtotal or total maxillectomy and reconstruction with VFOF using a minimal facial incision approach at a single hospital were reviewed. Transconjunctival incisions were performed in some patients. Fibular bone placement for midface defects was performed using the stacked fibula method. The exposed bone and titanium plates in the nasal cavity were covered with a nasal septal mucosal flap and a fibular skin paddle. The oronasal fistula was closed using another fibular skin paddle in the oral cavity. All patients with VFOF after maxillectomy were successfully treated, maintained their overall facial contours postoperatively, and were satisfied with their facial appearance.