Outcomes of Free Flap Bony Reconstruction for Maxillary Defects: A Systematic Review and Meta-Analysis.

[OBJECTIVE] To analyze the clinical outcomes associated with free flap bony reconstruction of maxillary defects.

[DATA SOURCES] A systematic search was performed on PubMed, Scopus, and Google Scholar databases.

[REVIEW METHODS] A single-arm meta-analysis of proportions was performed to calculate the pooled effect size. The inverse variance method was used to combine the effect sizes from individual studies and calculate the 95% confidence interval (CI).

[RESULTS] A total of 837 patients undergoing scapula (35.1%), fibula (37.3%), iliac crest (15.4%), and radial forearm (12.2%) reconstruction were included. The pooled flap success rate was 93.0% (95% CI: 90.6-94.9). A low fistula rate (15.9%; 95% CI: 12.8-19.6) and a high speech intelligibility rate (91.2%; 95% CI: 86.9-94.2) were measured. The pooled unrestricted diet rate was 81.2% (95% CI: 69.6-89.0), while the pooled dental implant rate was 23.5% (95% CI: 12.0-40.9). Scapula (13.6%, 95% CI: 5.2-31.2) showed a lower dental implant rate compared to fibula (33.4%, 95% CI: 6.1-79.6) and iliac crest (37.1%, 95% CI: 23.0-53.7) flaps. None of the patients with radial forearm flap received dental implants. No significant differences were found between flaps for the other outcomes.

[CONCLUSIONS] Free flap bony reconstruction for maxillary defects is a reliable approach achieving excellent speech intelligibility and low fistula rates. Although the rates of unrestricted dietary intake were encouraging, dental implant placement remains a significant area for improvement.

[LEVEL OF EVIDENCE] NA.