Reconstruction of Extensive Midfacial Defects After Nasal Cavity Cancer Using Three Free Flaps

Reconstruction of extensive midfacial defects poses significant challenges due to the need for simultaneous restoration of function and appearance. In this report, the authors present a case of an extensive midfacial defect following nasal cavity cancer resection, in which favorable functional and aesthetic outcomes were achieved through reconstruction using three free flaps. The first free flap-a thoracodorsal artery perforator flap combined with scapular bone was used for hard palate reconstruction; the second, a forearm flap prefabricated with costal cartilage was used to reconstruct the external nose; and the third anterolateral thigh flap was used to release contracture and improve facial contour. As a result of this carefully staged reconstructive strategy, the patient, who initially had dysphagia due to a palatal defect, was able to resume oral intake following scapular flap reconstruction and dental implant placement. Moreover, the correction of midfacial deformity, including the external nose, led to the recovery of social function.