Analysis of Facial Symmetry Following Maxillary Reconstruction with the Anterolateral Thigh Flap

BACKGROUND: The anterolateral thigh flap (ALTF) has been widely utilized clinically as one of the primary reconstruction methods for maxillary defects. However, there remains a paucity of research on postoperative facial soft tissue symmetry following maxillary defect reconstruction using the ALTF. MATERIALS AND METHODS: Fifty-nine patients who underwent maxillary resection and subsequent reconstruction with ALTF were included in this study. 3D stereophotogrammetry was employed to capture facial morphological data. Facial symmetry was quantitatively evaluated using a landmark-independent method, with qualitative assessment performed using Likert scale. RESULT: The magnitude of the maxillary defect significantly influenced facial asymmetry perception (P < 0.05). Substantial statistical variations (P < 0.05) in the asymmetry of the suborbital, superiolabial, and zygomatic areas across the different classes of maxillary defect were noted. ALTF reconstruction notably reduced lateral discrepancies in suborbital and buccal areas for Class IIId defects (P < 0.05). Flap folding technique showed no significant impact on symmetry across defect classifications. Postoperative removable partial dentures (RPD) significantly improved symmetry in zygomatic, buccal, nasal, and superiolabial areas (P < 0.05). CONCLUSION: Residual facial asymmetry persists following ALTF maxillary reconstruction. While ALTF demonstrates limited efficacy for small defects, it moderately improves facial symmetry in extensive defects. Small defects require thinning the ALTF to improve contour and extensive defects require supplemental hard tissue support in suborbital, zygomatic, buccal, and superiolabial areas. Flap folding did not show significant symmetry improvement, and RPD provide effective hard tissue support, mitigating soft tissue collapse-related deformities, which serving as exploratory observations warranting further investigation.