PURPOSE: Reconstruction of the orbit after total maxillectomy without orbital exenteration is technically challenging. The goals of reconstruction are functional and aesthetic. We present a simple method of reconstructing the orbital floor that rigidly fixes nonvascularized bone graft within a vascularized soft-tissue flap. Operative technique and complications are presented.

METHODS: Results from a prospectively maintained database were reviewed for nine patients (n=9) who underwent immediate orbital floor reconstruction with autologous non-vascularized bone graft by a single surgeon (PC) from 1997-2005. Using a diamond side-cutting burr, an osteotomy was created in the zygoma that allowed a bone graft to slide into place to reconstruct the orbital floor and infraorbital rim. The resulting tongue-in-groove joint was secured using a single transfixing screw. A free rectus abdominis flap was harvested and inset to fill the antrum and provide a vascular bed to nourish the bone graft.

RESULTS: Donor sites included four split calvaria (44.4%), four iliac crests (44.4%), and one mandible (11.1%). Five patients had an excellent or outstanding result (55.6%). Five patients (55.6%) underwent postoperative radiation treatment. Two patients who underwent radiation had mild enophthalmos (22.2%). One patient who underwent radiation had 1 mm of orbital dystopia (11.1%). One patient had mild ectropion (11.1%) that was treated with massage. One patient had mild diplopia that resolved spontaneously (11.1%). One patient had a mild infection that resolved with antibiotics (11.1%). Six patients expired (66.7%). No complications required further operative intervention.

CONCLUSION: The tongue-in-groove technique minimizes hardware use and provides rigid fixation that is stable over time. In sum, it is a simple and straightforward method to reconstruct the orbital floor after total maxillectomy that protects the globe and achieves reliable results.