Assistant Professor University of Florida Jacksonville, Florida
Microvascular free flap reconstruction is a standard in maxillofacial surgery, but conventional approaches typically require cervical incisions to access the recipient vessels. These incisions increase morbidity and leave visible scars that negatively impact esthetics.
The intraoral anastomosis offers an efficient minimally invasive approach for free flap reconstructions in the maxillofacial region by utilizing recipient vessels within the oral cavity, eliminating the need for external incisions, particularly in benign pathology cases.
Technique:
Through a buccal mucosal incision, vessels are dissected and prepared for microvascular anastomosis. End-to-end anastomoses are performed intraorally. Patency is confirmed with indocyanine green angiography. The mucosal incision is closed tension-free.
Advantages:
This approach avoids external scars, reduces the need for vein grafts or long-pedicle flaps and may shorten operative time by limiting cervical dissection. Patients benefit from preserved esthetics, less morbidity and quicker recovery, minimizing the psychosocial impact of the surgery.
Conclusion:
Intraoral anastomosis is a minimally invasive technique that expands the reconstructive options in maxillofacial surgery and eliminates the need for cervical incisions by accessing the vessels entirely within the oral cavity. Ideal for benign pathology or cases not requiring neck dissection, this scarless technique provides reliable vascularization while enhancing both functional and cosmetic outcomes for the patients.
Learning Objectives:
At the conclusion of this presentation, participants should be able to:
Demonstrate the surgical steps and technical considerations in the intraoral microvascular anastomosis.
Describe the indications and patient selection criteria for the intraoral microvascular anastomosis.
Evaluate the esthetic and functional outcomes of the intraoral microvascular anastomosis compared to conventional approaches.
