{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:00:12Z","timestamp":1791979212677,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,8,14]],"date-time":"2017-08-14T00:00:00Z","timestamp":1502668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The purpose of our study was to describe a novel technique for reconstruction of orbital defects after maxillectomy using a non\u2010anatomic titanium mesh suspension of orbital contents for both support and volume correction. This construct is then articulated with a layered fibula osteocutaneous free flap that restores orbital rim, zygoma, and maxillary alveolus. We herein present our application of this technique, including refinements over time and long\u2010term outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review was performed on 12 patients who underwent reconstruction of Brown class III orbitopalatomaxillary defects with extensive orbital involvement (at minimum complete orbital floor and rim absent) with titanium mesh sling and a layered fibula free flap.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Primary reconstruction was accomplished in all 12 patients. The mean postoperative length of stay was 8 days (6\u201314 days). There were no free flap failures or perioperative re\u2010explorations. Patients were routinely extubated on postoperative day #1 and began oral intake by postoperative day #3. At a mean follow\u2010up length of 48 months, unrestricted eye function was accomplished in all patients. Midfacial symmetry was accomplished in 10 of 12 patients; 2 patients had moderate asymmetry due to extirpation of facial musculature and\/or soft tissue. Minor revisions were necessary for lower lid ectropion and exposure of the titanium plate. Two patients required adipofascial free flap coverage of exposed intraoral bone after radiation therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This technique provides excellent restoration of eye position and function and also allows for implant\u2010based prosthetic rehabilitation. It has become our procedure of choice for orbitomaxillary reconstruction.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30199","type":"journal-article","created":{"date-parts":[[2017,8,14]],"date-time":"2017-08-14T15:02:40Z","timestamp":1502722960000},"page":"354-361","source":"Crossref","is-referenced-by-count":22,"title":["Large orbital defect reconstruction in the setting of globe\u2010sparing maxillectomy: The titanium hammock and layered fibula technique"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9210-0241","authenticated-orcid":false,"given":"Samuel J.","family":"Trosman","sequence":"first","affiliation":[{"name":"Head and Neck Institute Cleveland Clinic Foundation Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M.","family":"Haffey","sequence":"additional","affiliation":[{"name":"United States Air Force Otolaryngology\u2010Head and Neck Surgery, Keesler Air Force Base  Mississippi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael A.","family":"Couto","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic Foundation Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Fritz","sequence":"additional","affiliation":[{"name":"Head and Neck Institute Cleveland Clinic Foundation Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,8,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1054\/bjom.2001.0774"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0347(200001)22:1<17::AID-HED4>3.0.CO;2-2"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-39826"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20649"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199804000-00013"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e318246e895"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.128.2.161"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000200623.91956.66"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.20307"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000130940.46400.7F"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100102002"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2014.875"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2014.447"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181babb3d"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2006.10.027"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfacial.2011.1329"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(84)34307-X"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198206000-00004"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181fad2d3"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1054\/jcms.2000.0137"},{"key":"e_1_2_8_22_1","first-page":"862","article-title":"The scapular osteofasciocutaneous flap: A 12\u2010year experience","volume":"127","author":"Urken M. 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