Clinical Paper Reconstructive Surgery| Volume 52, ISSUE 4, P430-435, April 2023

Bone resorption after maxillary reconstruction with the vascularized free iliac flap

Published:August 22, 2022DOI:


      The aim of this study was to evaluate the resorption of the iliac bone after maxillary reconstruction with a vascularized free iliac flap. Twenty-seven patients with maxillary defects who underwent maxillary reconstruction with the vascularized free iliac flap between January 2017 and January 2021 were included. Computed tomography (CT) images taken at 1 week, approximately 6 months, and 1 year after the surgery were used for evaluation. The total iliac bone thickness and height, cortical bone thickness, and cancellous bone density were measured in the CT images. Compared with 1 week after the surgery, the total thickness and height of the iliac bone were reduced significantly 1 year after the surgery, and the cortical bone thickness and cancellous bone density were reduced significantly at 6 months and 1 year after the surgery. Compared with 6 months after the surgery, cancellous bone density was reduced significantly 1 year after the surgery. In conclusion, during the first year after maxillary reconstruction with a vascularized free iliac flap, there was significant resorption of iliac bone, including the total iliac bone thickness and height, the cortical bone thickness, and the cancellous bone density.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to International Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mucke T.
        • Holzle F.
        • Loeffelbein D.J.
        • Ljubic A.
        • Kesting M.
        • Wolff K.D.
        • Mitchell D.A.
        Maxillary reconstruction using microvascular free flaps.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 111: 51-57
        • Brown J.S.
        Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect.
        Head Neck. 1996; 18: 412-421
        • Khadembaschi D.
        • Brierly G.I.
        • Chatfield M.D.
        • Beech N.
        • Batstone M.D.
        Systematic review and pooled analysis of survival rates, success, and outcomes of osseointegrated implants in a variety of composite free flaps.
        Head Neck. 2020; 42: 2669-2686
        • Miyamoto I.
        • Tsuboi Y.
        • Wada E.
        • Suwa H.
        • Iizuka T.
        Influence of cortical bone thickness and implant length on implant stability at the time of surgery—clinical, prospective, biomechanical, and imaging study.
        Bone. 2005; 37: 776-780
        • He J.
        • Zhao B.
        • Deng C.
        • Shang C.
        • Zhang C.
        Assessment of implant cumulative survival rates in sites with different bone density and related prognostic factors: an 8-year retrospective study of 2684 implants.
        Int J Oral Maxillofac Implants. 2015; 30: 360-371
        • Goiato M.C.
        • dos Santos D.M.
        • Santiago Jr, J.F.
        • Moreno A.
        • Pellizzer E.P.
        Longevity of dental implants in type IV bone: a systematic review.
        Int J Oral Maxillofac Surg. 2014; 43: 1108-1116
        • Möhlhenrich S.C.
        • Kniha K.
        • Elvers D.
        • Ayoub N.
        • Golobrodoko E.
        • Holzel F.
        • Modabber A.
        Intraosseous stability of dental implants in free revascularized fibula and iliac crest bone flaps.
        J Craniomaxillofac Surg. 2016; 44: 1935-1939
        • Mertens C.
        • Decker C.
        • Engel M.
        • Sander A.
        • Hoffmann J.
        • Freier K.
        Early bone resorption of free microvascular reanastomized bone grafts for mandibular reconstruction—a comparison of iliac crest and fibula grafts.
        J Craniomaxillofac Surg. 2014; 42: e217-e223
        • Wilkman T.
        • Apajalahti S.
        • Wilkman S.
        • Törnwall J.
        • Lassus P.
        A comparison of bone resorption over time: an analysis of the free scapular, iliac crest, and fibular microvascular flaps in mandibular reconstruction.
        J Oral Maxillofac Surg. 2017; 75: 616-621
        • Brown J.S.
        • Shaw R.J.
        Reconstruction of the maxilla and midface: introducing a new classification.
        Lancet Oncol. 2010; 11: 1001-1008
        • Peng X.
        • Mao C.
        • Yu G.Y.
        • Guo C.B.
        • Huang M.X.
        • Zhang Y.
        Maxillary reconstruction with the free fibula flap.
        Plast Reconstr Surg. 2005; 115: 1562-1569
        • Genden E.M.
        • Wallace D.
        • Buchbinder D.
        • Okay D.
        • Urken M.L.
        Iliac crest internal oblique osteomusculocutaneous free flap reconstruction of the postablative palatomaxillary defect.
        Arch Otolaryngol Head Neck Surg. 2001; 127: 854-861
        • Bianchi B.
        • Ferri A.
        • Ferrari S.
        • Copelli C.
        • Boni P.
        • Sesenna E.
        Iliac crest free flap for maxillary reconstruction.
        J Oral Maxillofac Surg. 2010; 68: 2706-2713
        • Grinsell D.
        • Catto-Smith H.E.
        Modifications of the deep circumflex iliac artery free flap for reconstruction of the maxilla.
        J Plast Reconstr Aesthet Surg. 2015; 68: 1044-1053
        • Kang Y.F.
        • Liang J.
        • Xie S.
        • Shan X.F.
        • Cai Z.G.
        Cortical bone resorption of fibular bone after maxillary reconstruction with a vascularized fibula free flap: a computed tomography imaging study.
        Int J Oral Maxillofac Surg. 2019; 48: 1009-1014
        • Berger-Groch J.
        • Thiesen D.M.
        • Ntalos D.
        • Hennes F.
        • Hartel M.J.
        Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data.
        Eur Spine J. 2020; 29: 1098-1104
        • Sogo M.
        • Ikebe K.
        • Yang T.C.
        • Wada M.
        • Maeda Y.
        Assessment of bone density in the posterior maxilla based on Hounsfield unit to enhance the initial stability of implants.
        Clin Implant Dent Relat Res. 2012; 14: e183-e187
        • Wada M.
        • Suganami T.
        • Sogo M.
        • Maeda Y.
        Can we predict the insertion torque using the bone density around the implant?.
        Int J Oral Maxillofac Surg. 2016; 45: 221-225
        • de Elío Oliveros J.
        • Del Canto Díaz A.
        • Del Canto Díaz M.
        • Orea C.J.
        • Del Canto Pingarrón M.
        • Calvo J.S.
        Alveolar bone density and width affect primary implant stability.
        J Oral Implantol. 2020; 46: 389-395
        • Frost H.M.
        A 2003 update of bone physiology and Wolff’s law for clinicians.
        Angle Orthod. 2004; 74: 3-15
        • Coupaud S.
        • McLean A.N.
        • Purcell M.
        • Fraser M.H.
        • Allan D.B.
        Decreases in bone mineral density at cortical and trabecular sites in the tibia and femur during the first year of spinal cord injury.
        Bone. 2015; 74: 69-75
        • Wang L.
        • Wei J.H.
        • Yang X.
        • Yang Z.H.
        • Sun M.Y.
        • Cheng X.B.
        • Xu L.Q.
        • Lei D.L.
        • Zhang C.P.
        Preventing early-stage graft bone resorption by simultaneous innervation: innervated iliac bone flap for mandibular reconstruction.
        Plast Reconstr Surg. 2017; 139: 1152e-1161e