Postoperative Imaging Appearance of Iliac Crest Free Flaps Used for Palatomaxillary Reconstructions

The internal oblique muscle from the flap eliminates the maxillectomy cavity, thereby preventing the presence of dead space (arrows).

A, An iliac crest–internal oblique flap has been harvested based on the DCIA and DCIV (asterisk). B, The iliac crest is shown inset into a palatomaxillectomy defect with the crest oriented toward the bottom (arrow). The internal oblique muscle based on the ascending branch of the DCIA has been brought through the palatal defect, medial to the iliac bone (curved arrow). This patient underwent an orbital exenteration, and the internal oblique muscle (IOM) is shown filling the orbital defect as well as obliterating the maxillectomy cavity. Rigid fixation (RF) is achieved to the lateral and superior orbital rim. The upgoing arrow shows a dental implant placed into the neoalveolar ridge. C, The internal oblique muscle, which is not optimally visualized on bone window, is used to fill the maxillectomy defect (arrow).

Axial imaging of a normal ICFF demonstrating a thick sheet of bone with a hyperattenuated cortex and intermediate attenuation of the trabecular surface. An osteotomy site is demonstrated and filled with corticocancellous bone (arrow). Images were obtained in the immediate postoperative period. Left cheek prominence is an expected immediate postoperative finding in the flap setting. Normal cheek cosmesis will be obtained over time.