Simultaneous maxillary and mandibular reconstruction with one free osteocutaneous flap.

The concept of immediate reconstruction of massive facial injury with rigid internal fixation and free-tissue transfer continues to evolve. This case is unique in that it is the first report of the following: (1) simultaneous combined maxillary and mandibular reconstruction with one vascularized bone graft and (2) immediate total maxillary reconstruction with vascularized fibular bone. The nasopharynx was closed with a tubed radial forearm flap. Reconstruction was staged over several days, with dissection/banking of flaps, grafts, recipient sites, and debridement as a preliminary stage.