Outcomes of Free Flap Bony Reconstruction for Maxillary Defects: A Systematic Review and Meta‐Analysis

ABSTRACT Objective To analyze the clinical outcomes associated with free flap bony reconstruction of maxillary defects. Data Sources A systematic search was performed on PubMed, Scopus, and Google Scholar databases. Review Methods A single‐arm meta‐analysis of proportions was performed to calculate the pooled effect size. The inverse variance method was used to combine the effect sizes from individual studies and calculate the 95% confidence interval (CI). Results A total of 837 patients undergoing scapula (35.1%), fibula (37.3%), iliac crest (15.4%), and radial forearm (12.2%) reconstruction were included. The pooled flap success rate was 93.0% (95% CI: 90.6–94.9). A low fistula rate (15.9%; 95% CI: 12.8–19.6) and a high speech intelligibility rate (91.2%; 95% CI: 86.9–94.2) were measured. The pooled unrestricted diet rate was 81.2% (95% CI: 69.6–89.0), while the pooled dental implant rate was 23.5% (95% CI: 12.0–40.9). Scapula (13.6%, 95% CI: 5.2–31.2) showed a lower dental implant rate compared to fibula (33.4%, 95% CI: 6.1–79.6) and iliac crest (37.1%, 95% CI: 23.0–53.7) flaps. None of the patients with radial forearm flap received dental implants. No significant differences were found between flaps for the other outcomes. Conclusions Free flap bony reconstruction for maxillary defects is a reliable approach achieving excellent speech intelligibility and low fistula rates. Although the rates of unrestricted dietary intake were encouraging, dental implant placement remains a significant area for improvement. Level of Evidence NA.