Severe midface necrosis after liver failure induced fungal infection: A case report on the outcome after reconstruction

INTRODUCTION: Reconstruction of the complex anatomy of the midface is challenging and requires meticulous preparation. Immunosuppression therapy increases patient susceptibility to infection and can compromise wound healing. PRESENTATION OF CASE: A 22-year-old male presented with acute hepatic failure and underwent liver transplantation. The subsequent immunosuppressing therapy resulted in an invasive fungal infection in the midface involving the left lower eyelid, skin and soft tissue of the cheek and the underlying maxilla and zygoma. After multiple revisions, a primary surgical closure of the defect was performed with a free partial myocutaneous latissimus dorsi flap. 3 years post-transplantation the patient was referred to our hospital with no nasal airflow on the right side and completely obliterated nasal airway on the left side. He experienced trouble with the left eye tearing up and double vision when looking upward. Furthermore, he was troubled by missing 4 teeth in the left upper jaw. Lastly, he was not entirely satisfied with the general cosmetic outcome. These issues were addressed in two stages of surgery while considering that the patient was immunosuppressed. DISCUSSION: The patient did not suffer any complications or adverse side effects. Overall, the patient was satisfied with the results, and a questionnaire showed a clear improvement in patient reported outcome on both functional and cosmetic results of the problems addressed. CONCLUSION: Here we present how to plan a complex 3D midface reconstruction on an immunosuppressed patient and a questionnaire follow up on patient reported outcome. The patient reported overall satisfaction.