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Bottini GB, Joos V, Steiner C, Zeman-Kuhnert K, Gaggl A. Advances in Microvascular Reconstruction of the Orbit and Beyond: Considerations and a Checklist for Decision-Making. J Clin Med 2024; 13:2899. [PMID: 38792440 PMCID: PMC11122336 DOI: 10.3390/jcm13102899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
This paper aims to discuss the microvascular reconstruction of the orbit and adjacent regions and to propose a checklist to aid the reconstructive surgeon in this challenging undertaking. The discussion is based on a literature review that includes 32 retrospective case series, 5 case reports published in the last 34 years in PubMed, and 3 textbook chapters. Additionally, it relies on the senior author's expertise, described in a case series, and two case reports published elsewhere. Classifications and treatment algorithms on microvascular orbit reconstruction generally disregard patient-related factors. A more holistic approach can be advantageous: patient-related factors, such as age, comorbidities, prognosis, previous interventions, radiotherapy, and the wish for maximal dental rehabilitation and a prosthetic eye, have the same importance as defect-related considerations and can inform the choice of a reconstructive option. In this manuscript, we examine defect- and patient-related factors and new technologies, provide a checklist, and examine future directions. The checklist is intended as a tool to aid in the decision-making process when reconstructing the orbital region with microvascular flaps.
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Affiliation(s)
- Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Veronika Joos
- Private Practice for Dentistry and Oral and Maxillofacial Surgery, 5026 Salzburg, Austria
| | - Christoph Steiner
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Katharina Zeman-Kuhnert
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Alexander Gaggl
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Alqarni H, Alfaifi M, Ahmed WM, Almutairi R, Kattadiyil MT. Classification of maxillectomy in edentulous arch defects, algorithm, concept, and proposal classifications: A review. Clin Exp Dent Res 2023; 9:45-54. [PMID: 36600487 PMCID: PMC9932229 DOI: 10.1002/cre2.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 11/08/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Aramany's classification of postsurgical maxillectomy defects was introduced for partially edentulous situations, and has been widely used for education and effective communication among practitioners. Numerous classifications of maxillofacial defects, based on surgical procedure, resultant defects, or prosthodontist's perspective after rehabilitation, exist in the literature. However, no single classification has incorporated all these factors. The purpose of this review was to highlight the classification systems and describe a pragmatic classification series for edentulous maxillary arch defects (maxillectomy) by applying the Aramany classification criteria, to enhance treatment outcomes and communication among practitioners. MATERIAL AND METHODS An electronic search of the literature published in English was conducted using the PubMed/MEDLINE and Google Scholar database. Keywords used were "maxillectomy classification" AND "surgical resection," "maxillectomy classification" AND "complete edentulous." In addition, a manual search was also performed followed the same criteria in the following journals: Journal of Prosthetic Dentistry and Journal of Prosthodontics. RESULTS Several classification systems for partial dentition were found in terms of size, location, dentition, and extension of the defect (isolated or communication defects). The findings revealed a variety of maxillectomy defect classifications for partially dentate, considering surgical factors and rehabilitation. However, no study or classification system exist for the edentulous arch defects. CONCLUSIONS Different classification systems for maxillectomy defects exist in the literature, only for partially dentate patients. To the authors best knowledge, no classification system for completely edentulous maxillary arch defects have been proposed till date. A simple classification system with clear characteristics for edentulous maxillectomy dental arch defects has been proposed. This classification was modeled after Aramany classification for easier memorization and application.
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Affiliation(s)
- Hatem Alqarni
- Department of Restorative and Prosthetic Dental Sciences, College of DentistryKing Saud Bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
- King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Mohammed Alfaifi
- Department of Prosthtic Dental Sciences, King Khalid University College of Dentistry, Abha, Saudi Arabia; Fellow in Advanced Digital Prosthodontics and Implant Dentistry, Department of ProsthodonticsLoma Linda University School of DentistryLoma LindaCaliforniaUSA
| | - Walaa Magdy Ahmed
- Department of Restorative Dentistry, Faculty of DentistryKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Rania Almutairi
- Prosthodontic ResidentKing Saud UniversityRiyadhSaudi Arabia
| | - Mathew T. Kattadiyil
- Advanced Education Program in ProsthodonticsLoma Linda University School of DentistryLoma LindaCaliforniaUSA
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Bottini GB, Hutya V, Kummer D, Steiner C, Zeman-Kuhnert K, Wittig J, Gaggl A. Microvascular reconstruction of the orbit and adjacent regions: A case series. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kagaya Y, Arikawa M, Sekiyama T, Higashino T, Akazawa S. Chronological flap volume and distribution changes after reconstruction of total maxillectomy defect using a rectus abdominis myocutaneous flap. J Plast Reconstr Aesthet Surg 2021; 74:3341-3352. [PMID: 34215545 DOI: 10.1016/j.bjps.2021.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE After total or subtotal maxillectomy, reconstruction using a free rectus abdominis myocutaneous (RAMC) flap is a fundamental and useful option. The purpose of the present study was to clarify the degree of flap volume change and volume distribution change with time after total or subtotal maxillectomy and free RAMC flap reconstruction and to examine the factors affecting the results. METHODS A total of 20 patients who underwent total or subtotal maxillectomy with free RAMC flap reconstruction were examined, and the flap volume change rate (volume at final evaluation [POD 181-360] / volume at initial evaluation [POD 5-30]) was investigated using the results of imaging tests. Moreover, the flap was divided into four blocks (A-D) in the cranio-caudal direction, and the volume change of each block was individually analyzed. RESULTS The overall volume change rate of fat/muscle/total was 0.84 ± 0.21/0.36 ± 0.08/0.67 ± 0.15, at the mean follow-up period of 309±35 days after the operation. The multiple regression analysis revealed that weight loss (for fat), postoperative RT (for fat and muscle), and young age (for muscle) were independently associated with flap volume loss. The results also indicated that the fat volume was stable, whereas the muscle volume decreased to <40% over time, assuming there were no influencing factors. Regarding flap volume distribution change, the fat volume tended to gather toward the central-cranial direction, while the muscle volume gathered toward the cranial direction, and total flap volume gathered toward the central direction.
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Affiliation(s)
- Yu Kagaya
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Masaki Arikawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takuya Sekiyama
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba 277-8577, Japan
| | - Satoshi Akazawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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A Two-Scale Multi-Resolution Topologically Optimized Multi-Material Design of 3D Printed Craniofacial Bone Implants. MICROMACHINES 2021; 12:mi12020101. [PMID: 33498498 PMCID: PMC7909579 DOI: 10.3390/mi12020101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/15/2023]
Abstract
Bone replacement implants for craniofacial reconstruction require to provide an adequate structural foundation to withstand the physiological loading. With recent advances in 3D printing technology in place of bone grafts using autologous tissues, patient-specific additively manufactured implants are being established as suitable alternates. Since the stress distribution of these structures is complicated, efficient design techniques, such as topology optimization, can deliver optimized designs with enhanced functionality. In this work, a two-scale topology optimization approach is proposed that provides multi-material designs for both macrostructures and microstructures. In the first stage, a multi-resolution topology optimization approach is used to produce multi-material designs with maximum stiffness. Then, a microstructure with a desired property supplants the solid domain. This is beneficial for bone implant design since, in addition to imparting the desired functional property to the design, it also introduces porosity. To show the efficacy of the technique, four different large craniofacial defects due to maxillectomy are considered, and their respective implant designs with multi-materials are shown. These designs show good potential in developing patient-specific optimized designs suitable for additive manufacturing.
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The use of 3D virtual surgical planning and computer aided design in reconstruction of maxillary surgical defects. Curr Opin Otolaryngol Head Neck Surg 2020; 28:122-128. [PMID: 32102008 DOI: 10.1097/moo.0000000000000618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The present review describes the latest development of 3D virtual surgical planning (VSP) and computer aided design (CAD) for reconstruction of maxillary defects with an aim of fully prosthetic rehabilitation. The purpose is to give an overview of different methods that use CAD in maxillary reconstruction in patients with head and neck cancer. RECENT FINDINGS 3D VSP enables preoperative planning of resection margins and osteotomies. The current 3D VSP workflow is expanded with multimodal imaging, merging decision supportive information. Development of more personalized implants is possible using CAD, individualized virtual muscle modelling and topology optimization. Meanwhile the translation of the 3D VSP towards surgery is improved by techniques like intraoperative imaging and augmented reality. Recent improvements of preoperative 3D VSP enables surgical reconstruction and/or prosthetic rehabilitation of the surgical defect in one combined procedure. SUMMARY With the use of 3D VSP and CAD, ablation surgery, reconstructive surgery, and prosthetic rehabilitation can be planned preoperatively. Many reconstruction possibilities exist and a choice depends on patient characteristics, tumour location and experience of the surgeon. The overall objective in patients with maxillary defects is to follow a prosthetic-driven reconstruction with the aim to restore facial form, oral function, and do so in accordance with the individual needs of the patient.
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Breik O, Idle M, Martin T, Praveen P, Parmar S. Three-Dimensional Computer-Assisted Surgical Planning and Manufacturing in Complex Maxillary Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:151-164. [PMID: 32741512 DOI: 10.1016/j.cxom.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Omar Breik
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK.
| | - Matthew Idle
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Timothy Martin
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Prav Praveen
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Satyesh Parmar
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
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Olsson AB, Dillon J, Kolokythas A, Schlott BJ. Reconstructive Surgery. J Oral Maxillofac Surg 2019; 75:e264-e301. [PMID: 28728733 DOI: 10.1016/j.joms.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction. Arch Plast Surg 2018; 45:325-332. [PMID: 30037192 PMCID: PMC6062705 DOI: 10.5999/aps.2018.00311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022] Open
Abstract
Background Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. Methods A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision. Results The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. Conclusions The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.
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DAI NING, ZHU JIANFENG, ZHANG MIN, MENG LINGYIN, YU XIAOLING, ZHANG YIHUA, LIU BINGYAO, ZHANG SENLIN. DESIGN OF A MAXILLOFACIAL PROSTHESIS BASED ON TOPOLOGY OPTIMIZATION. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519418500240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The use of custom implants has recently gained increasing importance in craniofacial surgery in order to optimize preoperative planning and reduce operative time. The design of patient-specific implants plays an important role to restore craniofacial bone. Nevertheless, the design method has become the bottleneck. In this study, a new design method of a maxillofacial prosthesis based on the topology optimization was proposed to realize lightweight custom implants. At first, parametric predesign of the optimized model was carried out to ensure that the optimized model conformed to the main physiological anatomical structure and recover basic function structure. Then, the design region is defined under given load and boundary conditions. The material interpolation technique of SIMP with the penalization factor is adopted to get the final optimized 3D model. Finally, the experimental results verify that the method of topology optimization for the maxillofacial prosthesis proposed is efficient.
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Affiliation(s)
- NING DAI
- College of Mechanical & Electrical Engineering, Nanjing University of Aeronautics and Astronautics, P. R. China
| | - JIAN-FENG ZHU
- College of Mechanical & Electrical Engineering, Nanjing University of Aeronautics and Astronautics, P. R. China
| | - MIN ZHANG
- College of Mechanical & Electrical Engineering, Nanjing University of Aeronautics and Astronautics, P. R. China
| | - LING-YIN MENG
- College of Mechanical & Electrical Engineering, Nanjing University of Aeronautics and Astronautics, P. R. China
| | - XIAO-LING YU
- College of Mechanical & Electrical Engineering, Nanjing University of Aeronautics and Astronautics, P. R. China
| | - YI-HUA ZHANG
- College of Mechanical & Electrical Engineering, Nanjing University of Aeronautics and Astronautics, P. R. China
| | - BING-YAO LIU
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, P. R. China
| | - SEN-LIN ZHANG
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, P. R. China
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Orbital exenteration for sinonasal malignancies: indications, rehabilitation and oncologic outcomes. Curr Opin Otolaryngol Head Neck Surg 2018; 26:122-126. [DOI: 10.1097/moo.0000000000000441] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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13
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Urken ML, Roche AM, Kiplagat KJ, Dewey EH, Lazarus C, Likhterov I, Buchbinder D, Okay DJ. Comprehensive approach to functional palatomaxillary reconstruction using regional and free tissue transfer: Report of reconstructive and prosthodontic outcomes of 140 patients. Head Neck 2018. [PMID: 29537619 DOI: 10.1002/hed.25134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Palatomaxillary defects were historically restored with a prosthetic obturator; however, advances in local and free tissue transfer has provided a viable alternative for appropriately selected patients with palatomaxillary defects. METHODS A retrospective chart review of patients who underwent palatomaxillary reconstruction by the lead author between 1998 and 2016 was conducted. Patients who were restored with a palatal obturator were excluded. RESULTS One hundred forty patients were reconstructed with a total of 159 local, regional, and free flaps with a 96.7% success rate. Seventy-four patients (52.8%) underwent prosthodontic rehabilitation, with 183 implants placed and an 86% success rate. CONCLUSION Palatomaxillary reconstruction applying a systematic approach, using a multitude of techniques, is a safe and effective way to restore patients without compromising the ability to maintain surveillance. Prosthodontic rehabilitation can be achieved in a high percentage of patients using dental implants, leading to optimal aesthetic and functional results.
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Affiliation(s)
- Mark L Urken
- Thyroid, Head and Neck Cancer Foundation, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai New York, New York
| | - Ansley M Roche
- Thyroid, Head and Neck Cancer Foundation, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai New York, New York
| | | | - Eliza H Dewey
- Thyroid, Head and Neck Cancer Foundation, New York, New York
| | - Cathy Lazarus
- Thyroid, Head and Neck Cancer Foundation, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai New York, New York
| | - Ilya Likhterov
- Thyroid, Head and Neck Cancer Foundation, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai New York, New York
| | - Daniel Buchbinder
- Thyroid, Head and Neck Cancer Foundation, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai New York, New York
| | - Devin J Okay
- Thyroid, Head and Neck Cancer Foundation, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai New York, New York
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Eskander A, Kang SY, Teknos TN, Old MO. Advances in midface reconstruction: beyond the reconstructive ladder. Curr Opin Otolaryngol Head Neck Surg 2017; 25:422-430. [DOI: 10.1097/moo.0000000000000396] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Neel GS, Nagel TH, Hoxworth JM, Lal D. Management of Orbital Involvement in Sinonasal and Ventral Skull Base Malignancies. Otolaryngol Clin North Am 2017; 50:347-364. [DOI: 10.1016/j.otc.2016.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Alam D, Ali Y, Klem C, Coventry D. The Evolution of Complex Microsurgical Midface Reconstruction. Facial Plast Surg Clin North Am 2016; 24:593-603. [DOI: 10.1016/j.fsc.2016.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Palato-maxillary reconstruction by the angular branch-based tip of scapula free flap. Eur Arch Otorhinolaryngol 2016; 274:939-945. [DOI: 10.1007/s00405-016-4266-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
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Abu-Serriah M, Wong L, Richardson S, Fasanmade A, Wiesenfeld D, Martin IC. The SECONDI MAPZ(©) system: new approach for the classification of oncological defects of the midface. Br J Oral Maxillofac Surg 2016; 54:422-9. [PMID: 26907930 DOI: 10.1016/j.bjoms.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
The appearance and function of the midface are crucial physiologically, psychologically, and aesthetically, and defects in the region can be devastating. Most of these defects are caused by operations for cancer, for which surgical access and rehabilitation can be challenging. Clinical evidence in midfacial ablative surgery is limited because differences between existing classifications do not allow a uniform approach to data recording, which makes comparison difficult. We explore the history of the classification of midfacial and maxillary defects, we analyse the shortcomings of those currently in use, and propose a new system that enables defects to be mapped simply, logically, and accurately.
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Affiliation(s)
- Muammar Abu-Serriah
- Department of Oral and Maxillofacial Surgery, Manchester Head and Neck Centre, Manchester Royal Infirmary, Central Manchester Foundation Trust, Manchester, UK.
| | - Lilia Wong
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sophia Richardson
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Adekunmi Fasanmade
- The Head and Neck Surgery Supra-regional Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - David Wiesenfeld
- Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Ian C Martin
- Department of Oral and Facial Surgery, Sunderland Royal Hospital, Sunderland, UK
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Abu-Serriah M, Wong L, Richardson J, Richardson S. The SECONDI MAPZ(©) system: a practical guide and proof of concept. Br J Oral Maxillofac Surg 2016; 54:430-7. [PMID: 26898518 DOI: 10.1016/j.bjoms.2015.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/08/2015] [Indexed: 11/27/2022]
Abstract
The SECONDI MAPZ(©) system is a new, simple, and logical classification of oncological defects of the midface that combines regional anatomy, 3-dimensional visualisation, and the hierarchy of functional priorities. In this paper, we provide clinical and radiographic examples of defects of varying complexity to illustrate the application of the system, to highlight its versatility, and to give practical clinical and radiological guidance on its use. We hope that its introduction will result in better communication of information, and the collection of more uniform data with which to compare outcomes, and ultimately will facilitate evidence-based practice in head and neck oncology.
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Affiliation(s)
- Muammar Abu-Serriah
- Department of Oral and Maxillofacial Surgery, Manchester Head and Neck Centre, Manchester Royal Infirmary, Central Manchester Foundation Trust, Manchester, UK.
| | - Lilia Wong
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jeremy Richardson
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sophia Richardson
- Department of Oral and Maxillofacial Surgery, the Head and Neck Surgery Supra-regional Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Designing patient-specific 3D printed craniofacial implants using a novel topology optimization method. Med Biol Eng Comput 2015; 54:1123-35. [PMID: 26660897 DOI: 10.1007/s11517-015-1418-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
Large craniofacial defects require efficient bone replacements which should not only provide good aesthetics but also possess stable structural function. The proposed work uses a novel multiresolution topology optimization method to achieve the task. Using a compliance minimization objective, patient-specific bone replacement shapes can be designed for different clinical cases that ensure revival of efficient load transfer mechanisms in the mid-face. In this work, four clinical cases are introduced and their respective patient-specific designs are obtained using the proposed method. The optimized designs are then virtually inserted into the defect to visually inspect the viability of the design . Further, once the design is verified by the reconstructive surgeon, prototypes are fabricated using a 3D printer for validation. The robustness of the designs are mechanically tested by subjecting them to a physiological loading condition which mimics the masticatory activity. The full-field strain result through 3D image correlation and the finite element analysis implies that the solution can survive the maximum mastication of 120 lb. Also, the designs have the potential to restore the buttress system and provide the structural integrity. Using the topology optimization framework in designing the bone replacement shapes would deliver surgeons new alternatives for rather complicated mid-face reconstruction.
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Kekatpure VD, Hedne N, Chavre S, Pillai V, Trivedi N, Kuriakose MA. Versatility of adipofascial anterolateral thigh flap for reconstruction of maxillary defects with infratemporal fossa extension. Craniomaxillofac Trauma Reconstr 2014; 7:213-7. [PMID: 25136410 DOI: 10.1055/s-0034-1371973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/07/2013] [Indexed: 10/25/2022] Open
Abstract
Tumors arising from the posterior hard palate or posterolateral maxilla may extend to involve the infratemporal fossa (ITF). Resection of these tumors results in infrastructural maxillectomy with ITF defects. In this study, we describe the use of an adipofascial anterolateral thigh flap (ALT) specifically for such defects. This case series includes four patients who underwent an infrastructure maxillectomy with ITF clearance and the resultant defects were reconstructed using adipofascial anterolateral thigh flaps. The complications as well as the functional outcomes were assessed. This study included patients with lesions involving the hard palate, posterolateral part of maxilla with extension into the ITF. The mean flap dimension was 150 cm(2) (range, 120-180 cm(2)). All flaps were harvested based on a single perforator. The flap was used to obliterate the ITF defect and also to achieve oroantral separation. All flaps mucosalized well within 6 weeks. All patients were on oral diet and had adequate mouth opening. There were no donor-site complications. Adipofascial ALT is an excellent choice for infrastructural maxillectomy defects with ITF extension. The intraoral part got mucosalized well and provided a smooth and taut surface. A large adipofascial tissue flap helps obliterate the ITF, thus minimizing complications.
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Affiliation(s)
- Vikram D Kekatpure
- Department of Head and Neck Oncology, Mazumdar Shaw Cancer Center, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - Naveen Hedne
- Department of Head and Neck Oncology, Mazumdar Shaw Cancer Center, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - Sachin Chavre
- Department of Head and Neck Oncology, Mazumdar Shaw Cancer Center, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - Vijay Pillai
- Department of Head and Neck Oncology, Mazumdar Shaw Cancer Center, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - Nirav Trivedi
- Department of Head and Neck Oncology, Mazumdar Shaw Cancer Center, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - Moni Abraham Kuriakose
- Department of Head and Neck Oncology, Mazumdar Shaw Cancer Center, Narayana Hrudayalaya, Bangalore, Karnataka, India
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Gibber MJ, Clain JB, Jacobson AS, Buchbinder D, Scherl S, Zevallos JP, Mehra S, Urken ML. Subscapular system of flaps: An 8-year experience with 105 patients. Head Neck 2014; 37:1200-6. [DOI: 10.1002/hed.23738] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/06/2014] [Accepted: 05/03/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Marc J. Gibber
- Department of Otolaryngology - Head and Neck Surgery; Montefiore Green Medical Arts Pavilion; Bronx New York
| | - Jason B. Clain
- Thyroid Head and Neck Cancer Foundation; Department of Head and Neck Oncology; New York New York
| | - Adam S. Jacobson
- Department of Head and Neck Surgery; Beth Israel Medical Center; New York New York
| | - Daniel Buchbinder
- Department of Otolaryngology - Head and Neck Surgery; Beth Israel Medical Center; New York New York
| | - Sophie Scherl
- Thyroid Head and Neck Cancer Foundation; Department of Head and Neck Oncology; New York New York
| | - Jose P. Zevallos
- Department of Otolaryngology - Head and Neck Surgery; Baylor College of Medicine; Houston Texas
| | - Saral Mehra
- Department of Otolaryngology; Yale University School of Medicine; New Haven Connecticut
| | - Mark L. Urken
- Department of Otolaryngology; Beth Israel Medical Center; New York New York
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Mitsimponas KT, Iliopoulos C, Stockmann P, Bumiller L, Nkenke E, Neukam FW, Schlegel KA. The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: A retrospective analysis of 130 reconstructions performed over a period of 5 years in a single Department. J Craniomaxillofac Surg 2014; 42:536-43. [DOI: 10.1016/j.jcms.2013.07.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/05/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022] Open
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Rahpeyma A, Khajehahmadi S. Reconstruction of the maxilla by submental flap. ANZ J Surg 2014; 85:873-7. [DOI: 10.1111/ans.12638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Surgery; Oral and Maxillofacial Diseases Research Center; School of Dentistry; Mashhad University of Medical Sciences; Mashhad Iran
| | - Saeedeh Khajehahmadi
- Oral and Maxillofacial Pathology; Dental Research Center; School of Dentistry; Mashhad University of Medical Sciences; Mashhad Iran
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Elo JA, Tandon R, Allen CN, Murray MD. Hemimaxillectomy for desmoplastic ameloblastoma with immediate temporalis flap reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:e33-9. [PMID: 24556494 DOI: 10.1016/j.oooo.2013.12.408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/07/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
Abstract
Ameloblastoma is one of the most common odontogenic tumors encountered, occurring more frequently than all other tumors combined, if one excludes the keratocystic odontogenic tumor. These tumors can cause severe expansion of the cortical bones and gross anatomic deformities. They can affect the dentition, causing tooth mobility and displacement. Fortunately, morbidity can be minimized with recognition on routine radiographic examination. The tissue may be unilocular or multilocular and has been described as having a "soap-bubble" appearance. Nevertheless, its radiographic appearance is insufficient to make a definitive diagnosis, because other tumors have similar appearance. Although the anatomic distribution and progression of ameloblastoma remain fairly consistent, alternative manifestations follow an atypical clinical course. One such variant is the desmoplastic ameloblastoma. We present a case of maxillary desmoplastic ameloblastoma treated with hemimaxillectomy and immediate reconstruction with temporalis flap that was recurrence-free at 36 months.
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Affiliation(s)
- Jeffrey A Elo
- Associate Professor, Oral and Maxillofacial Surgery, Western University College of Dental Medicine; Assistant Professor, Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
| | - Rahul Tandon
- Boyne & Geistlich Research Fellow, Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Chad N Allen
- Chief Resident, Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Matthew D Murray
- Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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Scalp, Skull, Orbit, and Maxilla Reconstruction and Hair Transplantation. Plast Reconstr Surg 2013; 131:411e-424e. [DOI: 10.1097/prs.0b013e31827c7167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Management of maxillary defects is among the most challenging and controversial areas of head and neck reconstruction. The authors develop a treatment algorithm based on outcomes following free flap reconstruction of various maxillary defects. METHODS A review of 246 maxillary free flap reconstructions was performed. RESULTS The authors' analysis demonstrated that the palatoalveolar resection predicted use of soft-tissue (n = 200) versus osteocutaneous (n = 46) free flaps, depending on the location and extent of the defect. Whether the orbital floor or the entire orbital contents were resected also had implications for flap choice and whether bone grafts or alloplasts were needed. The perioperative complication rate was 37.8 percent, including a 3.3 percent incidence of flap loss. The long-term complication rate was 12.1 percent, including a 7.5 percent fistula rate. Complications related to orbital floor reconstruction were not dependent on the material used (p = 0.18). Greater than 80 percent speech intelligibility was achieved by 95.1 percent of patients, and 90.6 percent tolerated an unrestricted or soft diet. CONCLUSIONS To restore both midfacial form and function, the palatoalveolar defect and the status of the orbital floor and orbital contents must be addressed. Defects that involve the anterior maxilla should be addressed with osteocutaneous free flaps if possible, and posterior defects can often be reconstructed with soft-tissue free flaps. The orbital floor requires rigid reconstruction, with either bone grafts or alloplasts, unless the orbital contents have also been exenterated, in which case a soft-tissue free flap should be used to close the orbital cavity.
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Bidra AS, Jacob RF, Taylor TD. Classification of maxillectomy defects: a systematic review and criteria necessary for a universal description. J Prosthet Dent 2012; 107:261-70. [PMID: 22475469 DOI: 10.1016/s0022-3913(12)60071-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STATEMENT OF PROBLEM Maxillectomy defects are complex and involve a number of anatomic structures. Several maxillectomy defect classifications have been proposed with no universal acceptance among surgeons and prosthodontists. Established criteria for describing the maxillectomy defect are lacking. PURPOSE This systematic review aimed to evaluate classification systems in the available literature, to provide a critical appraisal, and to identify the criteria necessary for a universal description of maxillectomy and midfacial defects. MATERIAL AND METHODS An electronic search of the English language literature between the periods of 1974 and June 2011 was performed by using PubMed, Scopus, and Cochrane databases with predetermined inclusion criteria. Key terms included in the search were maxillectomy classification, maxillary resection classification, maxillary removal classification, maxillary reconstruction classification, midfacial defect classification, and midfacial reconstruction classification. This was supplemented by a manual search of selected journals. After application of predetermined exclusion criteria, the final list of articles was reviewed in-depth to provide a critical appraisal and identify criteria for a universal description of a maxillectomy defect. RESULTS The electronic database search yielded 261 titles. Systematic application of inclusion and exclusion criteria resulted in identification of 14 maxillectomy and midfacial defect classification systems. From these articles, 6 different criteria were identified as necessary for a universal description of a maxillectomy defect. Multiple deficiencies were noted in each classification system. Though most articles described the superior-inferior extent of the defect, only a small number of articles described the anterior-posterior and medial-lateral extent of the defect. Few articles listed dental status and soft palate involvement when describing maxillectomy defects. CONCLUSIONS No classification system has accurately described the maxillectomy defect, based on criteria that satisfy both surgical and prosthodontic needs. The 6 criteria identified in this systematic review for a universal description of a maxillectomy defect are: 1) dental status; 2) oroantral/nasal communication status; 3) soft palate and other contiguous structure involvement; 4) superior-inferior extent; 5) anterior-posterior extent; and 6) medial-lateral extent of the defect. A criteria-based description appears more objective and amenable for universal use than a classification-based description.
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Affiliation(s)
- Avinash S Bidra
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT, USA
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Bluebond-Langner R, Rodriguez ED. Application of skeletal buttress analogy in composite facial reconstruction. Craniomaxillofac Trauma Reconstr 2011; 2:19-25. [PMID: 22110793 DOI: 10.1055/s-0028-1098966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Reconstructive algorithms for composite craniofacial defects have focused on soft tissue flaps with or without bone grafts. However, volumetric loss over time limits long-term preservation of facial contour. Application of craniofacial skeletal buttress principles to high-energy trauma or oncologic defects with composite vascularized bone flaps restores the soft tissue as well as the buttresses and ultimately preserves facial contour. We conducted a retrospective review of 34 patients with craniofacial defects treated by a single surgeon with composite bone flaps at R Adams Cowley Shock Trauma Center and Johns Hopkins Hospital from 2001 to 2007. Data collected included age, sex, mechanism of injury, type of defect, type of reconstructive procedures, and outcome. Thirty-four patients with composite tissue loss, primarily males (n = 24) with an average age of 37.4 years, underwent reconstruction with vascularized bone flaps (28 fibula flaps and 6 iliac crest flaps). There were 4 cranial defects, 8 periorbital defects, 18 maxillary defects, and 4 maxillary and periorbital defects. Flap survival rate was 94.1% with an average follow-up time of 20.5 months. Restoration of facial height, width, and projection is achieved through replacement of skeletal buttresses and is essential for facial harmony. Since 2001, our unit has undergone a paradigm shift with regard to treatment of composite oncologic and traumatic defects, advocating vascularized bone flaps to achieve predictable long-term outcomes.
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Affiliation(s)
- Rachel Bluebond-Langner
- R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine and Johns Hopkins Medical Institutions, Baltimore, Maryland
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Brown JS. Reconstruction of the maxilla with loss of the orbital floor and orbital preservation: a case for the iliac crest with internal oblique. Semin Plast Surg 2011; 22:161-74. [PMID: 20567711 DOI: 10.1055/s-2008-1081400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although many techniques have been described to reconstruct the midface and the maxilla, there remains little agreement on the most effective methods when the orbit itself is preserved but there is loss of the maxilla, orbital floor, and often the medial wall. If the principle of replacing form and function is to be preserved, then a complex three-dimensional bony shape is required, which can support the orbital floor and provide a functioning dentition through an implant-retained prosthesis. At the same time, the oral fistula must be closed and a nasal lining provided. The iliac crest with internal oblique provides a bone structure that can be shaped for the defect and can easily articulate with the malar remnant, the nasal bones, and the upper alveolus. The internal oblique muscle effectively closes the oral fistula and lines the nasal cavity and becomes epithelialized resulting in a natural appearance. This article describes the principles of use of the iliac crest with internal oblique in the reconstruction of this defect and compares this technique with the many other methods reported in the literature. The article is mainly descriptive as there are few comparative studies comparing reconstructive techniques for a similar defect.
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Affiliation(s)
- James S Brown
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, United Kingdom
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Abstract
Reconstruction of a midfacial defect can represent a formidable challenge for the reconstructive surgeon. Attesting to both the variety and the complexity of midfacial defects, numerous different classification schemes have been proposed, and are reviewed in this article. The approach to reconstruction can be simplified, however, by classifying maxillectomy defects into four types. Understanding the complex three-dimensional anatomy of the maxilla and its relationship to contiguous structures is the first step in approaching reconstruction of the midface. Achieving basic functional and aesthetic goals of maxillary reconstruction can be achieved using free flap reconstruction with good reliability and predictability in the majority of patients. A specific approach to each defect type is outlined.
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Miyamoto S, Ujigawa K, Kizu Y, Tonogi M, Yamane GY. Biomechanical three-dimensional finite-element analysis of maxillary prostheses with implants. Design of number and position of implants for maxillary prostheses after hemimaxillectomy. Int J Oral Maxillofac Surg 2010; 39:1120-6. [DOI: 10.1016/j.ijom.2010.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 12/16/2009] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
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Michaelidis IGA, Hatzistefanou IM. Functional and aesthetic reconstruction of extensive oral ablative defects using temporalis muscle flap: a case report and a sort review. J Craniomaxillofac Surg 2010; 39:200-5. [PMID: 20488720 DOI: 10.1016/j.jcms.2010.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Temporalis muscle flap (TMF) provides a reliable solution in reconstruction of extensive intraoral ablative defects, providing a valuable alternative to more complex and extensive reconstructive procedures, combining excellent functional and aesthetic rehabilitation with minimal complications. In this article is described in detail the TMF surgical technique with attention to specific methods useful for preventing facial nerve injury and donor-site deformity. MATERIALS AND METHODS It is presented the case of a patient with malignant tumour in the region of the upper jaw, palate and inferior half of the nasal cavity, who underwent extensive surgical excision and the resultant defect was successfully reconstructed with TMF. RESULTS The reconstructive procedure resulted in excellent immediate and long-term functional (aspiration, feeding and speech) and aesthetic results. During the 5-year follow-up period no complications associated with the flap or the temporal implant, used for donor-site reconstruction were encountered and no local recurrence or tumour metastasis was observed. CONCLUSION The TMF is a reliable, technically easy and anatomically sound technique, which combines excellent aesthetic and functional results with minimal complications, if performed correctly.
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Caputo G, Fiorino F, Barbieri F, Barisoni D. Mid-face reconstruction with free rectus abdominis flap: report on a case of chronic cocaine abuse. J Plast Reconstr Aesthet Surg 2008; 61:1107-9. [PMID: 18555000 DOI: 10.1016/j.bjps.2007.12.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 12/20/2007] [Accepted: 12/21/2007] [Indexed: 10/22/2022]
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Preservation of Contour in Periorbital and Midfacial Craniofacial Microsurgery: Reconstruction of the Soft-Tissue Elements and Skeletal Buttresses. Plast Reconstr Surg 2008; 121:1738-1747. [DOI: 10.1097/prs.0b013e31816b13e1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suga H, Asato H, Okazaki M, Okochi M, Narushima M. Combination of Costal Cartilage Graft and Rib-Latissimus Dorsi Flap. J Craniofac Surg 2007; 18:639-42. [PMID: 17538331 DOI: 10.1097/scs.0b013e3180333f22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In secondary reconstruction of the maxilla, skeletal reconstruction as well as soft tissue augmentation is required to obtain a good contour. We present a new strategy for combining a costal cartilage graft with a rib-latissimus dorsi flap. We used this method to treat a 39-year-old man who had previously undergone total maxillectomy. First, a vascularized rib, elevated together with a latissimus dorsi flap, was fixed between the middle of the maxilla and the edge of the zygomatic arch. The small defects that could not be reconstructed with the rib only were reconstructed with a costal cartilage graft. The patient did not develop any postoperative infection or flap necrosis. Thirteen months after the secondary reconstruction, he presented with a good contour of the cheek. Our method was effective for the reconstruction of a complex skeletal defect of the maxilla.
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Affiliation(s)
- Hirotaka Suga
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Sarukawa S, Sakuraba M, Asano T, Yano T, Kimata Y, Hayashi R, Ebihara S. Immediate maxillary reconstruction after malignant tumor extirpation. Eur J Surg Oncol 2007; 33:518-23. [PMID: 17125962 DOI: 10.1016/j.ejso.2006.10.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 10/16/2006] [Indexed: 11/16/2022] Open
Abstract
AIMS Immediate maxillary reconstruction after malignant tumor extirpation differs from other types of maxillary reconstruction. Our reconstruction algorithm is described in this article. METHODS One hundred ninety-four patients who had undergone maxillectomy for malignant tumors were reviewed, and maxillectomy defects were classified with the method of Cordeiro and Santamaria. RESULTS Mean total blood loss was 848 ml, and 71 patients died within 2 years after surgery. For type IIIa defects of the orbital floor, titanium mesh or vascularized bone or cartilage was used for reconstruction, but the rate of postoperative complications did not differ between titanium and autografts. Therefore, to reconstruct orbital floor defects we have recently used only titanium mesh. For type I or II defects, we use autografts for only selected cases. CONCLUSIONS We strive to perform less-invasive reconstructive surgery after resection for maxillary malignancy.
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Affiliation(s)
- S Sarukawa
- Division of Plastic and Reconstructive Surgery and Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.
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Clark JR, Vesely M, Gilbert R. Scapular angle osteomyogenous flap in postmaxillectomy reconstruction: Defect, reconstruction, shoulder function, and harvest technique. Head Neck 2007; 30:10-20. [PMID: 17636540 DOI: 10.1002/hed.20649] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Maxillary reconstruction continues to challenge in terms of optimal aesthetic and functional outcomes. The aim of this study was to describe the utility of the scapular angle osteomyogenous flap in a series of maxillectomy patients and to examine the donor site morbidity. METHODS This is a retrospective series of 14 patients undergoing maxillectomy and either primary or secondary reconstruction. The scapular angle can be oriented vertically and horizontally. Aesthetic, functional, and operative morbidity is described. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to examine shoulder and upper limb morbidity. RESULTS Perioperative morbidity occurred in 4 patients. There were no free flap failures. Functional and aesthetic outcomes were acceptable with all patients having intelligible speech and none requiring nutritional supplementation. The DASH was completed by 12 of 14 patients. The mean and median DASH scores were 10.6 and 13, respectively. All patients gained full range of shoulder movement by 6 months after surgery. CONCLUSIONS The scapular angle flap is well suited for maxillary reconstruction and donor site morbidity is low.
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Affiliation(s)
- Jonathan R Clark
- Department of Otolaryngology, Head and Neck Surgery, Princess Margaret Hospital, Toronto, Canada
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Sekido M, Yamamoto Y, Makino S. Maxillary reconstruction using a free deep inferior epigastric perforator (DIEP) flap combined with vascularised costal cartilages. J Plast Reconstr Aesthet Surg 2006; 59:1350-4. [PMID: 17113517 DOI: 10.1016/j.bjps.2006.01.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Revised: 01/10/2006] [Accepted: 01/18/2006] [Indexed: 11/17/2022]
Abstract
In this article, we describe a case of maxillary carcinoma requiring reconstruction in which we used a free deep inferior epigastric perforator (DIEP) flap combined with vascularised costal cartilages. The DIEP flap was harvested with a rectus abdominis muscle in its cranial side. Eighth and ninth costal cartilages were harvested and connected with the muscle. The Zygomaticomaxillary buttress was reconstructed using vascularised costal cartilages. Nasal and oral lining were reconstructed with a DIEP flap. The viability of grafted bone was proved in bone scintigraphy and three-dimensional computed tomography after six months. Cosmetically the result was good. Compared with other methods, this flap can be thinned easily to match a defect and vascularised cartilages connected with rectus muscle can be nourished by the same vascular pedicle. This is a first report of perforator flap combined with vascularised cartilage. This flap has a possibility to be used for a lot of reconstruction that needs bone reconstruction with perforator flap.
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Affiliation(s)
- Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo 060-0012, Hokkaido, Japan.
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Germain MA, Hartl DM, Marandas P, Juliéron M, Demers G. Free flap reconstruction in the treatment of tumors involving the hard palate. Eur J Surg Oncol 2006; 32:335-9. [PMID: 16469475 DOI: 10.1016/j.ejso.2005.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Accepted: 12/12/2005] [Indexed: 11/19/2022] Open
Abstract
AIM To report our experience in free flap reconstruction of the hard palate after malignant tumor resection, in terms of reconstruction method, immediate post-operative course and subjective functional results. PATIENTS AND METHODS Files from 1988 to 1999 were reviewed for patients having undergone microvascular reconstruction of the hard palate. The immediate post-operative course (during the first month) was reviewed to determine the occurrence of complications. The surgeon's evaluation 1 year post-operatively was used to determine the intelligibility of speech, type of diet and the quality of nasal permeability. RESULTS Thirty eight patients (28 men and 10 women) with malignant tumors involving the hard palate had undergone surgical reconstruction using microvascular free flap techniques: free radial forearm flap (13 cases), scapular flap (24 cases) or fibular flap (five cases). Two different flaps were employed in two cases (scapula plus fibula). A second flap was used with success in two cases of failure of the first flap, for a total of 42 free flaps for 38 patients. Complications occurred in seven cases, with two cases of flap necrosis. At 1 year, 33 patients achieved a normal diet and 35 normal or easily intelligible speech. CONCLUSIONS Microsurgical reconstruction using free tissue transfer allows reconstruction of large defects of the hard palate, with low morbidity and an excellent functional outcome. We propose criteria for free flap reconstruction and choice of flap.
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Affiliation(s)
- M A Germain
- Department of Otolaryngology-Head and Neck Surgery, Institute Gustave Roussy, 39 Avenue Camille Desmoulins, 94805 Villejuif Cedex, France
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Rapidis AD, Day TA. The use of temporal polyethylene implant after temporalis myofascial flap transposition: clinical and radiographic results from its use in 21 patients. J Oral Maxillofac Surg 2006; 64:12-22. [PMID: 16360852 DOI: 10.1016/j.joms.2005.09.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE The use of temporalis myofascial flap (TMF) as a pedicled flap in craniofacial reconstructive surgery is well established. The transposition of temporalis muscle results in a large hollowing of the temporal fossa that leaves the patient with a cosmetic impairment. Reconstruction of this donor site deformity is desirable. One of the established reconstructive techniques is the use of a prefabricated porous high-density polyethylene (HDPE) temporal implant. In order to evaluate results from its use, we retrospectively reviewed a series of 21 consecutive patients. MATERIALS AND METHODS From October 1999 to October 2004, 21 patients (7 men and 14 women) aged 32 to 85 years (mean, 65) had their surgical defects reconstructed with the use of a TMF. The majority of patients (15 of 21) had squamous cell carcinoma of the maxilla or the maxillary sinus. In 17 patients, the reconstructive procedure was performed simultaneously with the oncological resection, whereas in 4, a secondary reconstruction was performed. In 1 patient, bilateral TMFs were used to cover a total maxillectomy defect. Standard surgical approach was used in all patients during TMF elevation. The temporal defect was reconstructed with the use of a prefabricated sterile HDPE implant (Medpor; Porex Surgical Inc, College Park, GA). Fixation of the implant to the recipient infratemporal fossa was performed with black silk sutures (in 2 patients) or titanium miniscrews (in 19 patients). The manufacturer's instructions for the placement of the implant were followed in all cases. One of the 21 operated patients preoperatively received radiotherapy (RT). Of the remaining 20 patients, 5 underwent postoperative RT. RESULTS Eighteen patients are alive and free from disease. One died during the perioperative period from myocardial infarction and 2 more from locoregional recurrence of their disease, 18 and 27 months postoperatively. In all 21 patients, the placement of the Medpor temporal implant was successful and no immediate or perioperative complications resulting from its use were encountered, giving an overall success implantation rate of 100%. Follow-up ranged from 9 to 70 months (mean, 39). The condition of the implant was evaluated with computed tomography in 18 of the 21 patients as part of the standard postoperative assessment. Radiographic results of the recipient site did not reveal any abnormalities. In 7 patients, the contour of the HDPE implant could be manually palpated, and in 3, it could be seen to protrude subcutaneously. Esthetic results were judged satisfactory from all patients. The hemicoronal skin flap healed uneventfully in all patients and did not cause a visible scar even to bald male patients. CONCLUSIONS The reconstruction of the temporal defect after TMF transposition with the use of a Medpor temporal implant is an easy and safe method. The implant does not seem to cause any tissue reaction, and long-term functional and esthetic results are excellent. When properly used and the relevant manufacturers' instructions are carefully followed, the success rate of the method is extremely high.
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Affiliation(s)
- Alexander D Rapidis
- Department of Maxillofacial Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece.
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Abstract
Reconstruction following extensive resection of the maxilla has been a challenging problem in the field of head and neck cancer surgery. At our institutes, maxillectomy defects have been restored based on the principles of repair involving the important concept of maxillary buttress reconstruction. Reconstruction of the zygomaticomaxillary buttress (ZMB), including the orbital floor, is essential for prevention of the malpositioning of the eyeglobe in preservation of the orbital contents. ZMB reconstruction is also important to provide a good contour of malar prominence. Pterygomaxillary buttress (PMB) reconstruction provides sufficient support for the fitting of a dental prosthesis. In patients with extensive resection of buccal soft tissue, a PMB and nasomaxillary buttress (NMB) should be reconstructed to prevent superior and posterior deviation of the alar base and oral commissure. We advocate that critical assessment of skeletal defects, as well as associated soft-tissue defects, following various types of maxillectomies is essential for a rational approach to achieve satisfactory clinical results.
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Affiliation(s)
- Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 14 Nishi 7, Sapporo 060-8638, Japan.
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Chang EL, Hatton MP, Bernardino CR, Rubin PAD. Simplified Repair of Zygomatic Fractures through a Transconjunctival Approach. Ophthalmology 2005; 112:1302-9. [PMID: 15921754 DOI: 10.1016/j.ophtha.2005.01.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Accepted: 01/23/2005] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe a simplified technique of zygomatic fracture repair. DESIGN Retrospective, noncomparative case series with description of a surgical technique. PARTICIPANTS Twenty consecutive patients with zygomatic fractures undergoing repair with the described technique. INTERVENTION Fracture repair was accomplished with a technique that used a T-bar screw for reduction through a transconjunctival approach. MAIN OUTCOME MEASURE Successful fracture reduction. RESULTS Twenty patients with zygomatic fractures underwent successful reduction with the simplified technique. No complications were observed. CONCLUSIONS The use of the T-bar through a transconjunctival approach is a simplified and effective technique for zygomatic fracture repair.
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Affiliation(s)
- Eli L Chang
- Ophthalmic Plastic, Orbital & Reconstructive Surgery, Doheny Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA
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