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Qi J, Li M, Wu X, Li X, Yuan Y, Guo K, Han S, Wu Y, Guo F. From zygomatic to zygomatic: Application of 5-segmented fibula flap in orbitomaxillary defects reconstruction. Curr Probl Surg 2024; 61:101472. [PMID: 38704175 DOI: 10.1016/j.cpsurg.2024.101472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Jiewen Qi
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Min Li
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Xiaoshan Wu
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Xuechun Li
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Yongxiang Yuan
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Kaizhao Guo
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Shengyang Han
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Yuhua Wu
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Feng Guo
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
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Desai DD, Alwani M, Sheen D, Narayanan A, Gordin E. The Use of Patient-Specific Orbital Reconstruction Implants During Maxillectomy Reconstruction. Facial Plast Surg Aesthet Med 2023; 25:403-408. [PMID: 36856488 DOI: 10.1089/fpsam.2022.0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Background: Reconstruction of the orbital floor after maxillectomy can result in significant functional and aesthetic morbidity. Study Objective: To measure eyelid position, self-reported visual outcomes, and complications in patients undergoing concurrent maxillectomy and reconstruction with a patient-specific orbital reconstruction implant (PSORI). Design Type: Case series. Materials and Methods: Case series including 12 patients who received PSORI for orbital floor reconstruction after tumor extirpation. Primary outcomes gathered were diplopia, ectropion, and wound healing complications. Results: The majority of patients were men (75%) and the mean age was 53.3 years. Ten patients underwent free flap reconstruction with the majority receiving fibula free flaps (n = 6). Median follow-up was 415.5 days. Three patients (25%) experienced long-term complications, including diplopia (n = 1) and hardware extrusion (n = 3). Each of these occurred in the context of total maxillectomy and radiation. This prompted subsequent use of a modified implant design for the final six patients and the preferential use of a midface-degloving approach. These interventions eliminated extrusions in subsequent patients. Conclusion: PSORIs can be used for orbital floor reconstruction following maxillectomy in combination with free tissue transfer. Implant design is critical to reduce complications. The use of a midface degloving approach and a modified low-profile design was associated with a low rate of complications.
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Affiliation(s)
- Dipan D Desai
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mohamedkazim Alwani
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Derek Sheen
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ajay Narayanan
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Eli Gordin
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
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Kang YF, Lv XM, Qiu SY, Ding MK, Xie S, Zhang L, Cai ZG, Shan XF. Virtual Surgical Planning of Deep Circumflex Iliac Artery Flap for Midface Reconstruction. Front Oncol 2021; 11:718146. [PMID: 34540688 PMCID: PMC8443798 DOI: 10.3389/fonc.2021.718146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Midface reconstruction is challenging for functional and esthetic reasons. The present study analyzed the effect of virtual surgical planning (VSP) of the deep circumflex iliac artery (DCIA) flap for midface reconstruction. Patients and Methods Thirty-four patients who underwent midface reconstruction with the DCIA flap were included in this retrospective study. Of the 34 patients, 16 underwent preoperative VSP, which used a three-dimensionally printed surgical guide, computer-assisted navigation system, and pre-bent titanium implants to transfer VSP into real-world surgery. The other 18 patients underwent traditional midface reconstruction. The following were compared between the two groups: bony contact rate in the buttress region (BCR), dental arch reconstruction rate (DAR), surgical approach, position of vascular anastomosis, and dental implantation rate. The independent-samples t-test and Fisher's exact test were used for analysis. P < 0.05 was considered statistically significant. Results In total, 12 males and 22 females were included in this study. All patients underwent midface reconstruction using the DCIA flap at the same institution. The median age of patients was 33 years (range: 16-68 years). The average BCR and DAR values in the VSP group were 59.4% ± 27.9% and 87.5% ± 18.9%, respectively, which were significantly higher compared with the non-VSP group (P = 0.049 and P = 0.004, respectively). The dental implantation rate in the VSP group (50.0%) was significantly higher compared with the non-VSP group (11.1%; P = 0.023). The intraoral approach for tumor ablation and vascular anastomosis was the most frequent choice in both groups. There was no significant difference between the two groups. All patients were satisfied with facial symmetry postoperatively. Conclusions VSP could effectively augment the effect of midface reconstruction with the DCIA flap. Stronger bone contact in the buttress region and higher DAR provide more opportunity for dental implantation, which might be the best solution to improve masticatory function in patients with midface defects.
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Affiliation(s)
- Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Xiao-Ming Lv
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Shi-Yu Qiu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Meng-Kun Ding
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Shang Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
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