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Chan TG, Nickel C, Solares C, Irizarry R, Pipkorn P, Baddour HM, Gross JH. Stacked fibula flap for unilateral total maxillectomy reconstruction with orbital preservation. Head Neck 2024; 46:218-227. [PMID: 37933883 DOI: 10.1002/hed.27567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
Unilateral total maxillectomy is indicated for locally advanced maxillary tumors that require complete removal of the midface bony structure and inferior orbital rim. Reconstruction of this defect is challenging due to aesthetic and functional concerns. A retrospective review of patients at two tertiary-care institutions undergoing unilateral total maxillectomy reconstruction with a stacked fibula flap from 2018 to 2022 was performed. Each patient's clinical course was reviewed, and attention was focused on the demonstration of surgical steps with photos. Twenty patients underwent stacked fibula flap reconstruction for unilateral total maxillectomy orbital preservation defects. Surgical extirpation was performed for malignancy (80%, 16/20) and for osteoradionecrosis or benign tumor in 20% (4/20). The complication rate was 30% (6/20). Most flaps survived (95%, 19/20). We present a modified, reproducible method of fibula flap reconstruction for unilateral total maxillectomy with orbital preservation that only requires two segments and maintains positive aesthetic and functional results.
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Affiliation(s)
- Tyler G Chan
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chris Nickel
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Clementino Solares
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Rachel Irizarry
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Siteman Cancer Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Harry Michael Baddour
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jennifer H Gross
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Moore EJ, Price DL, Van Abel KM, Janus JR, Moore ET, Martin E, Morris JM, Alexander AE. Association of Virtual Surgical Planning With External Incisions in Complex Maxillectomy Reconstruction. JAMA Otolaryngol Head Neck Surg 2021; 147:526-531. [PMID: 33792635 DOI: 10.1001/jamaoto.2021.0251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Maxillectomy can commonly be performed through a transoral approach, but maxillectomy defect reconstruction can be difficult to precisely design, contour, and inset through this approach. Objective To evaluate whether the use of virtual surgical planning (VSP) and 3-dimensional (3-D) modeling is associated with a decrease in the requirement of lateral rhinotomy (LR) for patients undergoing total and partial maxillectomy reconstruction. Design, Setting, and Participants This retrospective cohort study was conducted among patients undergoing subtotal or total maxillectomy with microvascular free flap reconstruction with or without VSP and 3-D modeling at a single tertiary care academic medical center between January 1, 2008, and October 3, 2019. Interventions Maxillectomy and free flap reconstruction with or without VSP. Main Outcomes and Measures Necessity of LR or other external incision for contouring, placement, and fixation of reconstruction as well as surgical complications. Results Fifteen patients (12 men [80%]; mean age, 64 years) underwent maxillectomy with free flap reconstruction without VSP. Eight patients (53%) in this group underwent total maxillectomy, and 4 patients in this group (27%) underwent partial maxillectomy. Twenty-three patients (18 men [78%]; mean age, 58 years) underwent maxillectomy with free flap reconstruction and VSP and 3-D modeling. Twelve of these patients (52%) underwent total maxillectomy, and 11 (48%) underwent partial maxillectomy. Lateral rhinotomy was necessary for 1 patient (4%) in the VSP group vs 12 patients (80%; 95% CI, 54%-98%) in the pre-VSP group. There were no LR complications in the VSP group vs 6 in the pre-VSP group. Among both groups, 14 patients underwent fibula free flap, 22 patients underwent subscapular system free flap, and 2 patients underwent cutaneous or osteocutaneous radial forearm free flap. There were no flap failures in the LR group and 1 flap failure in the group without LR. Conclusions and Relevance This cohort study suggests that the use of VSP and 3-D modeling for maxillectomy reconstruction is associated the a decrease in the need for external incisions without compromising reconstructive flap utility.
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Affiliation(s)
- Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffery R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ethan T Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Eli Martin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Amy E Alexander
- Department of Anatomic Modeling, Mayo Clinic, Rochester, Minnesota
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Hammer D, Vincent AG, Williams F, Ducic Y. Considerations in Free Flap Reconstruction of the Midface. Facial Plast Surg 2021; 37:759-770. [PMID: 33588473 DOI: 10.1055/s-0041-1722981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Midface reconstruction has been a consistent challenge for reconstructive surgeons even with the significant advances in technology and technique achieved over the recent years. A meticulous preoperative assessment of the patient is required to properly assess the defect or anticipated defect, determine proper reconstructive surgical plan, and discuss expected functional and aesthetic outcomes with the patient. For years we have employed local flaps, regional flaps, obturators, alloplastic implants, free flaps, or a combination of the previously mentioned techniques to address complex midface reconstruction. Free flap reconstruction in the midface requires special considerations for the pedicle, flap selection, and flap design to ensure an optimal outcome. The introduction of virtual surgical planning for reconstruction has enhanced patient outcomes to include advances in immediate dental rehabilitation at the time of free flap surgery. Postoperative considerations including quality of life, functional and aesthetic outcomes, and management of complications will also be discussed.
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Affiliation(s)
- Daniel Hammer
- Oral Oncology and Maxillofacial Reconstructive Microsurgery, Department of Oral and Maxillofacial Surgery, Naval Medical Center, San Diego, California
| | - Aurora G Vincent
- Facial Plastic and Reconstructive Surgery, Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Fayette Williams
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Zhang WB, Soh HY, Yu Y, Guo CB, Yu GY, Peng X. Improved procedure for Brown's Class III maxillary reconstruction with composite deep circumflex iliac artery flap using computer-assisted technique. Comput Assist Surg (Abingdon) 2021; 26:9-14. [PMID: 33503386 DOI: 10.1080/24699322.2021.1876168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Reconstruction of Brown's Class III maxillary defect can be challenging due to the complex geometry of maxilla. We aimed to introduce an improved method for maxillary reconstruction with a composite deep circumflex iliac artery (DCIA) flap aided by virtual surgical planning and intraoperative navigation. A 27-year-old woman diagnosed with left maxillary fibromyxoma was admitted to our institution in December 2018. Pre-operative facial and iliac computed tomography data were obtained for virtual surgical planning. Personalized cutting template, tooth-supported surgical guide, and rapid prototype model with reconstructed orbital floor were printed for pre-operative preparation. Surgery was completely guided by the intraoperative navigation system. The root mean square estimate of the reconstructed area was 3.68 mm. The average errors measured on the lateral and medial DCIA segments were 0.61 and 0.85 mm, respectively. Application of virtual surgical planning and intraoperative navigation could potentially enhance the reconstruction outcomes.
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Affiliation(s)
- Wen-Bo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hui Yuh Soh
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,Department of Oral and Maxillofacial Surgery, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Yao Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chuan-Bin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Shokri T, Wang W, Vincent A, Cohn JE, Kadakia S, Ducic Y. Osteoradionecrosis of the Maxilla: Conservative Management and Reconstructive Considerations. Semin Plast Surg 2020; 34:106-113. [PMID: 32390778 PMCID: PMC7202910 DOI: 10.1055/s-0040-1709144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The implementation of radiotherapy in the multimodal treatment of advanced head and neck cancer has greatly improved survival rates. In some patients, however, this benefit comes at the potential expense of the tissue surrounding the primary site of malignancy. Osteoradionecrosis (ORN) of the facial bones, in particular the maxilla, is a debilitating complication of radiation therapy. Exposure to ionizing radiation results in devitalization of underlying bone with necrosis of adjacent soft tissue. Controversy surrounding appropriate early intervention in ORN persists and no consensus for clinical treatment has been established. In the present article, we review the pathophysiology of maxillary ORN and discuss the role of both conservative medical therapy and reconstruction.
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Affiliation(s)
- Tom Shokri
- Department of Otolaryngology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aurora Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jason E. Cohn
- Department of Otolaryngology–Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Rehabilitation after maxillectomy in patients with implant-retained obturator: A preliminary report. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:8-13. [PMID: 31562033 DOI: 10.1016/j.oooo.2019.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/19/2019] [Accepted: 08/26/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical outcomes of implant-retained obturator rehabilitation after maxillectomy, based on quality of life (QOL) and masticatory function. STUDY DESIGN The present study included 12 patients who underwent dental implant surgery after maxillectomy. Oral health-related QOL and masticatory function before and after completion of implant-retained obturator rehabilitation were evaluated. RESULTS Oral Health Impact Profile-Short Form (OHIP-14) scores showed significant differences in the domain for functional limitation (before, 4.08 ± 2.47; after, 1.33 ± 0.98; P < .01); physical pain (before, 2.75 ± 2.05; after, 0.42 ± 0.51; P < .01); physical disability (before, 3.24 ± 2.11; after, 1.33 ± 1.30; P < .01), psychological disability (before, 3.83 ± 2.48; after, 1.67 ± 2.50; P < .01); social disability (before, 2.17 ± 1.75; after, 1.08 ± 1.38; P < .05); handicap (before, 3.17 ± 1.90; after, 1.08 ± 1.00; P < .01); and total score (before, 22.41 ± 10.17; after, 8.83 ± 6.82; P < .01) Furthermore, masticatory function score was significantly higher after completing implant-retained obturator rehabilitation (before, 38.75 ± 22.97; after, 69.17 ± 21.41; P < .01). CONCLUSIONS Implant-retained obturator rehabilitation contributed to improved masticatory function and oral health-related QOL after maxillectomy.
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Abstract
Tumors of the maxilla and midface are some of the most difficult to manage, not only in terms of treatment but also in terms of achieving acceptable orofacial reconstruction. Today, free flaps dominate the reconstructive field. Many patients can achieve successful reconstruction after free flap transfer with a return of intelligible speech, a regular diet, and acceptable cosmesis. Herein, the authors review free flap reconstruction of the maxilla, with a focus on the classifications of defects, when obturators are appropriate, types and sources of free flaps, and complications for which to beware.
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Affiliation(s)
- Aurora Vincent
- Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Jason Burkes
- Maxillofacial Oncology and Microvascular Reconstructive Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Fayette Williams
- Maxillofacial Oncology and Microvascular Reconstructive Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Khatib B, Patel A, Dierks EJ, Bell RB, Cheng A. The Biaxial Double-Barrel Fibula Flap-A Simplified Technique for Fibula Maxillary Reconstruction. J Oral Maxillofac Surg 2018; 77:412-425. [PMID: 30347200 DOI: 10.1016/j.joms.2018.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Previously described techniques for microvascular fibula reconstruction of Brown Class II to IV maxillectomy defects are complex, require multiple osteotomies, result in a short pedicle, and inadequately reconstruct the dental alveolus in preparation for endosseous implants. This report describes a simplified technique for Brown Class II to IV defects that re-creates facial support, allows for dental reconstruction with appropriately positioned implants, and maintains adequate pedicle length. MATERIALS AND METHODS A retrospective chart review was performed of all patients with Brown Class II to IV maxillectomy defects immediately reconstructed with a biaxial double-barrel fibula flap technique. The reconstructive surgeon evaluated each patient at least 1 month after reconstruction for enophthalmos, facial symmetry, nasal patency, satisfactory jaw position, deglutition, intelligible speech, and intraoperative need for vein grafting. RESULTS The sample was composed of 6 patients (mean age, 54 yr; range, 33 to 78 yr; 67% women) who underwent reconstruction with the biaxial double-barrel fibula flap technique for Brown Class II to IV defects. None of these patients required vein grafting. None of these patients had flap failure. Diagnoses for these patients were a hybrid odontogenic tumor (n = 1), squamous cell carcinoma (n = 3), adenoid cystic carcinoma (n = 1), and sinonasal melanoma (n = 1). All 6 patients had excellent facial contour and malar projection, regular oral intake, 100% intelligible speech, and a new maxillary skeletal Class I relation without need for intraoperative vein grafting. One patient developed enophthalmos related to inferior rectus sacrifice and removal of orbital fat. Complications included development of nasal synechia and occlusion of the maxillary sinus ostium (n = 1). CONCLUSIONS The biaxial double-barrel fibula flap technique achieves the goals of providing adequate facial support and an alveolar segment amenable to implant dentistry. It allows for intelligible speech, deglutition, orbital support, and separation of the oronasal, orbital, and sinus cavities. In addition, it minimizes the need for vein grafting.
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Affiliation(s)
- Baber Khatib
- Assistant Clinical Professor, Maxillofacial Microvascular Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, SC; Previously, Fellow, Head and Neck Oncologic and Microvascular Reconstructive Surgery, Providence Cancer Center Head and Neck Institute, Portland, OR.
| | - Ashish Patel
- Attending Head and Neck/Microvascular Surgeon, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland; Consultant, Head and Neck Institute, Portland, OR
| | - Eric J Dierks
- Director of Maxillofacial Trauma, Trauma Service, Legacy Emanuel Medical Center, Portland; Consultant, Head and Neck Institute, Portland, OR
| | - R Bryan Bell
- Medical Director, Providence Oral, Head and Neck Cancer Program and Clinic, Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland; Director, Fellowship in Head and Neck Oncologic and Microvascular Reconstructive Surgery, Head and Neck Institute, Portland, OR
| | - Allen Cheng
- Director, Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, Portland; Consultant, Head and Neck Institute, Portland, OR
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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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Connolly TM, Sweeny L, Greene B, Morlandt A, Carroll WR, Rosenthal EL. Reconstruction of midface defects with the osteocutaneous radial forearm flap: Evaluation of long term outcomes including patient reported quality of life. Microsurgery 2017; 37:752-762. [PMID: 28843005 DOI: 10.1002/micr.30201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 05/23/2017] [Accepted: 06/23/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maxillectomy defects significantly impair quality of life. Prosthetics can overcome some of these issues, but has limitations. The role of the osteocutaneous radial forearm free flap (OC-RFFF) has been established for reconstruction of smaller maxillectomy defects, but its role in larger defects is not well defined. We aim to evaluate outcomes after midface reconstruction utilizing the OC-RFFF. METHODS Retrospective review of prospective database collected between 2005 and 2014 of midface reconstruction using OC-RFFF in a tertiary care centre. Donor site complications and acute and long-term recipient site complications were measured. Health related quality of life was assessed using the University of Washington Quality of Life (UW-QOL) Questionnaire. RESULTS A total of 68 midface defects were reconstructed using the OC-RFFF. Acute recipient site complications included three flap failures (4%), and two additional microvascular revision cases for vascular compromise. Late recipient complications included fistula (n = 10, 14%), ectropion (n = 7, 10%), diplopia (n = 6, 9%) and exposed hardware (n = 5, 7%). Resection of cheek skin or orbital rim correlated with orbital complications. The incidence of fistula was not affected by defect size or prior radiation. There were two donor site infections and no instances of forearm fracture. Patients undergoing OC-RFFF repair had mean scores for UW-QOL outcomes higher than published rates of obturator quality of life. CONCLUSION The OC-RFFF is suited to a variety of midface defects and can be combined with hardware to reconstruct the orbital floor. Recipient site complications are common, but donor site morbidity is low and outcomes, including HR-QOL, are acceptable.
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Affiliation(s)
- Timothy M Connolly
- Department of Otolaryngology-Head & Neck Surgery, University Hospital Geelong, Geelong, Victoria, Australia
| | - Larissa Sweeny
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Benjamin Greene
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anthony Morlandt
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - William R Carroll
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eben L Rosenthal
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California
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Kamochi H, Sarukawa S, Uda H, Nishino H, Yoshimura K. Orbitomaxillary Reconstruction Using a Combined Latissimus Dorsi Musculocutaneous and Scapular Angle Osseous Flap. J Oral Maxillofac Surg 2017; 75:439.e1-439.e6. [DOI: 10.1016/j.joms.2016.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
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12
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Reconstruction of the Maxillectomy Defect. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Combined use of an anterolateral thigh flap and rapid prototype modeling to reconstruct maxillary oncologic resections and midface defects. J Craniofac Surg 2015; 25:1147-9. [PMID: 25006885 DOI: 10.1097/scs.0000000000000602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The most complex area for reconstruction of the head and the neck is the maxilla and the midface because of the difficult anatomy of this region. This article aimed to describe our design for the reconstruction of the zygomaticomaxillary complex using an anterolateral thigh (ALT) flap combined with a rapid prototyping technology. Seven patients were involved in this study. All free ALT flaps survived, and the patients were satisfied with the results both esthetically and functionally 8 months after surgery. The free ALT flap with a titanium mesh made by rapid prototyping technology is a reliable option for the treatment of oncologic resections of the maxilla and other midface defects. This technique has a significantly shorter surgical time than conventional procedures, with good and predictable postoperative outcomes.
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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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Mueller S, Hohlweg-Majert B, Buergers R, Steiner T, Reichert TE, Wolff KD, Gosau M. The functional and aesthetic reconstruction of midfacial and orbital defects by combining free flap transfer and craniofacial prosthesis. Clin Oral Investig 2014; 19:413-9. [DOI: 10.1007/s00784-014-1243-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/03/2014] [Indexed: 12/15/2022]
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Chigurupati R, Aloor N, Salas R, Schmidt BL. Quality of Life After Maxillectomy and Prosthetic Obturator Rehabilitation. J Oral Maxillofac Surg 2013; 71:1471-8. [DOI: 10.1016/j.joms.2013.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Bianchi B, Ferri A, Ferrari S, Copelli C, Ferri T, Sesenna E. Iliac crest free flap and submental island flap for maxillary reconstruction. J Plast Surg Hand Surg 2013; 47:538-42. [PMID: 23402599 DOI: 10.3109/2000656x.2012.748299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The iliac crest free flap is one of the most reliable flaps for maxillary reconstruction because of the large amount of bone provided and the chance to harvest both muscle and skin. However, reconstruction of maxillary through-and-through defects requires special skills to be managed. Simultaneous replacement of oral lining and external tissue with the same features as the resected skin is difficult to achieve with conventional techniques and the use of flaps association is often necessary to ensure acceptable cosmetic and functional results. In the case presented the submental island flap was a good choice to overcome these difficulties.
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Yetzer J, Fernandes R. Reconstruction of orbitomaxillary defects. J Oral Maxillofac Surg 2012; 71:398-409. [PMID: 22766382 DOI: 10.1016/j.joms.2012.04.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 04/03/2012] [Accepted: 04/25/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Defects of the orbitomaxillary complex are problematic, not only for the patient, who deals with physical and psychological sequelae of his or her condition, but also for the surgeon, who must select from numerous treatment options to achieve the best possible outcome. As is often the case in surgically managed disease states, there is minimal high-level evidence to direct decision making in this area of medicine. We aim with this case series to at least provide our perspective on orbitomaxillary reconstruction based on a single-surgeon's 6-year experience at the University of Florida in Jacksonville. MATERIALS AND METHODS A chart review was performed for patients treated by the maxillofacial surgery division from August 2006 through August 2011, who underwent reconstruction of orbitomaxillary defects (Classes III to VI) resulting from ablative surgery. Data collected included patient demographics, surgery performed, reconstructive methods, pathology, and adjuvant radiotherapy. Inclusion criteria consisted of an initial surgery involving maxillectomy with orbital involvement performed at our institution, adequate follow-up, and complete medical records. Patients treated elsewhere or with inadequate records were excluded from the study. RESULTS We identified 21 patients who met the criteria for this study. Their ages ranged from 44 to 79 years, with 8 men and 13 women. Histologic evaluation showed squamous cell carcinoma in the majority of cases (14 patients). All defects were either Brown Class III, IV, V, or VI with the distribution as follows: 7 Class IIIs, 5 Class IVs, 7 Class Vs, and 2 Class VIs. The reconstructions included 8 radial forearm flaps, 4 anterolateral thigh flaps, 2 thoracodorsal artery perforator fasciocutaneous flaps, 1 thoracodorsal angular artery composite flap, 2 latissimus dorsi myofasciocutaneous flaps, and 1 composite fibula flap. Three patients had only an obturator with local flaps or skin grafting. Of the 21 patients, 18 had postoperative radiation. Follow-up ranged from 2 to 60 months. Three patients died of their disease, 14 were alive without disease, and 4 were lost to follow-up. Mean follow-up was 24.5 months. CONCLUSIONS On the basis of our patient experience, we believe that we can offer the following perspective: patients reconstructed for these larger defects, Classes III to VI, were less likely to be discontented with their reconstruction as compared with those who underwent obturation. The choice of bone versus soft tissue-only reconstruction was not a significant issue for our patient population because the vast majority of patients were not interested in dental implants because of out-of-pocket costs. In the era of perforator flaps, we believe that the use of these flaps provides a more predictive outcome compared with musculocutaneous flaps, which will atrophy over time and lead to a change in facial contour.
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Affiliation(s)
- Jacob Yetzer
- Division of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL 32209, USA
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Decesare GE, Deleyiannis FWB, Losee JE. Reconstruction of osteomyelitis defects of the craniofacial skeleton. Semin Plast Surg 2011; 23:119-31. [PMID: 20567734 DOI: 10.1055/s-0029-1214164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteomyelitis of the craniofacial skeleton closely resembles osteomyelitis elsewhere in the body in its pathophysiology and medical management; subsequent reconstruction after debridement remains distinctly challenging. The goals of reconstruction must include the restoration of the complex and readily visible morphology of the cranium and face, as well as the adequate return of vital sensory, expressive, and digestive functions. In this article, the various reconstructive modalities will be discussed including pedicled and nonpedicled flaps with or without an osseous component, nonvascularized bone grafts, alloplastic implants, and bone regeneration using protein therapy. Although reconstruction of craniofacial defects after osteomyelitis commonly proves formidable, the satisfactory return of form and function remains a plausible reconstructive goal.
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Affiliation(s)
- Gary E Decesare
- Division of Pediatric Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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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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Bell RB, Weimer KA, Dierks EJ, Buehler M, Lubek JE. Computer Planning and Intraoperative Navigation for Palatomaxillary and Mandibular Reconstruction With Fibular Free Flaps. J Oral Maxillofac Surg 2011; 69:724-32. [DOI: 10.1016/j.joms.2009.12.040] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 11/24/2009] [Accepted: 12/29/2009] [Indexed: 10/19/2022]
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Alveolar crest regeneration using curvilinear dentoalveolar distraction osteogenesis: a preliminary study. ACTA ACUST UNITED AC 2011; 112:430-8. [PMID: 21310630 DOI: 10.1016/j.tripleo.2010.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/01/2010] [Accepted: 11/02/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to reconstruct alveolar crest at home position using distraction osteogenesis (DO) with a personalized curvilinear distractor designed through computer-aided technology. STUDY DESIGN Five adult dogs were recruited and the maxillary alveolar bone from the first incisor to the first premolar was excised. The dentoalveolar segment adjacent to the defect was osteotomized as a bone transport disk. After 8 weeks of consolidation, the dogs were humanely killed, and the regenerated bone was analyzed. RESULTS The DO was successful in the experimental group. The radiographs and histology both verified new bone bridging distraction gap. However, the newly formed bone was located more internally and was not in original position. CONCLUSIONS The proposed method to reconstruct alveolar crest at home position is improper. The key point was how to maintain the distraction space and hold it at the home position. The barrier membrane technique may be used together with DO to resolve the problem.
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Bianchi B, Ferri A, Ferrari S, Copelli C, Boni P, Sesenna E. Iliac Crest Free Flap for Maxillary Reconstruction. J Oral Maxillofac Surg 2010; 68:2706-13. [DOI: 10.1016/j.joms.2010.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 01/03/2010] [Accepted: 01/12/2010] [Indexed: 11/30/2022]
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The Temporoparietal Fascial Flap Is an Alternative to Free Flaps for Orbitomaxillary Reconstruction. Plast Reconstr Surg 2010; 126:880-888. [DOI: 10.1097/prs.0b013e3181e3b6f0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baliarsing AS, Kumar VV, Malik NA, B. DK. Reconstruction of maxillectomy defects using deep circumflex iliac artery–based composite free flap. ACTA ACUST UNITED AC 2010; 109:e8-13. [DOI: 10.1016/j.tripleo.2009.10.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Revised: 09/24/2009] [Accepted: 10/21/2009] [Indexed: 10/19/2022]
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Lethaus B, Lie N, de Beer F, Kessler P, de Baat C, Verdonck HW. Surgical and prosthetic reconsiderations in patients with maxillectomy. J Oral Rehabil 2009; 37:138-42. [PMID: 20002530 DOI: 10.1111/j.1365-2842.2009.02031.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to establish and evaluate new possibilities for rehabilitation of patients with obturator prosthesis who had undergone partial or total maxillectomy because of tumour ablation surgery. Eleven patients with maxillary defects were reconstructed with a computer-aided design/computer-aided manufacturing designed prosthesis. Missing retention was gained by inserting implants in the remaining bone, so that an expansion of the surgical defect to gain further retention could be avoided. All patients were treated successfully according to the previously described treatment plan. The Obturator Functioning Scale (OFS) of the Memorial Sloan-Kettering Cancer Centre was applied to evaluate the functional quality of the obturator prosthesis and patient's satisfaction. It showed good results in all fields of functional outcome and social acceptance.
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Affiliation(s)
- B Lethaus
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Bianchi B, Ferri A, Ferrari S, Copelli C, Sesenna E. Maxillary reconstruction using anterolateral thigh flap and bone grafts. Microsurgery 2009; 29:430-6. [DOI: 10.1002/micr.20619] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Kevin Arce
- Department of Oral and Maxillofacial Surgery, John Peter Smith Hospital, 1500 S. Main Street, Fort Worth, TX 76104, USA.
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