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Lee KC, Neal TW, Tung R, Coelho PG, Markiewicz MR, Melville JC. History of Maxillary Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:65-71. [PMID: 39059875 DOI: 10.1016/j.cxom.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Kevin C Lee
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA; Department of Oral and Maxillofacial Surgery, University at Buffalo, Buffalo, NY, USA
| | - Timothy W Neal
- Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Robert Tung
- Department of General Surgery, Division of Plastic and Reconstructive Surgery, University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 1400, Houston, TX 77030, USA
| | - Paulo G Coelho
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL, USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, 3435 Main Street, 112 Squire Hall, Buffalo, NY 14214, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, Craniofacial Center of Western New York, John Oishei Children's Hospital; Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Craniofacial Center of Western New York, John Oishei Children's Hospital; Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - James C Melville
- Department of Oral & Maxillofacial Surgery, University of Texas Health Science Center at Houston, 7500 Cambridge Street Suite 6510, Houston, TX 77054, USA.
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2
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Zaid W, Amin D, Carlson ER. Obturating the Maxillary Defect: Surgical and Prosthetic Considerations. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:81-90. [PMID: 39059877 DOI: 10.1016/j.cxom.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Waleed Zaid
- Department of Oral and Maxillofacial Surgery, Louisiana State University, School of Dentistry, 7777 Hennessy Boulevard / Suite 306 Medical Plaza 1, Baton Rouge, LA 70808, USA
| | - Dina Amin
- Department of Oral and Maxillofacial Surgery, University of Rochester Schools of Medicine and Dentistry, 601 Elmwood Avenue, Suite 4.0241A, Rochester, NY 14642, USA
| | - Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, 1930 Alcoa Highway, Suite 335, Knoxville, TN 37920, USA.
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3
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Callahan N, Pu JJ, Richard Su YX, Zbarsky SJD, Weyh A, Viet CT. Benefits and Controversies of Midface and Maxillary Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:109-116. [PMID: 39059870 DOI: 10.1016/j.cxom.2023.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Nicholas Callahan
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, 801 South Paulina Street, Chicago, IL 60612, USA.
| | - Jane Jingya Pu
- Division of Oral and Maxillofacial Surgery, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
| | - Yu-Xiong Richard Su
- Division of Oral and Maxillofacial Surgery, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
| | - Steven J D Zbarsky
- Department of Oral & Maxillofacial Surgery, Loma Linda University, 11092 Anderson Street 3304, Loma Linda, CA 92350, USA
| | - Ashleigh Weyh
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, 801 South Paulina Street, Chicago, IL 60612, USA
| | - Chi T Viet
- Oral Maxillofacial Surgery, Loma Linda University, 11092 Anderson Street 3304, Loma Linda, CA 92350, USA
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Gigliotti J, Makhoul NM, El-Hakim M. Classification of the Midface Defect: A Defect-Oriented Approach to Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:73-80. [PMID: 39059876 DOI: 10.1016/j.cxom.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Jordan Gigliotti
- Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Nicholas M Makhoul
- Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Michel El-Hakim
- Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
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5
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Caldwell A, Cheng A, Patel A, Khatib B. Fibula Reconstruction of the Maxilla and Midface. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:117-123. [PMID: 39059871 DOI: 10.1016/j.cxom.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Alita Caldwell
- Oral & Maxillofacial Surgery, Detroit Medical Center, 4201 St. Antoine Boulevard, Suite 2F UHC, Detroit, MI 48201, USA
| | - Allen Cheng
- Head and Neck Surgical Associates, 1849 Northwest Kearney Street, Suite 300, Portland, OR 97209, USA; Legacy Good Samaritan Cancer Center and Legacy Emanuel Medical Center, Portland, OR, USA; Providence Cancer Center, Portland, OR, USA.
| | - Ashish Patel
- Head and Neck Surgical Associates, 1849 Northwest Kearney Street, Suite 300, Portland, OR 97209, USA; Legacy Good Samaritan Cancer Center and Legacy Emanuel Medical Center, Portland, OR, USA; Providence Cancer Center, Portland, OR, USA
| | - Baber Khatib
- Head and Neck Surgical Associates, 1849 Northwest Kearney Street, Suite 300, Portland, OR 97209, USA; Legacy Good Samaritan Cancer Center and Legacy Emanuel Medical Center, Portland, OR, USA; Providence Cancer Center, Portland, OR, USA
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6
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Betz S, Kim RY, Jelmini J, Williams FC, Hammer DA. Is Maxillary Jaw in a Day Feasible? Atlas Oral Maxillofac Surg Clin North Am 2024; 32:141-149. [PMID: 39059874 DOI: 10.1016/j.cxom.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Sasha Betz
- Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | - Roderick Y Kim
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Hospital, 1625 Saint Louis Avenue, Fort Worth, TX 76104, USA
| | - Jonathan Jelmini
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Hospital, 1625 Saint Louis Avenue, Fort Worth, TX 76104, USA
| | - Fayette C Williams
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Hospital, 1625 Saint Louis Avenue, Fort Worth, TX 76104, USA
| | - Daniel A Hammer
- Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
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7
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Naik K, Francois K, Tursun R, Kaleem A, Marwan H. Soft Tissue Reconstruction of the Maxilla. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:97-108. [PMID: 39059879 DOI: 10.1016/j.cxom.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Keyur Naik
- Department of Head and Neck and Microvascular Surgery, High Desert Oral and Facial Surgery, 240 Desert Pass Street, Apartment 1006, El Paso, TX 79912, USA
| | - Kevin Francois
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Ramzey Tursun
- Department of Oral and Maxillofacial Surgery, Oral, Head and Neck Oncologic and Microvascular Reconstructive Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Arshad Kaleem
- Head and Neck Oncologic and Microvascular Reconstructive Surgery Fellowship, High Desert Oral and Facial Surgery, El Paso, TX, USA; University of Texas Health Sciences Center, San Antonio, TX, USA; Texas Tech University Health Sciences Center, 7352 Cimarron Gap Drive, El Paso, TX 79911, USA
| | - Hisham Marwan
- Department of Oral and Maxillofacial Surgery, Oral, Head and Neck Oncologic and Microvascular Reconstructive Surgery, University of Texas, Medical Branch, 301 University Boulevard, John Sealy Annex,6.106, Glaveston, TX, 77555, USA.
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Nedrud S, Bunnell AM, Fernandes R. Deep Circumflex Iliac Artery Free Flap Reconstruction for the Midface and Maxilla. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:125-133. [PMID: 39059872 DOI: 10.1016/j.cxom.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Stacey Nedrud
- Oral and Maxillofacial Surgery, Private Practice, Jacksonville, FL, USA.
| | - Anthony M Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Rui Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
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Kumari A, Singh V, Haq A, Sharma S, Bhalara N. Role of three-dimensional printing and laser scanning in aesthetic restoration of Parry Romberg's disease using de-epithelialized anterolateral thigh flap: a case report. J Surg Case Rep 2024; 2024:rjae469. [PMID: 39155925 PMCID: PMC11329301 DOI: 10.1093/jscr/rjae469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/20/2024] [Indexed: 08/20/2024] Open
Abstract
Parry Romberg syndrome also known as progressive hemifacial atrophy is an uncommon degenerative condition, characterized by unilateral, slow, and progressive atrophy of face. Patient presents with loss of facial symmetry and neurological manifestations. After the degenerative process settles, reconstructive surgeries are performed to address facial asymmetry. For accurate assessment of volume deficit, laser scanning and three- dimensional printing can be used which offers the advantage of precise surgical planning and good aesthetic outcome. We present a case of soft tissue reconstruction in Parry Romberg syndrome with anterolateral thigh flap with use of three- dimensional laser scanning.
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Affiliation(s)
- Anupama Kumari
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences Phulwarisharif, Patna 801507, India
| | - Veena Singh
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences Phulwarisharif, Patna 801507, India
| | - Ansarul Haq
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences Phulwarisharif, Patna 801507, India
| | - Sarsij Sharma
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences Phulwarisharif, Patna 801507, India
| | - Niraj Bhalara
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences Phulwarisharif, Patna 801507, India
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Mousa MA, Husein A, El-Anwar MI, Yusoff N, Abdullah JY. Evaluation of the biomechanics of Aramany class I obturators of different designs using numerical and experimental methods. Part I: Retention and associated stress. J Prosthet Dent 2024:S0022-3913(24)00469-4. [PMID: 39048390 DOI: 10.1016/j.prosdent.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
STATEMENT OF PROBLEM Studies on the biomechanics of obturators in the currently used designs of Aramany class I defect are lacking. Also, modifications of the designs presently used in unilateral palatal defects are needed to produce a prosthesis with more retention and less stress on the abutments. PURPOSE The purpose of part I of this study was to differentiate among Aramany class I obturators of 4 designs regarding retention and associated stress using numerical and experimental methods. MATERIAL AND METHODS Four finite element models and 36 different base obturators were fabricated and divided into 9 acrylic resin bases retained with Adams clasps and 9 linear, 9 tripodal, and 9 fully tripodal design obturators from casts obtained from a scanned skull. After modification, the prostheses were fabricated on the casts obtained from a 3-dimensionally printed cast. The retention was evaluated, and the data were collected and analyzed using a statistical software program (α=.05). The displacement and associated stress in the assorted casts were compared by using 5-N displacing force at 3 points using finite element analysis. The quantitative assessment was made by measuring the displacement and von Mises stress distribution on the prostheses and their supporting structures. The qualitative analysis was done by using a visual color mapping to depict stress location and intensity. RESULTS No significant differences were found between fully tripodal (4.478 ±2.303 MPa) and tripodal obturators (4.478 ±2.286 MPa; P=.153), although fully tripodal showed more resistance to anterior displacement (4.522 ±0.979 and 3.553 ±1.58 MPa for fully tripodal and tripodal designs, respectively; P=.007), and tripodal obturators produced more resistance to middle displacement (5.441 ±1.778 and 2.784 ±0.432 MPa for tripodal and fully tripodal design respectively; P=.001). The fully tripodal obturator showed more retention (3.736 ±1.182 MPa) than the linear one (2.493 ±1.052 MPa; P=.001). The maxillary central incisor was the most stressed abutment, followed by the lateral incisor, while the second molar was the least. CONCLUSIONS Regarding retention, the fully tripodal obturator produces retention comparable with the tripodal and significantly more than the linear. Acrylic resin prostheses retained with Adams clasps may be similar to metal-based prostheses regarding retention and stress distribution on the supporting structures.
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Affiliation(s)
- Mohammed A Mousa
- Lecturer, Prosthetic Dental Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia; and Researcher, Prosthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Adam Husein
- Professor, Prosthodontics, Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates; and Professor, Prosthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | | | - Norwahida Yusoff
- Senior Lecturer, School of Mechanical Engineering, Universiti Sains Malaysia, Nibong Tebal, Malaysia
| | - Johari Yap Abdullah
- Senior Lecturer, Craniofacial Imaging Laboratory, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia; and Adjunct Professor, Dental Research Unit, Center for Transdisciplinary Research (CFTR), Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
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11
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Chen X, Yu B, Wang Z, Zhou Q, Wu Q, He J, Dai C, Li Q, Wei J. Dynamic Transcriptome Analysis of SFRP Family in Guided Bone Regeneration With Occlusive Periosteum in Swine Model. J Craniofac Surg 2024; 35:1432-1437. [PMID: 39042069 DOI: 10.1097/scs.0000000000010365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/04/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND A variety of congenital or acquired conditions can cause craniomaxillofacial bone defects, resulting in a heavy financial burden and psychological stress. Guided bone self-generation with periosteum-preserved has great potential for reconstructing large bone defects. METHODS A swine model of guided bone regeneration with occlusive periosteum was established, the rib segment was removed, and the periosteum was sutured to form a closed regeneration chamber. Hematoxylin and eosin staining, Masson's staining, and Safranine O-Fast Green staining were done. Nine-time points were chosen for collecting the periosteum and regenerated bone tissue for gene sequencing. The expression level of each secreted frizzled-related protein (SFRP) member and the correlations among them were analyzed. RESULTS The process of bone regeneration is almost complete 1 month after surgery, and up to 1 week after surgery is an important interval for initiating the process. The expression of each SFRP family member fluctuated greatly. The highest expression level of all members ranged from 3 days to 3 months after surgery. The expression level of SFRP2 was the highest, and the difference between 2 groups was the largest. Secreted frizzled-related protein 2 and SFRP4 showed a notable positive correlation between the control and model groups. Secreted frizzled-related protein 1, SFRP2, and SFRP4 had a significant spike in fold change at 1 month postoperatively. Secreted frizzled-related protein 1 and SFRP2 had the strongest correlation. CONCLUSIONS This study revealed the dynamic expression of the SFRP family in guided bone regeneration with occlusive periosteum in a swine model, providing a possibility to advance the clinical application of bone defect repair.
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Affiliation(s)
- Xiaoxue Chen
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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12
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Chen C, Batstone M, Taheri T, Johnson N. Surgical Resection and Reconstruction of Ameloblastoma: A 13-Year Retrospective Review. J Oral Maxillofac Surg 2024; 82:862-868. [PMID: 38636548 DOI: 10.1016/j.joms.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Ameloblastoma is a locally aggressive, benign tumor presenting in the maxilla and mandible prone to recurrence. Resection greatly limits recurrence; however, reconstruction becomes critical to preserve patients' functionality and esthetics. PURPOSE The aim of this study was to describe surgical resection and reconstructive approaches in the treatment of ameloblastoma and compare clinical outcomes to conservative methods of treatment. STUDY DESIGN, SETTING, SAMPLE A retrospective case series was completed through analysis of patient records. The study population was composed of patients treated for ameloblastoma at the Royal Brisbane Hospital (Queensland, Australia) in the Oral and Maxillofacial Surgery Unit from January 1, 2008, to December 31, 2020. Patients without histological confirmation of intraosseous ameloblastoma were excluded from the study sample. PREDICTOR VARIABLE Not applicable. MAIN OUTCOME VARIABLE(S) The primary outcome variable was time to recurrence. Secondary outcome variables included any surgical complications incurred. COVARIATES The covariate variables collected included age at diagnosis/treatment, gender, ethnicity, location of lesion and site(s) of involvement, tumor extent, alveolar expansion, histopathological growth pattern, and soft tissue involvement. ANALYSES Descriptive statistics were computed for each study variable. RESULTS A total of 48 cases of histologically confirmed ameloblastoma were identified (41 mandibular, 7 maxillary) involving 50 excisional operations (44 resections, 6 enucleations). Of these cases, 44 were followed up > 12 months, with a mean length of follow-up time of 65.6 months. No recurrence was detected for resected lesions. One enucleated lesion recurred at 25 months. Thirty-seven reconstructive procedures were undertaken, including 32 immediate free flaps. All reconstructive flaps and grafts survived, and no major complications were recorded. CONCLUSION AND RELEVANCE Resection of ameloblastoma limits recurrence and should be considered curative. Immediate microvascular free flap reconstruction of maxillary and mandibular defects from resection of ameloblastoma is safe and predictable.
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Affiliation(s)
- Cheryl Chen
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Unit, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Martin Batstone
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Unit, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Touraj Taheri
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Anatomical Pathology, Pathology Queensland, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Nigel Johnson
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Li CQ, Xie S, LiuFu JF, Ding MK, Kang YF, Shan XF, Cai ZG. Retrospective study of the deep circumflex iliac artery flap and the vascularized fibula free flap for maxillary defect repair. Oral Oncol 2024; 154:106860. [PMID: 38801787 DOI: 10.1016/j.oraloncology.2024.106860] [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: 03/03/2024] [Revised: 05/09/2024] [Accepted: 05/18/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES The deep circumflex iliac artery flap (DCIA) and vascularized fibular free flap (FFF) are mainstay flaps for maxillary defect reconstruction. This study compared the functional outcomes and success rates of these flaps to provide midface reconstruction strategies. MATERIALS AND METHODS Maxillary defects reconstructed with DCIA or FFF at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology between May 2016 and May 2023 were retrospectively analyzed. The length, width, and height of the grafted bone segments; intermaxillary distance; buttress reconstruction rate (BRR); dental arch reconstruction rate (DAR); success rate; and dental implantation rate were compared. RESULTS The DCIA and FFF groups had 33 and 27 patients, respectively. Success rate in the DCIA group was 93.94 % and 100 % in the FFF group. The DCIA length was less than that of FFF; however, the width and height were significantly larger. 87.10 % of cases in the DCIA group were classified as Brown class b and c, 51.85 % of cases in the FFF group were classified as Brown class d. The average BRR in the DCIA group was 69.89 % ± 16.05 %, which was significantly higher than that in the FFF group. A total of 38.7 % and 11.1 % patients in the DCIA and FFF groups, respectively, had completed implantation. CONCLUSION DCIA has a greater width and height, and is more suitable for repairing Brown class b and c defects, providing sufficient bone for implantation, while the FFF is longer and more suitable for Brown class d defect reconstruction.
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Affiliation(s)
- Cheng-Qian Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases &National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, PR China
| | - Shang Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases &National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, PR China
| | - Jian-Feng LiuFu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases &National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, PR China
| | - Meng-Kun Ding
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases &National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, PR China
| | - Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases &National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, PR China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases &National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, PR China.
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases &National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, PR China
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14
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Lin S, Hu LH, Zhang WB, Lin Y, Di P, Peng X. Single-stage computer-assisted approach for tumour resection and functional restoration of Brown class III maxillary defects-titanium mesh and zygomatic implants combined with vascularized anterolateral thigh flap. Int J Oral Maxillofac Surg 2024; 53:558-562. [PMID: 37872055 DOI: 10.1016/j.ijom.2023.09.008] [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: 03/02/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
The functional restoration of Brown class III maxillary defects is a challenging endeavour in oral and maxillofacial surgery. Conventional reconstruction techniques with osseous free flaps have certain limitations, such as the need for multiple operations and greater patient morbidity. This study introduces a single-stage computer-assisted approach for tumour resection and functional restoration of these defects using titanium mesh, zygomatic implants, and a vascularized anterolateral thigh flap (ALTF). Virtual surgical planning was used to simulate tumour resection, titanium mesh placement, and zygomatic implant insertion. Surgery was performed under the guidance of mixed reality and surgical navigation. The tumour was resected by total hemimaxillectomy, and the reconstruction was performed using a pre-bent patient-specific titanium mesh for the orbital floor and two zygomatic implants placed and exposed through tunnels in an ALTF. The ALTF survived without any perioperative complications. A fixed prosthesis with built-in titanium frame was delivered 4 months postoperatively. At the 1-year follow-up, there was no tumour recurrence, the implants were osseointegrated, and aesthetics and masticatory function were satisfactory. An occlusal force of 155 N was attained on the reconstructed side, compared to 127 N on the non-surgical side.
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Affiliation(s)
- S Lin
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, PR China
| | - L-H Hu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, PR China
| | - W-B Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, PR China
| | - Y Lin
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, PR China
| | - P Di
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, PR China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, PR China.
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15
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Tsuge I, Yamanaka H, Katsube M, Sakamoto M, Morimoto N. Multiple Buttress Reconstruction for Extended Total Maxillectomy by Mixed Use of Vascularized and Nonvascularized Fibula. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5901. [PMID: 38868622 PMCID: PMC11167227 DOI: 10.1097/gox.0000000000005901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/01/2024] [Indexed: 06/14/2024]
Abstract
Reconstruction of extended total maxillectomy is challenging. This study aimed to isolate the skull base from the nasal cavity to avoid intracranial infection, cerebrospinal fluid fistula, and palate closure to maintain feeding and conversation. However, facial appearance and symmetry are important for quality of life. We report primary multiple buttress reconstruction using a removed nonvascularized fibula that reduced the risk of infection and exposure. A 74-year-old woman experienced a local recurrence of right maxillary sinus cancer after subtotal maxillectomy and postoperative radiotherapy (60 Gy). We performed extended total maxillectomy, including the right eyeball, orbit, temporal bone, palate, and zygomatic arch. Primary reconstruction was performed using fibular and anterolateral thigh free flaps. The proximal fibula bone was resected to obtain the length of the peroneal vessels, and the distal 9 cm of the fibula was made into two pieces while keeping the peroneal vessels attached. The nonvascularized 5-cm fibula was split sagittally with an L-shaped section to maintain the strength of the fragments. An anterolateral thigh flap was elevated from the ipsilateral thigh attached to the partial vastus lateralis muscle, which was divided into proximal (to the cheek skin and prosthetic eye bed) and distal (to the nasal cavity and palate) skin islands. Two nonvascularized bone fragments were fixed at the lateral and infraorbital rims. The dead space around the built-up pillar made of transferred bone was filled with vastus lateralis muscle to prevent infection and depression. This approach allowed for one-stage multiple buttress reconstruction for extended total maxillectomy.
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Affiliation(s)
- Itaru Tsuge
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Yamanaka
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoki Katsube
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiharu Sakamoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Morimoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Kurosawa K, Sato N, Ohkoshi A, Harata T, Ishi S, Hayashi M, Imai T, Takamura N, Matsunaga H, Imai Y. Multiple Buttresses Reconstruction of Maxilla with Fibular Flap Using Computer-aided Design/Computer-aided Manufacturing after Maxillectomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5914. [PMID: 38911572 PMCID: PMC11191015 DOI: 10.1097/gox.0000000000005914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/01/2024] [Indexed: 06/25/2024]
Abstract
Background The maxilla comprises horizontal and vertical buttresses, each with specific functions, supporting various organs, such as the eyes, nose, and oral cavity. Notably, they combine to form a three-dimensional structure, which enables the buttresses to provide their inherent support strength. However, reconstructing the maxilla after maxillectomy by assembling new buttresses is challenging. We successfully reconstructed all the buttresses crucial for facial appearance and dental rehabilitation using a vascularized fibular flap. Methods Four patients underwent maxillary buttress reconstruction with a fibular flap after total or subtotal maxillectomy. We used computer-aided design/computer-aided manufacturing digital technology to osteotomize the fibula into multiple segments and assemble them to reconstruct the maxillary buttresses. Each buttress was assembled based on a preoperative simulation. Results All patients underwent immediate one-stage maxillary reconstruction. They had good maxillary buttress alignment and acquired good facial appearance, eye position, nasal airway, and prosthetically suitable maxillary alveolus ridge. Conclusions The combination of computer-aided design/computer-aided manufacturing digital technology and surgical techniques has enabled novel maxillary reconstruction, providing great hope to patients experiencing facial disfigurement and loss of function after maxillectomy.
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Affiliation(s)
- Koreyuki Kurosawa
- From the Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Naoko Sato
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Miyagi, Japan
| | - Akira Ohkoshi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Takayuki Harata
- Dental Laboratories, Central Clinical Facilities, Tohoku University Hospital, Miyagi, Japan
| | - Shinyo Ishi
- From the Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masanobu Hayashi
- From the Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toshiro Imai
- From the Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Nariaki Takamura
- From the Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiromu Matsunaga
- From the Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yoshimichi Imai
- From the Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
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17
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Shang JW, Tian YY, Xu ZY, Liu XM, Cao Y, Sui L, Mao C, Zhou YS, Liu CL, Ye HQ, Yan YB. Validation of the "obturator functioning scale" for Chinese-speaking patients with obturator prostheses after cancer-related maxillectomy. Heliyon 2024; 10:e31071. [PMID: 38803891 PMCID: PMC11128901 DOI: 10.1016/j.heliyon.2024.e31071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 04/13/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Objective The Obturator Functioning Scale (OFS) is a scale without formal measures of validity in any language. This study aimed to translate and adapt the OFS from English to Chinese and check its reliability and validity in Chinese-speaking patients with obturator prostheses after cancer-related maxillectomy. Methods The 15-item Chinese preversion of the OFS was completed by 133 patients in three tertiary stomatological hospitals. Of these, 41 completed it again one week after the first measurement. The patients also completed the Chinese version of the University of Washington quality of life scale (UW-QOL, Version 4). Results Item 12 ("upper lip feels numb") was deleted to achieve a better statistical fit. The 14-item Chinese version of the OFS (OFS-Ch) demonstrated high internal consistency (Cronbach's alpha = 0.908). The test-retest reliability coefficients for most items exceeded 0.90, indicating substantial reproducibility. Confirmatory factor analysis found that the scale consisted of three correlated factors: 1) eating (four items), 2) speech (five items), and 3) other problems (five items). This explained 70.2 % of the total variance using exploratory factor analysis. The scale was significantly convergent and discriminant and could validly discriminate between patients with Brown I and IId maxillary defects. Conclusions Our results showed that the OFS-Ch scale is a valid tool for evaluating oral dysfunction and satisfaction with appearance for patients with the obturator prosthesis and identifying those at risk of poor obturator function in clinical settings.
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Affiliation(s)
- Jian-Wei Shang
- Department of Oral Pathology, Tianjin Stomatological Hospital, School of Medicine, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China
| | - Yuan-Yuan Tian
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, School of Medicine, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin, 300041, China
| | - Zhao-Yuan Xu
- Department of Oral Medical Center, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), No.2 Zheshan Road, Wuhu, 241001, China
| | - Xiao-Ming Liu
- Department of Prosthodontics, Tianjin Stomatological Hospital, School of Medicine, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China
| | - Ye Cao
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Lei Sui
- Department of Prosthodontics, Tianjin Medical University School and Hospital of Stomatology, 22 Qixiangtai Road, HepingDistrict, Tianjin, 300070, China
| | - Chi Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Yong-Sheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Chen-Lu Liu
- Department of Oral Medicine, Tianjin Stomatological Hospital, School of Medicine, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China
| | - Hong-Qiang Ye
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Ying-Bin Yan
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, School of Medicine, Nankai University, 75 Dagu Road, Heping District, Tianjin, 300041, China
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin, 300041, China
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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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19
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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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20
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Thariat J, Carsuzaa F, Beddok A, Deneuve S, Marcy PY, Merlotti A, Dejean C, Devauchelle B. Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy. Front Oncol 2024; 14:1379861. [PMID: 38665951 PMCID: PMC11043495 DOI: 10.3389/fonc.2024.1379861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Background Major advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy. Methods A systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT. Results Despite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap-tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications. Conclusion Flap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.
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Affiliation(s)
- Juliette Thariat
- Department of Radiotherapy, Centre François-Baclesse, Caen, France
- Corpuscular Physics Laboratory, IN2P3, Ensicaen, CNRS UMR 6534, Caen, France
- Faculté de Médecine de Caen, Université de Normandie, Caen, France
| | - Florent Carsuzaa
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Orsay, France
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie Deneuve
- Surgical Oncology Department, Centre Léon Bérard, UNICANCER, Lyon, France
- Inserm, U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon Bérard, Lyon, France
| | - Pierre-Yves Marcy
- Polyclinics ELSAN Group, Department of Radiodiagnostics and Interventional Imaging, PolyClinics Les Fleurs, Ollioules, France
| | - Anna Merlotti
- Radiotherapy Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | | | - Bernard Devauchelle
- Departement of Maxillofacial Surgery, University Hospital of Amiens Picardy, Research Unit, UR7516 CHIMERE, University of Picardy Jules Verne, Institut Faire Faces, Amiens, France
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21
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Rao SM, Knott PD, Sweeny L, Domack A, Tang A, Patel R, Pittman AL, Gardner JR, Moreno MA, Sunde J, Cave TB, Knight ND, Greene B, Pipkorn P, Joshi AS, Thakkar P, Ji K, Yang S, Chang BA, Wax MK, Thomas CM. Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis. Laryngoscope 2024; 134:1642-1647. [PMID: 37772913 DOI: 10.1002/lary.31081] [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: 06/17/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Microvascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to describe outcomes of free flap reconstruction for IFS defects, determine the optimal time to perform reconstruction, and if anti-fungal medications or other risk factors of an immunocompromised patient population affect reconstructive outcomes. METHODS Retrospective review of reconstruction for IFS (2010-2022). Age, BMI, hemoglobin A1c, number of surgical debridements, and interval from the last debridement to reconstruction were compared between patients with delayed wound healing versus those without. Predictor variables for delayed wound healing and the effect of time on free flap reconstruction were analyzed. RESULTS Twenty-seven patients underwent free flap reconstruction for IFS. Three patients were immunocompromised from leukemia and 21 had diabetes mellitus (DM). Patients underwent an average of four surgical debridements for treatment of IFS. The interval from the last IFS debridement to flap reconstruction was 5.58 months (±5.5). Seven flaps (25.9%) had delayed wound healing. A shorter interval of less than 2 months between the last debridement for IFS and reconstructive free flap procedure was associated with delayed wound healing (Fisher Exact Test p = 0.0062). Other factors including DM, BMI, HgA1c, and bone reconstruction were not associated with delayed wound healing. CONCLUSION Patients with maxillectomy defects from IFS can undergo microvascular-free flap reconstruction with good outcomes while on anti-fungal medication. Early reconstruction in the first 2 months after the last IFS debridement is associated with delayed wound healing. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1642-1647, 2024.
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Affiliation(s)
- Shilpa M Rao
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - P Daniel Knott
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Larissa Sweeny
- Department of Otolaryngology - Head and Neck Surgery, University of Miami, Miami, Florida, USA
| | - Aaron Domack
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alice Tang
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rusha Patel
- Department of Otolaryngology - Head and Neck Surgery, Oklahoma University Health Science Center, Oklahoma City, Oklahoma, USA
| | - Amy L Pittman
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Chicago, Illinois, USA
| | - J Reed Gardner
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mauricio A Moreno
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jumin Sunde
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Taylor B Cave
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Nicolaus D Knight
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ben Greene
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Washington University, St. Louis, Missouri, USA
| | - Arjun S Joshi
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC, USA
| | - Punam Thakkar
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC, USA
| | - Keven Ji
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Sara Yang
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Brent A Chang
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Mark K Wax
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Carissa M Thomas
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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22
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Liu W, Li C, Ma Z, Zhang G, Lubamba GP, Lian H, Zhang Z, Tang W. Reconstruction of Total Maxillectomy Defects Using Coronoid-Temporalis Pedicled Flap, Titanium Mesh, and Free Flap. Otolaryngol Head Neck Surg 2024; 170:1200-1203. [PMID: 38104317 DOI: 10.1002/ohn.618] [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: 09/19/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
The maxilla plays a crucial role in maintaining midfacial contour, supporting the globe and dentition and separating the oral and nasal cavity. Reconstruction of total maxillectomy defects has always been a challenge in head and neck surgery. In recent years, on the basis of existing methods, we have used the coronoid-temporalis pedicled flap combined with personalized titanium mesh and free flap to reconstruct total maxillectomy defects. This combination of multiple methods can restore the functional subunits of the maxilla. In this report, we introduce our surgical procedures in detail and assess the postoperative effects. Postoperative facial aesthetic outcomes were satisfactory in all 8 patients. None of the patients showed diplopia, oral-nasal reflux, hypernasality, titanium mesh exposure, or trismus. This new surgical procedure may be a simple and feasible option for the reconstruction of total maxillectomy defects.
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Affiliation(s)
- Wei Liu
- Department of Trauma and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Zhongkai Ma
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Gaowei Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Grace Paka Lubamba
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Haosen Lian
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Zhuoyuan Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Wei Tang
- Department of Trauma and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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23
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Mattavelli D, Verzeletti V, Deganello A, Fiorentino A, Gualtieri T, Ferrari M, Taboni S, Anfuso W, Ravanelli M, Rampinelli V, Grammatica A, Buffoli B, Maroldi R, Elisabetta C, Rezzani R, Nicolai P, Piazza C. Computer-aided designed 3D-printed polymeric scaffolds for personalized reconstruction of maxillary and mandibular defects: a proof-of-concept study. Eur Arch Otorhinolaryngol 2024; 281:1493-1503. [PMID: 38170208 PMCID: PMC10857968 DOI: 10.1007/s00405-023-08392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To investigate the potential reconstruction of complex maxillofacial defects using computer-aided design 3D-printed polymeric scaffolds by defining the production process, simulating the surgical procedure, and explore the feasibility and reproducibility of the whole algorithm. METHODS This a preclinical study to investigate feasibility, reproducibility and efficacy of the reconstruction algorithm proposed. It encompassed 3 phases: (1) scaffold production (CAD and 3D-printing in polylactic acid); (2) surgical simulation on cadaver heads (navigation-guided osteotomies and scaffold fixation); (3) assessment of reconstruction (bone and occlusal morphological conformance, symmetry, and mechanical stress tests). RESULTS Six cadaver heads were dissected. Six types of defects (3 mandibular and 3 maxillary) with different degree of complexity were tested. In all case the reconstruction algorithm could be successfully completed. Bone morphological conformance was optimal while the occlusal one was slightly higher. Mechanical stress tests were good (mean value, 318.6 and 286.4 N for maxillary and mandibular defects, respectively). CONCLUSIONS Our reconstructive algorithm was feasible and reproducible in a preclinical setting. Functional and aesthetic outcomes were satisfactory independently of the complexity of the defect.
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Affiliation(s)
- Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy.
| | - Vincenzo Verzeletti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
| | - Alberto Deganello
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), Milan, Italy
| | - Antonio Fiorentino
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Department of Otorhinolaryngology, Head and Neck Surgery, "Nuovo Santo Stefano" Civil Hospital, Prato, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada
| | - Stefano Taboni
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
- Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - William Anfuso
- Otolaryngology Head and Neck Surgery Department of IRCCS, National Cancer Institute (INT), Milan, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Unit of Radiology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, School of Medicine, Brescia, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Unit of Radiology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Ceretti Elisabetta
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, School of Medicine, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-Azienda Ospedale Università di Padova, Padua, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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24
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Ritschl LM, Schwarz M, Klinger F, Wolff KD, Niu M, Weitz J. Extended orbital exenteration, epithetic restoration, and patient supply: A cross-sectional study of a historic cohort. Head Neck 2024; 46:473-484. [PMID: 38095351 DOI: 10.1002/hed.27594] [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: 07/18/2023] [Revised: 09/01/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical course and to redefine an optimized algorithm for OE cases until epithetic restoration. METHODS Indication, defect type according to Kesting, reconstructive technique, incidence of postoperative complications and peri-implantitis, patients' quality of life, timing of periorbital implant insertion, incidence of and interval to implant loss, and time until epithetic restoration were analyzed in 43 patients. RESULTS A significant correlation was detected between wound dehiscence and defect type. Out of 24 patients, 7 were implanted secondarily with a median time interval of 399 days (270-2015) after OE. Eleven out of 83 placed implants were lost in 8 patients with a median time interval of 586 days (264-4485) after insertion. The majority of epithesis carriers had no or few restrictions in their quality of life. CONCLUSIONS We recommend our modified treatment algorithm to further improve and shorten the clinical course.
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Affiliation(s)
- Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Schwarz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Franziska Klinger
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Minli Niu
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
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25
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Do J, Han JJ, Kwon IJ. Application of double layer with collagen-elastin matrix (Matriderm®) and polyglycolic acid sheet (Neoveil®) for oroantral and oronasal fistula closure after maxillectomy: a retrospective single center experience. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101648. [PMID: 37769966 DOI: 10.1016/j.jormas.2023.101648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE This study investigates the effectiveness of a new double-layer approach for closing oroantral and oronasal fistulas (OA/ONFs) using Matriderm® and Neoveil®. Matriderm®, an acellular dermal matrix composed of collagen and elastin fibers, supports tissue regeneration, while Neoveil®, a biodegradable mesh sheet, serves as a barrier to prevent leakage and scarring. MATERIAL AND METHODS A retrospective study of 12 maxillectomy patients with oral cancer between January 2022 and May 2023 was conducted. Patient data, including tumor stage, bone invasion, and defect size, were analyzed. Surgical techniques included sinus mucosa preservation, and either buccal fat grafting combined with the double layer technique or the double layer technique alone, with statistical analysis performed using R software to evaluate outcomes. RESULTS The results indicate a 41.7% incidence rate of fistula formation with lower T stages, absence of bone invasion, smaller defect dimensions, and intact sinus mucosa correlating with reduced fistula risk (p < 0.05). Notably, no patients required fistula-related surgical revisions, validating the efficacy of the approach. CONCLUSION This study introduced a novel double-layer technique using Matriderm® and Neoveil® for closing OA/ONFs after maxillectomy. The technique demonstrated promising outcomes in addressing these post-operative complications. Lower tumor stages, no bone invasion, smaller defects, and intact sinus mucosa correlated with reduced fistula risk. This technique holds potential to enhance maxillectomy outcomes, offering a comprehensive approach to functional concerns, but warrants further investigation.
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Affiliation(s)
- Jiwon Do
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea; Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea; Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Ik-Jae Kwon
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea; Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea.
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26
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Pucci R, Cassoni A, Weyh A, Mangini N, Della Monaca M, Battisti A, Fernandes R, Valentini V. Transoral versus transfacial surgical approach to maxillary tumors: evaluation of outcomes and perspectives. Int J Oral Maxillofac Surg 2024; 53:101-108. [PMID: 37271627 DOI: 10.1016/j.ijom.2023.05.006] [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: 07/29/2022] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023]
Abstract
Neoplasms of the maxilla have multiple different origins and histology, and often extend towards the infratemporal fossa, orbit, or skull base. Extensive resection may be required, often leading to poor esthetic and functional results. Usually, these lesions are removed via a transfacial approach. The aim of this study was to compare the outcomes of the transoral versus transfacial approach for maxillary tumors. A single-institution retrospective study was conducted on patients with maxillary-midface tumors, treated between January 2009 and December 2019. The patients were divided into two groups according to the surgical approach, transfacial or transoral, and the following outcomes were assessed: extent of the resection based on Brown's classification; postoperative pathology margin assessment; reconstruction technique; esthetic/functional results. A total of 178 patients were included. A satisfactory resection was obtained in both groups, with the transoral cohort achieving a higher rate of clear oncological margins (positive margins: transoral group 3.7% versus transfacial group 6.8%, P = 0.389) and a significantly higher University of Washington Quality of Life score (mean 72.2 versus 67.8, P < 0.001). Even large and invasive tumors can be treated successfully with the transoral approach, avoiding unesthetic facial scars while still providing complete resection of the tumor.
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Affiliation(s)
- R Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - A Cassoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.
| | - A Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Health, Jacksonville, FL, USA
| | - N Mangini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - M Della Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - A Battisti
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Health, Jacksonville, FL, USA
| | - V Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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27
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Muylaert F, De Kock L, Creytens D, Verstraete K, Coopman R. High-grade osteosarcoma arising in DCIA flap reconstruction after a prior resection of maxillar cemento-ossifying fibroma: A case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101591. [PMID: 37558180 DOI: 10.1016/j.jormas.2023.101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
Cemento-ossifying fibroma is a rare benign odontogenic tumour of the tooth-bearing jaws. Its concomitant occurrence with osteosarcoma, a malignant maxillofacial bone tumour, has never been described before. We present an uncommon case of a 43-year-old woman in whom a cemento-ossifying fibroma in the right maxilla was treated by resection and reconstruction using a deep circumflex iliac artery flap. During surgical prosthetic rehabilitation one-year post-operative, an osteosarcoma extending from the contralateral maxilla was coincidentally discovered in the deep circumflex iliac artery flap. The aim of this case report is to raise awareness on the extremely rare but possible simultaneous and independent occurrence of a cemento-ossifying fibroma and an osteosarcoma.
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Affiliation(s)
- Frances Muylaert
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Lisa De Kock
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Koenraad Verstraete
- Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium; Head of Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Renaat Coopman
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
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28
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Zhou KX, Patel M, Shimizu M, Wang E, Prisman E, Thang T. Development and validation of a novel craniofacial statistical shape model for the virtual reconstruction of bilateral maxillary defects. Int J Oral Maxillofac Surg 2024; 53:146-155. [PMID: 37391321 DOI: 10.1016/j.ijom.2023.06.002] [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: 09/23/2022] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 07/02/2023]
Abstract
Bilateral maxillary defects are a challenge for fibula free flap reconstruction (FFFR) surgery due to limitations in virtual surgical planning (VSP) workflows. While meshes of unilateral defects can be mirrored to virtually reconstruct missing anatomy, Brown class c and d defects lack a contralateral reference and associated anatomical landmarks. This often results in poor placement of osteotomized fibula segments. This study was performed to improve the VSP workflow for FFFR using statistical shape modeling (SSM) - a form of unsupervised machine learning - to virtually reconstruct premorbid anatomy in an automated, reproducible, and patient-specific manner. A training set of 112 computed tomography scans was sourced from an imaging database by stratified random sampling. The craniofacial skeletons were segmented, aligned, and processed via principal component analysis. Reconstruction performance was validated on a set of 45 unseen skulls containing various digitally generated defects (Brown class IIa-d). Validation metrics demonstrated promising accuracy: mean 95th percentile Hausdorff distance of 5.47 ± 2.39 mm, mean volumetric Dice coefficient of 48.8 ± 14.5%, compactness of 7.28 × 105 mm2, specificity of 1.18 mm, and generality of 8.12 × 10-6 mm. SSM-guided VSP will allow surgeons to create patient-centric treatment plans, increasing FFFR accuracy, reducing complications, and improving postoperative outcomes.
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Affiliation(s)
- K X Zhou
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
| | - M Patel
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - M Shimizu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Oral and Maxillofacial Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - E Wang
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - E Prisman
- Division of Otolaryngology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Thang
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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29
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Li ZM, Kang YF, Zhang L, Yang YF, Shan XF, Cai ZG. Reconstruction of the anterior maxillary defect using a vascularized bone flap with residual teeth in the posterior maxilla. Head Neck 2024; 46:336-345. [PMID: 38031636 DOI: 10.1002/hed.27589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/12/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Microsurgical bone reconstruction is challenging in cases of anterior maxillary defects because of the presence of residual teeth. The study analyzed the method and feasibility of using vascularized bone flaps to reconstruct anterior maxillary defects. METHODS We retrospectively analyzed 15 patients treated at the Department of Oral and Maxillofacial Surgery, Peking University School, and Hospital of Stomatology between November 2017 and January 2023. RESULTS A total of 14 patients were successfully reconstructed using the digital technique: 6 deep circumflex iliac artery (DCIA) flaps and 8 fibular free flaps. Palatal and buccal pedicle paths were used in 4 and 10 cases, respectively, for vascular anastomosis. The implant coverage rates of the DCIA and fibular free flaps were 87.2% and 92.6%, respectively (p > 0.05). CONCLUSION Anterior maxillary defects reconstructed with the DCIA and fibular free flaps are reliable methods. Furthermore, the palatal and buccal paths are recommended for vascular anastomosis.
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Affiliation(s)
- Zi-Meng Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Yi-Fan Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
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30
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König J, Kelemen K, Váncsa S, Szabó B, Varga G, Mikulás K, Borbély J, Hegyi P, Hermann P. Comparative analysis of surgical and prosthetic rehabilitation in maxillectomy: A systematic review and meta-analysis on quality-of-life scores and objective speech and masticatory measurements. J Prosthet Dent 2023:S0022-3913(23)00775-8. [PMID: 38151428 DOI: 10.1016/j.prosdent.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023]
Abstract
STATEMENT OF PROBLEM Patients with oro-antral communication, whether from trauma, disease, or congenital anomalies, have options for surgical reconstruction or prosthetic obturation, but guiding interdisciplinary protocols are lacking. PURPOSE The purpose of this systematic review and meta-analysis was to compare surgical reconstruction and prosthetic obturation, identifying correlations with baseline characteristics to determine the most effective approach for specific patients. MATERIAL AND METHODS A systematic search was conducted in 4 databases. Searching, screening, data extraction, and risk of bias assessment were performed by 2 reviewers. Eligible studies focused on patients with palatomaxillary defects from cancer-related maxilla surgeries. Traumatic or congenital defects were excluded. The study compared prosthetic restoration (either with surgical or definitive obturators) to surgical reconstruction using flaps or grafts. Patients with surgical restoration after tooth extraction were excluded. Both subjective and objective outcomes were used for comparison. RESULTS Thirteen articles were included in the qualitative synthesis and 9 in the meta-analysis. Patient scores on quality-of-life questionnaires, objective speech, and masticatory ability evaluations were compared. The number of patients who underwent surgical reconstruction was 206, whereas 260 patients received prosthetic obturators. Results showed no significant differences. In the "activity" domain of the University of Washington QoL questionnaire, however, the 1.92 (0.45, 3.40) score difference was not clinically relevant. However, the heterogeneity of trials, the transient nature of subjective evaluations, the low number of participants, and major confounding biases did not allow a solid conclusion to be drawn. CONCLUSIONS The growing number of maxillectomy patients demands firm evidence on which rehabilitation to choose and when it should be done. The result suggests that obturator devices and surgical reconstruction have similar effects on quality of life and health outcomes. A multicentric registry in which patient strata could be analyzed separately by age, adjuvant therapies, defect sizes, and remaining dentition is advocated.
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Affiliation(s)
- János König
- Assistant Lecturer, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and PhD student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Kata Kelemen
- Assistant Lecturer, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and PhD student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Scientific Methodological Expert, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Bence Szabó
- Biostatistician, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- General & Operative Vice Director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Full Professor, Department of Oral Biology, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztina Mikulás
- Assistant Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Borbély
- Associate Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Strategic Director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Strategic Director, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hermann
- Director and Full Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
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31
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Laurila M, Mäntynen P, Mauno J, Suojanen J. Prosthetic Oral Rehabilitation with CAD/CAM Suprastructures in Patients with Severe Tissue Deficits: A Case Series. Dent J (Basel) 2023; 11:289. [PMID: 38132427 PMCID: PMC10742847 DOI: 10.3390/dj11120289] [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: 11/10/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
This article presents the outcomes of prosthetic oral rehabilitation using CAD/CAM telescopic bar overdentures in patients with oral cancer (n = 3), severe facial trauma (n = 2), or various syndromes (n = 1), all suffering from severe tissue deficits and requiring complex and comprehensive oral rehabilitation. The aim was to assess the durability and functionality of implant-retained prosthetic structures, ensuring easy oral hygiene and minimizing specialized follow-up needs. The data for this study were sourced from a retrospective cohort at Helsinki University Hospital. The prosthetic reconstruction encompassed the Atlantis 2in1 and the Createch removable telescopic systems. Thus, 40 implants were placed (4 to 7 per patient), with prosthetic structures in the maxilla (n = 4 patients), in the mandible (n = 1), and in both jaws (n = 1). Two patients experienced no complications, two patients had part of the acrylic resin break, and one patient experienced loosening of the bar structure. All complications associated with prosthetic structures were successfully managed, and none of the implants were lost. The follow-up time ranged from 7 to 126 months. This rehabilitation is proved to be an effective solution for patients with complex oral conditions, facilitating both functional restoration and ease of maintenance. These findings underscore the importance of individualized treatment approaches in cases of tissue deficits.
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Affiliation(s)
- Marisa Laurila
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, 15850 Lahti, Finland; (M.L.)
| | - Pilvi Mäntynen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, 15850 Lahti, Finland; (M.L.)
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland;
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Jari Mauno
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland;
| | - Juho Suojanen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, 15850 Lahti, Finland; (M.L.)
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland;
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
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Kämmerer PW, Tavakoli M, Gaggl A, Maranzano M. Intraoral Microvascular Anastomosis in Immediate Free Flap Reconstruction for Midfacial Tumor Defects: A Retrospective Multicenter Study. J Clin Med 2023; 12:7064. [PMID: 38002676 PMCID: PMC10672123 DOI: 10.3390/jcm12227064] [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: 10/08/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The current landscape of midface reconstruction is marked by ongoing evolution, with notable advancements in surgical techniques, microvascular procedures, and the implementation of multidisciplinary approaches, all of which have significantly enhanced both functional and aesthetic outcomes. Conventionally, microvascular anastomoses for free flaps in midfacial reconstruction have been executed using cervical vessels. However, this approach necessitates neck access, resulting in extraoral scars and a substantial pedicle length. In light of these considerations, using intraoral anastomoses via the facial vessels emerges as a promising alternative. This retrospective multicentric study aims to provide a comprehensive account of immediate midface reconstruction through intraoral anastomoses. (2) Methods: Between 2020 and 2023, patients were included who underwent intraoral resection of midface/orbit segments (Brown Classes I-VI) as a result of malignant diseases. In all cases, immediate reconstruction was accomplished by utilizing the facial vessels through an intraoral approach. Outcome criteria were identification of vessels, parotid duct or facial nerve damage, success of vascular anastomoses, and flap survival. (3) Results: A total of 117 patients with 132 flaps (91 osseous and 41 cutaneous) were included. The intraoral preparation of facial vessels was successfully completed in less than 1 h, and no complications related to the dissection or anastomoses were observed. In two cases, the vessel diameter was insufficient to facilitate anastomoses, necessitating adopting an extraoral approach. During a follow-up period of 48 months, two osseous flaps were lost, accounting for a 1.5% loss rate out of 132 flaps used. Additionally, 3 flaps experienced partial loss, including a skin island of a scapula, the border zone of a femur, and a rectus flap, resulting in a 2.3% partial loss rate out of 130 flaps utilized. (4) Conclusions: This case series underscores the feasibility of employing intraoral anastomoses for immediate complex midface reconstruction following oncological resection. This approach is particularly advantageous for flaps with shorter pedicles, as it helps mitigate external scarring and minimizes the risk of facial nerve injury.
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Affiliation(s)
- Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Milad Tavakoli
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Manchester University NHS Foundation Trust (MFT), Manchester M13 9WL, UK; (M.T.); (M.M.)
| | - Alexander Gaggl
- Department of Oral and Craniomaxillofacial Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Massimo Maranzano
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Manchester University NHS Foundation Trust (MFT), Manchester M13 9WL, UK; (M.T.); (M.M.)
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Sun Q, Zhu Z, Meng F, Zhao R, Li X, Long X, Li Y, Dong H, Zhang T. Application of a modified osteotomy and positioning integrative template system (MOPITS) based on a truncatable reconstruction model in the precise mandibular reconstruction with fibula free flap: a pilot clinical study. BMC Oral Health 2023; 23:842. [PMID: 37940900 PMCID: PMC10630995 DOI: 10.1186/s12903-023-03596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Mandibular defects can greatly affect patients' appearance and functionality. The preferred method to address this issue is reconstructive surgery using a fibular flap. The current personalized guide plate can improve the accuracy of osteotomy and reconstruction, but there are still some problems such as complex design process and time-consuming. Therefore, we modified the conventional template to serve the dual purpose of guiding the mandible and fibula osteotomy and facilitating the placement of the pre-bent titanium. METHODS The surgery was simulated preoperatively using Computer-Aided Design (CAD) technology. The template and truncatable reconstruction model were produced in the laboratory using 3D printing. After pre-bending the titanium plate according to the contour, the reconstruction model was truncated and the screw trajectory was transferred to form a modified osteotomy and positioning integrative template system (MOPITS). Next, the patient underwent a composite template-guided vascularized fibula flap reconstruction of the mandible. All cases were reviewed for the total operative time and accuracy of surgery. RESULTS The procedures involved 2-4 fibular segments in 15 patients, averaging 3 fibular segments per procedure. The osteotomy error is 1.01 ± 1.02 mm, while the reconstruction angular error is 1.85 ± 1.69°. The preoperative and postoperative data were compared, and both p > 0.05. During the same operation, implant placement was performed on four patients, with an average operative time of 487.25 ± 60.84 min. The remaining malignant tumor patients had an average operative time of 397.18 ± 73.09 min. The average postoperative hospital stay was 12.95 ± 3.29 days. CONCLUSIONS This study demonstrates the effectiveness of MOPITS in facilitating precise preoperative planning and intraoperative execution of fibula flap reconstruction. MOPITS represents a promising and reliable tool for reconstructive surgery, particularly for inexperienced surgeons navigating the challenges of mandible defect reconstruction.
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Affiliation(s)
- Qing Sun
- Department of Plastic Surgery, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Zhihui Zhu
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Fanhao Meng
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ruiqi Zhao
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Xing Li
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Yansheng Li
- Beijing University of Technology, Beijing, China
| | - Haitao Dong
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Tao Zhang
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China.
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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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Katayama R, Yazawa M, Kishi K. Maxillary Reconstruction With a Rib-attached Free Latissimus Dorsi Muscle Flap. J Craniofac Surg 2023; 34:2485-2487. [PMID: 37439551 DOI: 10.1097/scs.0000000000009544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/21/2023] [Indexed: 07/14/2023] Open
Abstract
In defect reconstruction after maxillary tumor resection, filling the dead space created by resection and reconstruction of surrounding areas are crucial for good cosmetic outcomes. Although various procedures have been described in the literature, most are complex and require advanced surgical skills. Therefore, in this study, the authors aimed to identify a simple procedure for successful reconstruction with minimal bone fixation. Three patients who underwent total maxillectomy and reconstruction using the rib-attached free latissimus dorsi flap at Keio University Hospital between 2012 and 2014 were included and followed up with for a minimum of 5 years. After total maxillectomy, the authors used a free latissimus dorsi flap with a portion of the rib to fill the dead space and reconstructed the orbit, nasal cavity, and oral cavity.The authors performed a rigid reconstruction of the zygomatic ridge using only 2-point plate fixations of the ribs at the outer orbit and anterior nasal spine. Patients were followed up for ≥5 years, and the flap successfully survived in all cases. There was an issue with rib fixation in 1 case; however, all patients were highly satisfied with the procedure's cosmetic results.
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Affiliation(s)
- Riku Katayama
- Department of Plastic and Reconstructive Surgery, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguroku, Tokyo, Japan
| | - Masaki Yazawa
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
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Qayyum MU, Keerio AA, Faisal M, Rashid A, Hussain R, Jamshed A. Survival Outcomes and Patterns of Failure in Maxillary Alveolus Squamous Cell Carcinoma. Int Arch Otorhinolaryngol 2023; 27:e559-e564. [PMID: 37876703 PMCID: PMC10593516 DOI: 10.1055/s-0042-1758214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/05/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Squamous cell carcinoma (SCC) of the maxillary alveolus is a relatively rare disease. There is lack of data on this subsite as compared with other sites. The factors that affect survival in cases of maxillary alveolar SCC are tumor stage, local and cervical metastases, histological grading, and the margin status. Objectives To evaluate the overall survival (OS), the disease free survival (DFS), and the complex interaction and effects of margin status, histological differentiation, habits (such as smoking and the use of smokeless tobacco products), and cervical and distant metastases based on clinicopathological data. Methods We examined the electronic database at our hospital from 2003 to 2017. We included all cases with a histopathological diagnosis of SCC of the maxillary alveolus. Tumors originating primarily from the maxillary alveolus were included, while those originating from adjacent subsites, like the hard palate, the buccal mucosa or the maxillary sinus were excluded. We also excluded all the patients who were not operated on with a curative intent. Results More than half of the patients had stage-IV tumors at the time of presentation, while only one fourth of them had nodal metastasis. The rate of recurrence increased in cases of primary tumors in advanced stages and the degree of histological differentiation. The 2-year and 5-year OS rates were of 54.5% (18 patients) and 30.3% (10 patients) respectively. Conclusion Primary tumors in advanced stages, histological grade, and presence of nodal metastasis are poor prognostic markers in terms of long-term survival.
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Affiliation(s)
- Muhammad Umar Qayyum
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
- Department of Maxillofacial Surgery, Combined Military Hospital Lahore, Lahore, Pakistan
| | - Ahmed Ali Keerio
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Faisal
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asma Rashid
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology–Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Arif Jamshed
- Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
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Frias V, Al Afif A, Markiewicz MR. Immediate Free Fibula Flap After Maxillectomy With Simultaneous Full-arch Dental Implant-Supported Prosthetic Rehabilitation of the Midface and Mandible: The "Super Reconstruction Concept". J Craniofac Surg 2023; 34:2153-2156. [PMID: 37643124 DOI: 10.1097/scs.0000000000009695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Immediate reconstruction and dental rehabilitation for ablative defects of the head and neck in one surgery is now a commonly used technique among reconstructive surgeons. Often patients are edentulous or partially edentulous in the jaw opposing that with pathology. In this case, only rehabilitating the dental arch affected by pathology would not render the patient with a functional occlusion. We introduce the "super reconstruction" concept which includes not only rehabilitating the dental arch affected by pathology but also the opposing arch, giving the patient a fully functional occlusion at the time of ablative surgery. This concept is described through a case of a patient with a T4aN0M0 squamous cell carcinoma of the maxilla who underwent total maxillectomy, immediate fibula flap reconstruction of the maxilla with, and full arch dental implant placement into the maxilla and opposing mandible with prosthetic rehabilitation.
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Affiliation(s)
- Vladimir Frias
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center
| | - Ayham Al Afif
- Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center
| | - Michael R Markiewicz
- Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center
- Department of Oral and Maxillofacial Surgery, Associate Dean for Hospital Affairs, School of Dental Medicine, University at Buffalo
- Department of Neurosurgery, Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences
- Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY
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Yu Y, Zhang W, Sun Q, Peng X. Modified individualized titanium mesh in orbital floor reconstruction for preventing exposure. Laryngoscope Investig Otolaryngol 2023; 8:1196-1202. [PMID: 37899872 PMCID: PMC10601557 DOI: 10.1002/lio2.1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 05/12/2023] [Accepted: 05/26/2023] [Indexed: 10/31/2023] Open
Abstract
Objective To describe a novel method of medial fixation of titanium mesh with a right-angled screwdriver for orbital floor and maxillary reconstruction and to compare the reconstruction outcome of orbital floor reconstruction with modified and traditional methods. Methods The data of 23 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2018 and 2021 were retrospectively reviewed. While eight patients received modified orbital floor reconstruction with titanium mesh and angled screwdriver (group A), 15 patients received traditional orbital floor reconstruction (group B). The contact area with buccal flap for titanium mesh in groups A and B was calculated. Titanium mesh deformation, fracture or exposure was recorded. Postoperative ophthalmic function and success of esthetic restoration were assessed. Results Mean follow-up was for 15.7 months (range, 9-22 months). The contact area with buccal flap for the modified titanium mesh in group A (13.11 ± 1.41 cm2) was significantly less than that of the traditional titanium mesh in group B (21.83 ± 1.23 cm2; p < .05). The exposure of titanium mesh occurred in two patients in group B. The self-evaluation of facial symmetry for 23 patients showed no significant difference between group A (7.75 ± 0.71) and group B (6.68 ± 1.30; p > .05). No specific complications were reported. Conclusion We propose a novel method of zygomatic medial fixation of titanium mesh with a right-angled screwdriver for orbital floor and maxillary reconstruction, which has the potential to prevent the postoperative exposure of titanium mesh. Level of Evidence Level III (Retrospective comparative study).
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Affiliation(s)
- Yao Yu
- Department of Oral and Maxillofacial SurgeryPeking University School and Hospital of StomatologyBeijingChina
| | - Wen‐Bo Zhang
- Department of Oral and Maxillofacial SurgeryPeking University School and Hospital of StomatologyBeijingChina
| | - Qian Sun
- Department of Oral and Maxillofacial SurgeryPeking University School and Hospital of StomatologyBeijingChina
| | - Xin Peng
- Department of Oral and Maxillofacial SurgeryPeking University School and Hospital of StomatologyBeijingChina
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Gu L, Huang R, Ni N, Gu P, Fan X. Advances and Prospects in Materials for Craniofacial Bone Reconstruction. ACS Biomater Sci Eng 2023; 9:4462-4496. [PMID: 37470754 DOI: 10.1021/acsbiomaterials.3c00399] [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] [Indexed: 07/21/2023]
Abstract
The craniofacial region is composed of 23 bones, which provide crucial function in keeping the normal position of brain and eyeballs, aesthetics of the craniofacial complex, facial movements, and visual function. Given the complex geometry and architecture, craniofacial bone defects not only affect the normal craniofacial structure but also may result in severe craniofacial dysfunction. Therefore, the exploration of rapid, precise, and effective reconstruction of craniofacial bone defects is urgent. Recently, developments in advanced bone tissue engineering bring new hope for the ideal reconstruction of the craniofacial bone defects. This report, presenting a first-time comprehensive review of recent advances of biomaterials in craniofacial bone tissue engineering, overviews the modification of traditional biomaterials and development of advanced biomaterials applying to craniofacial reconstruction. Challenges and perspectives of biomaterial development in craniofacial fields are discussed in the end.
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Affiliation(s)
- Li Gu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Rui Huang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ni Ni
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ping Gu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
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Han Y, Chen Y, Cui L, Chai M, Guo L, Tao R, Chen L, Han M, Han Y. One stage reconstruction of mid-face fistulous defects after maxillary sinus carcinoma resection with chimeric perforator free flaps. Microsurgery 2023; 43:476-482. [PMID: 36530044 DOI: 10.1002/micr.30996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 11/12/2022] [Accepted: 12/09/2022] [Indexed: 07/20/2023]
Abstract
BACKGROUND The reconstruction of large fistulous defects following the radical ablation of maxillary sinus carcinoma remains challenging. The procedure requires not only the coverage of both intra-nasal lining and cheek skin but also sufficient obliteration of dead space between the two surfaces. In this report, we present our experience on the reconstruction of through-and-through defects in the mid-face with poly-foliated chimeric perforator flaps. METHODS Nine patients (five males and four females) who received a two-skin paddled and one muscle segment chimeric perforator flap reconstruction after maxillary sinus carcinoma ablation between March 2015 and December 2019 were retrospectively reviewed in authors' hospital. The mean age of the patients was 59.11. Six patients were diagnosed as squamous cell carcinoma, two as adenoid cystic carcinoma, and one as adenocarcinoma. Brown class IIIa defects were found in eight patients, and one patient had a Brown class IVa defect. The mean size of intra-nasal defect was 5.67 × 4.06 cm2 , and the mean size of facial skin defect was 8.94 × 6.56 cm2 . ALT flaps were used in five patients, LD flaps in four patients. The minor skin paddle was firstly inset to the mucosal defect site as the lining. Then, the muscle segment was inset to eliminate the dead cavity. Finally, the major skin paddle was inset to recover the cutaneous defect. RESULTS In ALT group, the mean size of the minor skin paddle was 5.7 × 4.7 cm2 , and the mean size of the major skin paddle was 8.7 × 6.6 cm2 . In LD group, the mean size of the minor skin paddle was 6.88 × 4.38 cm2 , and the mean size of the major skin paddle was 11 × 7.75 cm2 .All donor sites were closed primarily. All flaps survived and no partial flap loss was encountered. The mean follow-up time was 14.67 months, and there were no major postoperative complications. CONCLUSION The use of poly-foliated chimeric perforator free flaps can provide functional and aesthetic coverage for extensive through-and-through mid-face defects without significant donor-site morbidities.
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Affiliation(s)
- Yudi Han
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Youbai Chen
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Lei Cui
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Mi Chai
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Lingli Guo
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Ran Tao
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Lei Chen
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Mingkun Han
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Yan Han
- Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
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Jelovac D, Micic M, Hajdarevic S, Kuzmanovic C, Cukic B, Stefanovic B, Zelic K, Bonfante E, Ewers R, Petrovic M. Immediate placement of extra-short implants in refined scapula tip microvascular free flaps: In house virtual planning and surgical technique - Proof of concept. Heliyon 2023; 9:e18021. [PMID: 37496908 PMCID: PMC10366439 DOI: 10.1016/j.heliyon.2023.e18021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/24/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023] Open
Abstract
Scapula tip flaps have been introduced in the literature as an ideal surgical treatment option for large defects in the horizontal plane of the maxilla. This article aims to present a unique step by step protocol for a near total maxillectomy with a pterygoid bone resection and consecutive microvascular reconstruction with a harvested scapula tip flap. The protocol includes immediate placement of extra-short implants in donor bone with the aid of Virtual Surgical Planning (VSP), and an in-house 3D printing of medical 3D models and surgical guides. So far, there has been no presented surgical technique combining immediate implant placement in the scapula region with simultaneous microvascular repair. This technique allows: tumour resection; flap harvesting; extra-short implant placements and reconstruction to be performed in one simultaneous procedure. The technique is presented with illustrations, VSP (presented on videos), radiographs, and surgical findings. We discovered that this refinement of the scapula tip surgery has enabled reconstructive procedures to be performed at the same time as implant placements, providing expedited functional and aesthetic outcomes in selected cases. Moreover, modification of the surgical technique could enhance the competence of the oropharyngeal edge. In conclusion, this new surgical protocol utilizing VSP, 3D models and simultaneous extra-short implant placement provides indispensable advantages for such a complicated surgical procedures, while significantly shortening the duration of surgery.
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Affiliation(s)
- Drago Jelovac
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Milutin Micic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Sanela Hajdarevic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Cedomir Kuzmanovic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | | | | | - Ksenija Zelic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
- School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - E.A. Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo – Bauru School of Dentistry, Bauru, SP, Brazil
| | - Rolf Ewers
- University Hospital for Cranio Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18 - 20, 1090, Vienna, Austria
| | - Milan Petrovic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
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Ranz-Colio Á, Almeida-Parra F, De Leyva-Moreno P, Cárdenas-Serres C, García-Cosío M, Acero-Sanz J. Navigation-guided resection of locally advanced midface malignancies. Does it improve the safety of oncologic resection? Oral Oncol 2023; 143:106455. [PMID: 37295064 DOI: 10.1016/j.oraloncology.2023.106455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Treatment of malignant midface tumors is a surgical challenge with an increased difficulty to obtain free surgical margins. The computer assisted surgery (CAS) and intraoperative navigation (ION) can be very helpful in complex midface resections. The main objective of this paper is to evaluate if the ION could improve the rate of free surgical margins in locally advanced midface malignancies. MATERIALS AND METHODS A retrospective cohort study was performed including 40 patients with a locally advanced malignant midface tumor (T4a/b) surgically treated from September 2016 to September 2022. Patients were divided in two groups, a control group included 20 patients operated on without ION and the study group included 20 patients treated with Navigation assisted surgery. A systematic analysis was performed comparing surgical margins in both groups. RESULTS Squamous cell carcinoma was the most common histological type. Oral cavity was the most common primary location. Overall, considering each specimen as an hexahedrium, 240 surgical margins were analyzed. 15 out of 120 margins analyzed in the navigation group (12.5 %) were positive while 30 out of 120 margins analyzed in control group (25 %) were affected (p 0.013). Concerning margin location, the ION group showed less involvement of the upper surface of specimen than in control group (p 0.048). CONCLUSION Navigation Assisted Surgery seems to improve the rate of free surgical margins in patients with locally advanced midface malignancies, specially concerning involvement of the superior margin. Further studies are recommended to corroborate these results and its potential influence in survival rates.
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Affiliation(s)
- Álvaro Ranz-Colio
- Oral and Maxillofacial Surgeon in Ramon y Cajal University Hospital, Madrid, Spain; Puerta de Hierro University Hospital, Majadahonda, Spain; University of Alcala de Henares, Madrid, Spain.
| | - Fernando Almeida-Parra
- Puerta de Hierro University Hospital, Majadahonda, Spain; University of Alcala de Henares, Madrid, Spain; Oral and Maxillofacial Surgeon in the Head and Neck Oncology Section in the Department of Oral and Maxillofacial Surgery, Ramon y Cajal University Hospital, Madrid, Spain.
| | - Patricia De Leyva-Moreno
- Puerta de Hierro University Hospital, Majadahonda, Spain; University of Alcala de Henares, Madrid, Spain; Oral and Maxillofacial Surgeon in the Head and Neck Oncology Section in the Department of Oral and Maxillofacial Surgery, Ramon y Cajal University Hospital, Madrid, Spain
| | - Cristina Cárdenas-Serres
- Puerta de Hierro University Hospital, Majadahonda, Spain; University of Alcala de Henares, Madrid, Spain; Resident of the Department of Oral and Maxillofacial Surgery, Ramon y Cajal University Hospital, Madrid, Spain
| | - Mónica García-Cosío
- University of Alcala de Henares, Madrid, Spain; Pathology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Julio Acero-Sanz
- Puerta de Hierro University Hospital, Majadahonda, Spain; University of Alcala de Henares, Madrid, Spain; Department of Oral and Maxillofacial Surgery, Ramon y Cajal University Hospital, Madrid, Spain.
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43
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Singh SI, Shah AK, Singh MK, Sonnahalli NK. Simplified Zygomatic Implant Perforated (Zip) Flap for Rehabilitation in Low Level Maxillary Defects. J Maxillofac Oral Surg 2023:1-8. [PMID: 37362872 PMCID: PMC10221744 DOI: 10.1007/s12663-023-01935-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
Rehabilitation in Low level maxillectomy cases has plethora of options right from local flaps to microvascular flaps. Subsequent to flap surgery, a maxillary dental rehabilitation can be demanding and a fixed or removable prosthesis is obligatory to provide them with near-normal function and aesthetics. Unlike the original ZIP flaps which were dedicated to microvascular flaps, we present here our unique experience with ZIP-Temporalis flap specifically for rehabilitation for patients of CAM (covid associated mucormycosis), its methods, advantages and limitations.
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Affiliation(s)
- Swathi Iyengar Singh
- Manipal Hospital Yeshvanthpur, 26/4, Brigade Gateway, Besides Metro, Malleshwaram West, Bangalore, 560003 India
| | - Anjan Kumar Shah
- Manipal Hospital Yeshvanthpur, 26/4, Brigade Gateway, Besides Metro, Malleshwaram West, Bangalore, 560003 India
| | - Manish Kumar Singh
- Manipal Hospital Yeshvanthpur, 26/4, Brigade Gateway, Besides Metro, Malleshwaram West, Bangalore, 560003 India
| | - Nithin Kumar Sonnahalli
- Manaswa Facial Surgery & Dental Implant Center, 16, Shambala, 8th Main, 9th Cross, Malleshwaram, Bangalore, 560003 India
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Grecchi F, D'Ambrogio RG, Stefanelli LV, Grivetto F, Goker F, Del Fabbro M, Schreiber A, Piazza C, Salgarello S, Dosio C, Grecchi E. Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report. J Clin Med 2023; 12:jcm12113653. [PMID: 37297847 DOI: 10.3390/jcm12113653] [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: 04/26/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Oral rehabilitation after maxillary oncological resection is challenging. This case report presents the rehabilitation of a 65-year-old Caucasian male adenoid cystic carcinoma patient using a myo-cutaneous thigh flap, zygomatic implant placement, and an immediate fixed provisional prosthesis made with computer-aided technologies. The patient presented complaints of asymptomatic enlarged swelling of 5-mm on the right hard hemi-palate. There was an oro-antral communication deriving from a previous local excision. Preoperative radiographs showed the involvement of the right maxilla, maxillary sinus, and nose with a suspect involvement of the maxillary division of the trigeminal nerve. Treatment was planned through a fully digital workflow. A partial maxillectomy was performed endoscopically, and maxilla was reconstructed using an anterolateral thigh free flap. Two zygomatic implants were inserted simultaneously. A provisional fix full-arch prosthesis was manufactured preoperatively through a fully digital workflow and was placed in the operating room. Following post-operative radiotherapy, the patient received a final hybrid prosthesis. During the follow-up period of two years, the patient reported good function, aesthetics, and significant enhancement in quality of life. According to the results of this case, the protocol represented can be a promising alternative for oral cancer patients with large defects, and can lead to an improved quality of life.
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Affiliation(s)
| | - Roberto Giuseppe D'Ambrogio
- Department of Surgical Specialties, Dental Clinic, School of Dentistry, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
| | | | - Fabrizio Grivetto
- Azienda Ospedaliero Universitaria Maggiore Della Carità Largo Bellini, 28100 Novara, Italy
| | - Funda Goker
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alberto Schreiber
- Department of Surgical Specialties, Ear, Nose and Throat Clinic, School of Dentistry, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
| | - Cesare Piazza
- Department of Surgical Specialties, Ear, Nose and Throat Clinic, School of Dentistry, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
| | - Stefano Salgarello
- Department of Surgical Specialties, Dental Clinic, School of Dentistry, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
| | - Camilla Dosio
- Azienda Ospedaliero Universitaria Maggiore Della Carità Largo Bellini, 28100 Novara, Italy
| | - Emma Grecchi
- Private Practice, Via Boccaccio 34, 20123 Milan, Italy
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Alanezi A, Aljanahi M, Moharamzadeh K, Ghoneima A, Tawfik AR, Khamis AH, Abuzayeda M. Development and Comparison of Conventional and 3D-Printed Laboratory Models of Maxillary Defects. Dent J (Basel) 2023; 11:dj11050115. [PMID: 37232766 DOI: 10.3390/dj11050115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Recording accurate impressions from maxillary defects is a critical and challenging stage in the prosthetic rehabilitation of patients following maxillectomy surgery. The aim of this study was to develop and optimize conventional and 3D-printed laboratory models of maxillary defects and to compare conventional and digital impression techniques using these models. METHODS Six different types of maxillary defect models were fabricated. A central palatal defect model was used to compare conventional silicon impressions with digital intra-oral scanning in terms of dimensional accuracy and total time taken to record the defect and produce a laboratory analogue. RESULTS Digital workflow produced different results than the conventional technique in terms of defect size measurements which were statistically significant (p < 0.05). The time taken to record the arch and the defect using an intra-oral scanner was significantly less compared with the traditional impression method. However, there was no statistically significant difference between the two techniques in terms of the total time taken to fabricate a maxillary central defect model (p > 0.05). CONCLUSIONS The laboratory models of different maxillary defects developed in this study have the potential to be used to compare conventional and digital workflow in prosthetic treatment procedures.
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Affiliation(s)
- Ahmad Alanezi
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates
| | - May Aljanahi
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates
- Dubai Dental Hospital (DDH), Dubai P.O. Box 505097, United Arab Emirates
| | - Keyvan Moharamzadeh
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates
- School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK
| | - Ahmed Ghoneima
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates
| | - Abdel Rahman Tawfik
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates
| | - Amar Hassan Khamis
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates
| | - Moosa Abuzayeda
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai P.O. Box 505055, United Arab Emirates
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Bone resorption after maxillary reconstruction with the vascularized free iliac flap. Int J Oral Maxillofac Surg 2023; 52:430-435. [PMID: 36008218 DOI: 10.1016/j.ijom.2022.08.010] [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: 12/03/2021] [Revised: 07/24/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022]
Abstract
The aim of this study was to evaluate the resorption of the iliac bone after maxillary reconstruction with a vascularized free iliac flap. Twenty-seven patients with maxillary defects who underwent maxillary reconstruction with the vascularized free iliac flap between January 2017 and January 2021 were included. Computed tomography (CT) images taken at 1 week, approximately 6 months, and 1 year after the surgery were used for evaluation. The total iliac bone thickness and height, cortical bone thickness, and cancellous bone density were measured in the CT images. Compared with 1 week after the surgery, the total thickness and height of the iliac bone were reduced significantly 1 year after the surgery, and the cortical bone thickness and cancellous bone density were reduced significantly at 6 months and 1 year after the surgery. Compared with 6 months after the surgery, cancellous bone density was reduced significantly 1 year after the surgery. In conclusion, during the first year after maxillary reconstruction with a vascularized free iliac flap, there was significant resorption of iliac bone, including the total iliac bone thickness and height, the cortical bone thickness, and the cancellous bone density.
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Ohkoshi A, Ishii R, Higashi K, Nakanome A, Ishikawa K, Katori Y. Trismus after partial maxillectomy and radiotherapy: Free flap reconstruction versus prosthetic obturation. Auris Nasus Larynx 2023; 50:260-265. [PMID: 35688667 DOI: 10.1016/j.anl.2022.05.016] [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: 04/18/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Partial maxillectomy and postoperative radiotherapy are both risk factors associated with trismus. This retrospective study aimed to evaluate the incidence and severity of trismus in patients following partial maxillectomy with or without postoperative radiotherapy and to compare free flap reconstruction and prosthetic obturation. METHODS A retrospective review of 40 oral cancer patients who underwent partial maxillectomy with or without postoperative radiotherapy was performed. Maximum interincisal distance recorded at least 6 months after surgery was classified according to a revised subjective-objective management-analytical (SOMA) scale and compared between the free flap reconstruction group (n = 12) and the prosthetic obturation group (n = 28). RESULTS Trismus was observed in 16/40 (40%) patients, and severe trismus was observed in 4/40 (10%) patients. Although no significant difference in trismus grade was observed between the free flap reconstruction and prosthetic obturation groups, both severe trismus and radiation-induced osteonecrosis were only seen in the prosthetic obturation group with postoperative radiotherapy. CONCLUSION Free flap reconstruction was preferable to prosthetic obturation to avoid severe trismus and radiation-induced osteonecrosis in patients who underwent both partial maxillectomy and postoperative radiotherapy.
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Affiliation(s)
- Akira Ohkoshi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan.
| | - Ryo Ishii
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Kenjiro Higashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Ayako Nakanome
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Kenichiro Ishikawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Yukio Katori
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
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Kim H, Cha IH, Kim HJ, Nam W, Yang H, Cho SU, Koh YW, Kim D. Comparing Free-Flap Reconstruction After Robot-Assisted Neck Dissection via a Retroauricular Approach and a Traditional Transcervical Approach: Single-Surgeon Experiences of 90 Consecutive Cases. Ann Surg Oncol 2023; 30:2554-2561. [PMID: 36520236 DOI: 10.1245/s10434-022-12904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Predominant traditional approaches for most patients who have advanced-stage oral cancer with transcervical incision lines left irreversible scars. To address this, surgeons have continuously refined minimally invasive surgery (MIS) techniques, including robot-assisted neck surgeries. This article introduces and discusses the feasibility, versatility, and availability of free-flap reconstruction via the retroauricular approach (RA), considered difficult to date. METHODS This study retrospectively analyzed 90 consecutive patients who had free-flap reconstruction performed by a single surgeon (D.K.) in the Department of Oral and Maxillofacial Surgery, Yonsei University, from March 2021 to April 2022. The type of defects and flaps, hospitalization days, total operation time, and type of vessels and anastomoses were compared statistically. RESULTS The type of vessels used did not differ between the RA and the transcervical approach (TA) groups, nor in duration of hospital stays. Likewise, the total reconstruction time did not differ significantly between the TA group (240 min) and the RA group (245 min) (p = 0.756). However, the total operation time was about 1 h less in the TA group, a statistically significant difference (TA group [593 ± 152 min] vs. RA group [655 ± 117 min]; p = 0.044). All flaps were successful in the RA group, whereas one flap in the TA group led to a total loss (TA group [98.3%] vs. RA group [100.0%]; p = 1.000). CONCLUSIONS Even for patients with advanced oral cancer who require massive tumor ablation, it is feasible to obtain an aesthetic and functional surgical outcome by performing free-flap reconstruction via the retroauricular approach.
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Affiliation(s)
- Hyounmin Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyunwoo Yang
- Department of Oral and Maxillofacial Surgery, Yongin Severance Hospital, Yongin, Korea
| | - Sung-Uk Cho
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
| | - Dongwook Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.
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Honda K, Nishimura K, Tsujimura T, Miura M. Palatal mucoperiosteal flap for oro-nasal fistula following maxillectomy for maxillary sinus cancer. Auris Nasus Larynx 2023; 50:266-271. [PMID: 35778286 DOI: 10.1016/j.anl.2022.06.003] [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: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to describe the technique and clinical outcomes of using a palatal mucoperiosteal flap for oro-nasal fistula closure following resection of maxillary sinus cancer. METHODS The study was conducted with the permission of the internal review board of the Japanese Red Cross Wakayama Medical Center. Five consecutive cases from 2016 to 2020 of surgically treated maxillary sinus cancer in which the oro-nasal fistulas were closed using a palatal mucoperiosteal flap were retrospectively reviewed. RESULTS Following tumor resection, the oro-nasal fistula was closed using a palatal mucoperiosteal flap. Complete separation of the oral and nasal cavities was achieved in four patients. Oral intake was resumed within two weeks in four patients. All the patients were able to eat foods similar to those in the preoperative period. Their postoperative speech function was excellent, with no difficulty in communicating with others. CONCLUSION In the selected cases of maxillary sinus cancer, preservation of the palatal mucosa and closure of an oro-nasal fistula using a palatal mucoperiosteal flap was possible with reasonable outcomes for swallowing and speech functions. The use of this local flap is recommended as a minimally invasive procedure that can be performed especially in patients with limited physiological reserves which preclude free flap reconstruction.
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Affiliation(s)
- Keigo Honda
- Kyoto University Graduate School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Kyoto, Japan.
| | - Kazunari Nishimura
- Japanese Red Cross Wakayama Medical Center, Department of Otolaryngology, Wakayama, Japan
| | - Takashi Tsujimura
- Japanese Red Cross Wakayama Medical Center, Department of Otolaryngology, Wakayama, Japan
| | - Makoto Miura
- Japanese Red Cross Wakayama Medical Center, Department of Otolaryngology, Wakayama, Japan
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50
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Maxillectomy and Flap Reconstruction of Maxillary Defects After Cancer Ablation Through the Lip-Split Parasymphyseal Mandibulotomy Approach in Patients With Advanced-Stage Maxillary Malignant Tumors. J Craniofac Surg 2023:00001665-990000000-00576. [PMID: 36872494 DOI: 10.1097/scs.0000000000009221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND The conventional approach for maxillectomy has some common and serious complications. AIMS The present study evaluated the outcomes of maxillectomy and flap reconstruction after cancer ablation using the lip-split parasymphyseal mandibulotomy (LPM) approach. METHODS Twenty-eight patients with malignant tumors, including squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma, underwent maxillectomy through the LPM approach. Brown classes II and III were reconstructed with the facial-submental artery submental island flap, an extensive segmental pectoralis major myocutaneous flap, and a free anterolateral thigh flap with the use of a titanium mesh, respectively. RESULTS All proximal margin frozen section specimens showed negative surgical margins. Anterolateral thigh flap failure occurred in 1 patient, whereas ophthalmic and mandibulotomy complications developed in 4 and 7 patients, respectively. In all, 84.6% of the patients had satisfactory or excellent lip esthetic results. Of the patients, 57.1% were alive with no evidence of disease, whereas 28.6% were alive with disease and 14.3% died of local recurrence or distant metastasis. No significant survival difference was evident among the squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma groups. CONCLUSIONS The LPM approach can provide good surgical access, facilitating maxillectomy in advanced-stage malignant tumors with minimal morbidity. Facial-submental artery submental island flap and anterolateral thigh flap or extensive segmental pectoralis major myocutaneous flap with a titanium mesh are ideal techniques for reconstructing Brown classes II and III defects, respectively.
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