Palatomaxillary Reconstruction: Fibula or Scapula

3D Printing for the Development of Palatal Defect Prosthetics

Background

Three-dimensional (3D) printing has emerged as a promising new technology for the development of surgical prosthetics. Research in orthopedic surgery has demonstrated that using 3D printed customized prosthetics results in more precise implant placements and better patient outcomes. However, there has been little research on implementing customized 3D printed prosthetics in otolaryngology. The program sought to determine whether computed tomography (CT) serves as feasible templates to construct 3D printed palatal obturator prosthetics for defects in patients who have been treated for head and neck cancers.

Observations

A retrospective review of patients with palatal defects was conducted and identified 1 patient with high quality CTs compatible with 3D modeling. CTs of the patient's craniofacial anatomy were used to develop a 3D model and a Formlabs 3B+ printer printed the palatal prosthetic. We successfully developed and produced an individualized prosthetic using CTs from a veteran with head and neck deformities caused by cancer treatment who was previously treated at the Veterans Affairs Palo Alto Health Care System. This project was successful in printing patient-specific implants using CT reproductions of the patient's craniofacial anatomy, particularly of the palate. The program was a proof of concept and the implant we created was not used on the patient.

Conclusions

Customized 3D printed implants may allow otolaryngologists to enhance the performance and efficiency of surgeries and better rehabilitate and reconstruct craniofacial deformities to restore appearance and function to patients. Additional research will strive to enhance the therapeutic potential of these prosthetics to serve as low-cost, patient-specific implants.

Outcomes and influential factors in functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region: a systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis aimed to evaluate the factors influencing and success rates of dental implants for functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region.

MAIN TEXT

We conducted a comprehensive search of electronic databases, including MEDLINE, Web of Science, Embase, Scopus, and Cochrane's CENTRAL, as well as gray literature sources and manual searches of notable journals. The search was performed from inception until February 2023. Studies were included if they examined functional and dental rehabilitation outcomes in patients receiving maxillofacial reconstruction using microvascular fibula flaps and were retrospective or prospective cohort studies involving human subjects. Case-control studies, research involving other reconstruction methods, and animal-based studies were excluded. Data was extracted and confirmed by two independent researchers, and risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were conducted for dental implant and graft success rate, with separate analyses for different factors affecting the outcome. Heterogeneity was evaluated using Cochran's Q test and the I² test. The pooled success rate for implants was 92% and for grafts, 95%, with significant heterogeneity. Implants in fibular grafts had a 2.91 times higher failure rate than those in natural bones. Radiated bone and smoking were identified as factors influencing implant failure, with radiated bone having a 2.29 times higher risk and smokers having a 3.16 times higher risk compared to their respective counterparts. Patient-reported outcomes showed improvements in key areas such as dietary intake, mastication, speech, and esthetics. The success rates declined over time, emphasizing the importance of long-term follow-up.

CONCLUSIONS

Dental implants in free fibula grafts generally have favorable success rates, with minimal bone resorption, manageable probing depths, and limited bleeding on probing. Implant success is influenced by factors such as smoking and radiated bone.

Bone grafting in maxillofacial trauma

PURPOSE OF REVIEW

The purpose of this article is to review the recent grafting strategies in maxillofacial trauma.

RECENT FINDINGS

Recent technological advancements have applications in the management of maxillofacial trauma; advancements in imaging modalities such as 3D imaging can help surgeons in both the preoperative and intraoperative periods. These may be coupled with navigational systems to further facilitate complex reconstructions. 3D printing has been used in reconstruction and 3D, 4D, and 5D bioprinting technologies continue to improve and to find new uses, and stem cells and growth factors in maxillofacial trauma are also among the most studied topics. Maxillofacial traumas have decreased in number during the COVID-19 pandemic, as more conservative approaches have been preferred in COVID pandemic conditions.

SUMMARY

Preoperative planning is the most important step in the reconstruction of maxillofacial trauma defects, and early bone and soft tissue reconstructions are recommended in severe maxillofacial traumas. Autogenous grafts are the gold standard in bone grafting. Nonvascularized grafts are planned according to the size, shape, and location of the defect, with vascularized bone flaps preferred in large defects, wide soft tissue defects, and contaminated defects. Alloplastic grafts or xenografts may be used if autogenous grafts are not available.