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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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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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Jullian F, Kuster C, Zink S, Bodin F, Bruant-Rodier C, Dissaux C. Maxillary and total nasal reconstruction with a scapulo dorsal perforator flap. ANN CHIR PLAST ESTH 2024; 69:85-91. [PMID: 37032218 DOI: 10.1016/j.anplas.2023.03.002] [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: 01/24/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023]
Abstract
Facial gunshots injuries remain challenging and present functional and aesthetic problems. Such defects generally require composite tissue flaps for reconstruction. Rebuilding the palate and the maxilla is especially delicate because it requires reconstitution of the facial buttresses, and replacement of bony hard palate, based on occlusion, as well as the restoration of the thin intraoral and intranasal lining which normally constitute the soft palate. Various methods of reconstruction have been applied to this area in search of an ideal soft tissue and bone flap to restore the bony framework of the maxilla and palate while providing an internal lining. The scapula dorsal perforator flap is used in the case of a patient to successfully reconstruct the palate, the maxilla and the nasal pyramid in one stage. Free tissue transfer using thoracodorsal perforator flaps and scapula bone free flap have been already described in literature but never to perform the nasal pyramid reconstruction at the same time. Good functional and aesthetic results have been obtained in this case. This article also reviews, through the authors experience and literature, anatomical landmarks, indications, technical surgical tricks, advantages and disadvantages of this flap for palatal, maxillary and nose reconstruction.
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Affiliation(s)
- Flora Jullian
- Maxillofacial and Plastic Purgery Pepartment, Strasbourg University Hospital, Site Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France.
| | - Camille Kuster
- Maxillofacial and Plastic Purgery Pepartment, Strasbourg University Hospital, Site Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Simone Zink
- Maxillofacial and Plastic Purgery Pepartment, Strasbourg University Hospital, Site Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Frederic Bodin
- Maxillofacial and Plastic Purgery Pepartment, Strasbourg University Hospital, Site Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Catherine Bruant-Rodier
- Maxillofacial and Plastic Purgery Pepartment, Strasbourg University Hospital, Site Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Caroline Dissaux
- Maxillofacial and Plastic Purgery Pepartment, Strasbourg University Hospital, Site Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
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Hassani A, Hasheminasab M, Nikparto N, Kamali Hakim L. Staged reconstruction of hemimaxillectomy defect: Application of buccal fat pad flap, iliac bone graft and implant-supported dental prostheses. Clin Case Rep 2020; 8:2763-2768. [PMID: 33363818 PMCID: PMC7752413 DOI: 10.1002/ccr3.3268] [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: 04/13/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022] Open
Abstract
In order to achieve a fixed implant-supported prosthesis in a posthemimaxilectomy patient, ideal soft and hard tissue rehabilitation is necessary. Here, we present a staged approach for soft tissue reconstruction with local flaps followed by anterior iliac crest bone graft which resulted in a predictable and satisfactory outcome.
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Affiliation(s)
- Ali Hassani
- Implant Research Center, Oral and Maxillofacial Surgery DepartmentIslamic Azad University of Medical SciencesTehranIran
| | - Mahboube Hasheminasab
- Craniomaxillofacial Research Center, Oral and Maxillofacial Surgery DepartmentTehran University of Medical SciencesTehranIran
| | - Nariman Nikparto
- Oral and Maxillofacial Surgery DepartmentTehran University of Medical ScienceTehranIran
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Shokri T, Wang W, Cohn JE, Kadakia S, Ducic Y. Premaxillary Deficiency: Techniques in Augmentation and Reconstruction. Semin Plast Surg 2020; 34:92-98. [PMID: 32390776 DOI: 10.1055/s-0040-1709175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.
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Affiliation(s)
- Tom Shokri
- Department of Otolaryngology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Le Clerc N, Baudouin R, Carlevan M, Khoueir N, Verillaud B, Herman P. 3D titanium implant for orbital reconstruction after maxillectomy. J Plast Reconstr Aesthet Surg 2019; 73:732-739. [PMID: 31870721 DOI: 10.1016/j.bjps.2019.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/16/2019] [Accepted: 11/22/2019] [Indexed: 11/28/2022]
Abstract
The surgical treatment of maxillary tumours often consists of an open subtotal or total maxillectomy with a subsequent significant defect. Reconstruction is, therefore, a major challenge for head and neck surgeons. Along with 3D printing development, titanium pre-bent implants have been created for orbital wall and floor reconstruction. The aim of this study was to evaluate the post-operative tolerance of these implants in patients who had undergone this procedure in our department. Implant tolerance was the primary endpoint, evaluated by whether or not surgery was required for infection or extrusion 6 months after the procedure. The secondary endpoints were satisfactory functional and aesthetic characteristics of the reconstruction as well as the quality of life. Eleven patients underwent a maxillectomy with orbital floor resection for tumours and reconstruction using the titanium PorousiTi® (Materialise®, Leuven, Belgium) implant beginning in 2013 in Lariboisière Hospital, Paris. The mean follow-up time was 17 months (range, 6-34). During the follow-up period, two patients (n = 2/11; 18.2%) were operated again for implant extrusion and exposure through the skin 1 month later or during their radiotherapy course. During the follow-up period, no post-operative infection occurred in any of the patients. In our experience, the implant was well-tolerated with few post-operative complications and satisfactory aesthetic and functional results.
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Affiliation(s)
- N Le Clerc
- Lariboisière University Hospital, APHP, Department of Head and Neck Surgery, 10 rue Ambroise Paré, Paris Diderot University, Paris, France
| | - R Baudouin
- Lariboisière University Hospital, APHP, Department of Head and Neck Surgery, 10 rue Ambroise Paré, Paris Diderot University, Paris, France.
| | - M Carlevan
- Lariboisière University Hospital, APHP, Department of Head and Neck Surgery, 10 rue Ambroise Paré, Paris Diderot University, Paris, France
| | - N Khoueir
- Lariboisière University Hospital, APHP, Department of Head and Neck Surgery, 10 rue Ambroise Paré, Paris Diderot University, Paris, France
| | - B Verillaud
- Lariboisière University Hospital, APHP, Department of Head and Neck Surgery, 10 rue Ambroise Paré, Paris Diderot University, Paris, France
| | - P Herman
- Lariboisière University Hospital, APHP, Department of Head and Neck Surgery, 10 rue Ambroise Paré, Paris Diderot University, Paris, France
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Moya-Plana A, Veyrat M, Honart JF, de Fremicourt K, Alkhashnam H, Sarfati B, Janot F, Leymarie N, Temam S, Kolb F. Reconstruction of maxillectomy and midfacial defects using latissimus dorsi-scapular free flaps in a comprehensive cancer center. Oral Oncol 2019; 99:104468. [PMID: 31678764 DOI: 10.1016/j.oraloncology.2019.104468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/04/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The standard of care for sinonasal malignancies is a large surgical resection followed by radiotherapy. Midfacial defects resulting from maxillectomy require a complex reconstruction procedure. Given their adaptability, chimeric flaps such as latissimus dorsi-scapular (LDS) free flaps appear to be a good option. MATERIAL & METHODS We performed a single-center retrospective study of consecutive patients with sinonasal cancers where a LDS free flap was used for reconstruction. We assessed the postoperative complications and the functional, aesthetic and oncologic outcomes. RESULTS Eighty-four patients were included. Primary tumors were staged as T4a in 68% of cases; 38.3% of the patients received induction chemotherapy and 82.7% received adjuvant radiotherapy. Based on our classification of midfacial and palatal defects, the majority of the patients (69%) had a type IIa with interruption of the three facial pillars. The orbital floor was removed in 55.9% of cases. The median follow-up was 45 months. Total flap necrosis with no possible revascularization occurred in 5.9% of cases. For the orbital reconstruction, a revision procedure was needed for necrosis and/or infection of the costal cartilage graft in eight cases (17%). More than 90% of the patients had no functional disorders regarding speaking, swallowing and chewing. Soft palate involvement was a prognostic factor of speech (p < 10-4) and swallowing (p = .005) disorders. Dental rehabilitation was realized in 70.2% of the patients. No severe complications were observed in the donor site, except for one seroma. CONCLUSION A LDS free flap is a reliable technique for the reconstruction of complex midfacial defects.
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Affiliation(s)
- A Moya-Plana
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.
| | - M Veyrat
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - J F Honart
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - K de Fremicourt
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - H Alkhashnam
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - B Sarfati
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - F Janot
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - N Leymarie
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Temam
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - F Kolb
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
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Orbital outcomes after orbit-sparing surgery and free flap reconstruction. Oral Oncol 2019; 98:78-84. [DOI: 10.1016/j.oraloncology.2019.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/07/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
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Continuous Validity of Temporalis Muscle Flap in Reconstruction of Postablative Palatomaxillary Defects. J Craniofac Surg 2018; 28:e130-e137. [PMID: 28033186 DOI: 10.1097/scs.0000000000003323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Postablative palatomaxillary defects (PAPMDs) represent a challenging reconstructive problem. Temporalis muscle flap (TMF) has been widely used for reconstruction of these defects with minimal morbidity and satisfactory outcome. AIM OF THE STUDY To presents the authors' experience in the reconstruction of PAPMDs with TMF and to evaluate the validity of TMF in the reconstruction of such defects. METHODS This prospective study was conducted between July 2011 and July 2016 on selected patients for primary reconstruction of PAPMDs with TMF. Temporalis muscle flaps were assessed during surgery and postoperatively. Patients were followed up to evaluate functional and esthetic outcomes and detect complications. RESULTS This study included 32 patients with mean age 48.3 years. The pathology was squamous cell carcinoma in 15 patients (46.9%). Twenty-one patients (65.6%) had type II maxillectomy. Mean time of flap harvesting was 43 minutes. Zygomatic arch osteotomy was done in 3 patients while Coronoid osteotomy in 4 patients. Postoperatively, flaps were viable in 31 patients (96.9%) with good healing of recipient site. Flap epithelization completed within 28 to 59 days. Follow-up period was 13 to 55 months. Satisfactory functional and esthetic outcomes were reported in most of patients with no recurrence. Transient temporal nerve palsy occurred in 2 patients, limited mouth opening in 5 patients. One patient had Transient diplopia with enopthalmos and hypophthalmos. Flap failure occurred in another patient. CONCLUSIONS Temporalis muscle flap is still a valid reliable and versatile reconstructive tool in palatomaxillary reconstruction after ablative surgery. It has a good cosmetic and functional outcomes and minimal morbidity.
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O'Connell JE, Bajwa MS, Schache AG, Shaw RJ. Head and neck reconstruction with free flaps based on the thoracodorsal system. Oral Oncol 2017; 75:46-53. [DOI: 10.1016/j.oraloncology.2017.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 11/29/2022]
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Mertens C, Freudlsperger C, Bodem J, Engel M, Hoffmann J, Freier K. Reconstruction of the maxilla following hemimaxillectomy defects with scapular tip grafts and dental implants. J Craniomaxillofac Surg 2016; 44:1806-1811. [PMID: 27697398 DOI: 10.1016/j.jcms.2016.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 07/01/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Treatment of post-resective defects of the maxilla can be challenging and usually requires dental obturation or microvascular reconstruction. As compared to soft-tissue microvascular grafts, bone reconstruction can additionally allow for facial support and retention of dental implants. The aim of this study was to evaluate scapular tip grafts with respect to their applicability for maxillary reconstruction and their potential to retain dental implants for later dental rehabilitation. MATERIALS AND METHODS In this retrospective study, 14 patients with hemimaxillectomy defects were reconstructed with free scapular tip grafts, oriented horizontally, to rebuild the palate and alveolar ridge. After bone healing, three-dimensional virtual implant planning was performed, and a radiographic guide was fabricated to enable implant placement in the optimal anatomic and prosthetic position. All patients' mastication and speech were evaluated, along with the extent of defect closure, suitability of the graft sites for implant placement, and soft-tissue stability. Pre- and postsurgical radiographs were also evaluated. RESULTS A good postoperative outcome was achieved in all patients, with complete closure of maxillary defects that were class II, according to the system of Brown and Shaw. Additional bone augmentation was necessary in two patients in order to increase vertical bone height. Patients were subsequently treated with 50 dental implants to retain dental prostheses. In all cases, additional soft-tissue surgery was necessary to achieve a long-term stable periimplant situation. No implants were lost during the mean observation period of 34 months. CONCLUSIONS Due to its specific form, the scapular tip graft is well suited to reconstruct the palate and maxillary alveolar ridge and to enable subsequent implant-retained rehabilitation. Due to the limited bone volume, an accurate three-dimensional graft orientation is essential. Furthermore, most cases require additional soft-tissue surgery to achieve a long-term stable periimplant situation.
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Affiliation(s)
- Christian Mertens
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Christian Freudlsperger
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Bodem
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Engel
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Kolja Freier
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
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The Use of a Superiorly Based Melolabial Interpolated Flap for Reconstruction of Anterior Oronasal Fistulas: An Easy and Practical Solution. Ann Plast Surg 2016; 75:163-9. [PMID: 24317248 DOI: 10.1097/sap.0000000000000059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to propose the use of a superiorly based melolabial interpolated flap for reconstruction of anteriorly located oronasal fistulas maxillary defects. MATERIALS AND METHODS Using a prospective study design, we evaluated indications and outcomes of the reconstructive technique using the interpolated melolabial flap in 6 patients affected by anteriorly located maxillary defects with naso-sinonasal communication. The cases differed in demographic characteristics and etiology of the defect. The outcome variables were flap vitality/failure and persistent/recurrent oronasal fistula. Both the outcomes were clinically evaluated. RESULTS No partial or total flap failures were recorded. Two patients experienced recurrent oronasal fistula after previous attempts of correction that required second surgery repair; in both cases, the melolabial flap was available and functional for the secondary procedure. CONCLUSIONS In selected cases, the superiorly based interpolated melolabial flap could represent a valuable choice for repairing of anteriorly located maxillary defects with oronasal fistulas.
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Evolution of complex palatomaxillary reconstructions: the scapular angle osteomuscular free flap. Curr Opin Otolaryngol Head Neck Surg 2013; 21:95-103. [PMID: 23385785 DOI: 10.1097/moo.0b013e32835e8445] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the worldwide experience (105 patients) in primary and secondary reconstruction of palatomaxillary oncologic defects with the angular branch-based subscapular system of free flaps, comparing the advantages and disadvantages of the technique with those of other well known osseous donor sites such as the fibula and iliac crest. RECENT FINDINGS The most recognized indications for angular branch-based osteomuscular free flaps are class II (especially in association with zygomaticomaxillary buttress and/or floor of the orbit removal) and class III defects according to the Okay classification. Defects involving clearance of the orbital content have also been reconstructed in this manner. One of the most important drawbacks of this technique (i.e., need for intraoperative patient repositioning) is no longer considered an issue, and evidence has been provided that harvesting of angular branch-based scapular flaps may be routinely performed in a supine position. Three-dimensional morphologic similarity of the tip of the scapula with the native hard palate and other maxillary structures makes flap fabrication easy and practical, with at least two (horizontal and vertical) most commonly used flap orientations applied to reconstruct different defects. SUMMARY Angular branch-based osteomuscular scapular free flaps represent a major advance in palatomaxillary reconstruction: their versatility, long pedicle with large caliber donor vessels, morphologic similarity with maxillary bony structures, and limited donor-site morbidity compare favorably with those of other osteomuscular and osteomusculocutaneous free flaps described for such challenging reconstructive purposes.
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Computer-Assisted Orthognathic Surgery Combined With Fibular Osteomyocutaneous Flap Reconstruction to Correct Facial Asymmetry and Maxillary Defects Secondary to Maxillectomy in Childhood. J Craniofac Surg 2013; 24:886-9. [DOI: 10.1097/scs.0b013e31827ff370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Li BH, Jung HJ, Choi SW, Kim SM, Kim MJ, Lee JH. Latissimus dorsi (LD) free flap and reconstruction plate used for extensive maxillo-mandibular reconstruction after tumour ablation. J Craniomaxillofac Surg 2012; 40:e293-300. [DOI: 10.1016/j.jcms.2012.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 01/24/2012] [Accepted: 01/24/2012] [Indexed: 11/25/2022] Open
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Hamahata A, Saitou T, Beppu T, Yamaki T, Sakurai H. A new nasal cavity and maxilla reconstruction method using jejunum flap with non-vascularised bone. J Plast Reconstr Aesthet Surg 2012; 66:e12-5. [PMID: 23098586 DOI: 10.1016/j.bjps.2012.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 07/25/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
Abstract
Reconstruction of the midface is still challenging for reconstructive surgeons because of its complex structure and the need for an aesthetic result. We used a free jejunum flap for the nasal cavity and non-vascularised bone covered by the jejunal seromuscular patch for the facial bone structure. One patient who had a midface defect received reconstructive surgery using free jejunum flap with non-vascularised bone. The nasal cavity reconstruction using jejunal mucosa was moisturised and had less crust formation. The nasal cavity space was very large and patients could breathe easily via the nose. The non-vascularised bone covered by the jejunal seromuscular patch did not dry out or become less absorbent. The reconstruction of the nasal cavity and maxilla using free jejunum flap with non-vascularised bone is novel and useful in some surgical cases.
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Affiliation(s)
- Atsumori Hamahata
- Department of Plastic and Reconstructive Surgery, Saitama Cancer Center, 818 Komuro Inamachi Kitaadachigunn, Saitama 362-0806, Japan.
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Free Tensor Fascia Lata-Iliac Crest Osteomusculocutaneous Flap for Reconstruction of Combined Maxillectomy and Orbital Floor Defect. Ann Plast Surg 2012; 68:52-7. [DOI: 10.1097/sap.0b013e31820ebc19] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Smith ML, Clarke-Pearson E, Dayan JH. Fibula osteo-adipofascial flap for mandibular and maxillary reconstruction. Head Neck 2011; 34:1389-94. [PMID: 22025346 DOI: 10.1002/hed.21947] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The fibula free flap is a reliable method for reconstructing composite head and neck defects. However, its skin paddle has drawbacks, including its thickness, hair-bearing surface, desquamation, difficulty insetting it into maxillary defects, and the potential need for skin-grafting the donor site. The fibula osteo-adipofascial flap (FOAFF) is a modification of the fibula flap that overcomes these problems. METHODS A retrospective study of 6 consecutive patients who underwent FOAFF reconstruction was evaluated for outcomes and complications. RESULTS The mean follow-up was 22.6 months. All flaps survived, with complete oral mucosalization by 7 weeks. Four patients had dental implants placed at the time of reconstruction. Two patients received radiation therapy. Aside from loss of the labial sulcus in anterior maxillary reconstructions, complications were negligible. CONCLUSION The FOAFF is useful for reconstructing defects requiring bone, soft tissue, and mucosal replacement without the disadvantages of the traditional fibula skin paddle.
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Affiliation(s)
- Mark L Smith
- Department of Surgery, Beth Israel Medical Center, New York, New York, USA.
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Ahmed Djae K, Li Z, Li ZB. Temporalis muscle flap for immediate reconstruction of maxillary defects: review of 39 cases. Int J Oral Maxillofac Surg 2011; 40:715-21. [PMID: 21550782 DOI: 10.1016/j.ijom.2011.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/20/2011] [Accepted: 03/04/2011] [Indexed: 11/29/2022]
Abstract
This study evaluated the advantages and complications associated with immediate reconstruction of maxillary defects after maxillectomy and the relationship between defect tissues classification and postoperative results after using the temporalis muscle flap. In this retrospective study, the records of 39 patients who underwent immediate reconstruction surgery using temparolis myofascial flap following maxillectomy from April 1989 to February 2009 were reviewed. Demographic data, features of the disease, follow-up, outcome and complications were analysed. Patients were classified into three groups, to ascertain the influence between defect classification and functional results, aesthetic outcomes and complications in each group. Of the 39 cases, all tissue flaps survived. 5 patients underwent postoperative radiotherapy, which did not seem to influence the outcome of the reconstructive procedure. There was one case of oroantral fistula, which could easily be obturated with the prosthesis. One patient developed haematoma in the donor site 5 days after surgery. Postoperative speech was good, facial appearance was normal and ocular function remained unchanged. Postoperative aesthetic and functional results were satisfying. The temporalis muscle flap can be considered as a first-line reconstructive option for maxillary defects. Acceptable functional and aesthetic outcomes can be expected in high rates.
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Affiliation(s)
- K Ahmed Djae
- Department of Oral and Maxillofacial surgery, School and Hospital of Stomatology, Wuhan University, China
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Pitak-Arnnop P, Hemprich A, Dhanuthai K, Pausch NC. Free flap reconstruction of the maxilla: is there something missing? ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2011; 111:4-7. [PMID: 21176813 DOI: 10.1016/j.tripleo.2010.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 07/29/2010] [Indexed: 05/30/2023]
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21
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Avery C. Review of the radial free flap: still evolving or facing extinction? Part two: osteocutaneous radial free flap. Br J Oral Maxillofac Surg 2010; 48:253-60. [DOI: 10.1016/j.bjoms.2009.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 09/30/2009] [Indexed: 10/19/2022]
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22
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He Y, Zhu HG, Zhang ZY, He J, Sader R. Three-dimensional model simulation and reconstruction of composite total maxillectomy defects with fibula osteomyocutaneous flap flow-through from radial forearm flap. ACTA ACUST UNITED AC 2009; 108:e6-12. [DOI: 10.1016/j.tripleo.2009.07.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 07/10/2009] [Accepted: 07/17/2009] [Indexed: 10/20/2022]
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Kajikawa A, Ueda K, Katsuragi Y, Hirose T, Asai E. Three-step orbitofacial reconstruction after extended total maxillectomy using free RAM flap and expanded cervicofacial flap with cartilage grafts. J Plast Reconstr Aesthet Surg 2009; 63:1608-14. [PMID: 19892611 DOI: 10.1016/j.bjps.2009.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 11/27/2022]
Abstract
Facial defect after an extended total maxillectomy is one of the most difficult deformities to reconstruct aesthetically, because the defect is not only large but also three-dimensional. Although free-flap reconstruction is useful, the patchwork-like scar, bad colour match and poor texture match are major problems. The contracture and displacement of the reconstructed eyelids and eye socket are also serious matters. To resolve these problems, we have performed a three-step reconstruction using a free rectus abdominis myocutaneous (RAM) flap and an expanded cervicofacial flap with cartilage grafts. In the first step, a free RAM flap was transplanted to the defect after extended total maxillectomy. In the second step, tissue expanders were placed under the skin of the cheek and neck a year after the RAM flap transplantation. After expansion of the cheek and neck skin, the third step was performed. The inferior part of the external skin island of the RAM flap was raised and sutured to the superior margin of the skin island to create a pouch for the eye socket. Costal cartilage was grafted to reconstruct the orbital floor and malar prominence, and auricular cartilage was grafted to reconstruct the tarsal plates. Finally, the expanded cervicofacial flap was rotated to cover this construct. Two weeks after reconstruction, the neo-eyelids were divided to form the lid fissure. We performed the three-step reconstruction on six cases after extended total maxillectomy. In all cases, a deep and stable eye socket was reconstructed. The reconstructed eyelids and cheek were natural in appearance with good colour and texture match without conspicuous scars. To obtain symmetry and natural appearance in the orbitomaxillary reconstruction, there are five points that should be formed; the eye socket, the groundwork of the eye socket, the orbital floor and malar prominence, the tarsal plates and the surface of the eyelids and cheek. We do not reconstruct the palate to set prosthetic dentures and to clean the surface of the skin island in the nasal cavity. To reconstruct the indispensable five points and achieve satisfying results, we propose this three-step reconstruction.
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Affiliation(s)
- Akiyoshi Kajikawa
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, 960-1295, Japan.
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Korompilias AV, Soucacos PN. Vascularized bone grafts in trauma and reconstructive microsurgery, part 1. Microsurgery 2009; 29:337-41. [DOI: 10.1002/micr.20673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kosutic D, Uglesic V, Knezevic P, Milenovic A, Virag M. Latissimus dorsi-scapula free flap for reconstruction of defects following radical maxillectomy with orbital exenteration. J Plast Reconstr Aesthet Surg 2008; 61:620-7. [DOI: 10.1016/j.bjps.2007.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Revised: 07/23/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
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Kobayashi K, Ishihara H, Murakami R, Kinoshita N, Tokunaga K. Total lower eyelid reconstruction with a prefabricated flap using auricular cartilage. J Craniomaxillofac Surg 2008; 36:59-65. [DOI: 10.1016/j.jcms.2007.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2004] [Accepted: 08/28/2007] [Indexed: 11/26/2022] Open
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Gao W, Hong J, Li Z, Chen X. Hand reconstruction with lobulated combined flaps based on the circumflex scapular pedicle. Microsurgery 2008; 28:355-60. [DOI: 10.1002/micr.20500] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Suárez C, Ferlito A, Lund VJ, Silver CE, Fagan JJ, Rodrigo JP, Llorente JL, Cantù G, Politi M, Wei WI, Rinaldo A. Management of the orbit in malignant sinonasal tumors. Head Neck 2008; 30:242-50. [DOI: 10.1002/hed.20736] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Microsurgical Reconstruction of Posttraumatic High-Energy Maxillary Defects: Establishing the Effectiveness of Early Reconstruction. Plast Reconstr Surg 2007; 120:103S-117S. [DOI: 10.1097/01.prs.0000260728.60178.de] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suga H, Asato H, Okazaki M, Okochi M, Narushima M. Combination of Costal Cartilage Graft and Rib-Latissimus Dorsi Flap. J Craniofac Surg 2007; 18:639-42. [PMID: 17538331 DOI: 10.1097/scs.0b013e3180333f22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In secondary reconstruction of the maxilla, skeletal reconstruction as well as soft tissue augmentation is required to obtain a good contour. We present a new strategy for combining a costal cartilage graft with a rib-latissimus dorsi flap. We used this method to treat a 39-year-old man who had previously undergone total maxillectomy. First, a vascularized rib, elevated together with a latissimus dorsi flap, was fixed between the middle of the maxilla and the edge of the zygomatic arch. The small defects that could not be reconstructed with the rib only were reconstructed with a costal cartilage graft. The patient did not develop any postoperative infection or flap necrosis. Thirteen months after the secondary reconstruction, he presented with a good contour of the cheek. Our method was effective for the reconstruction of a complex skeletal defect of the maxilla.
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Affiliation(s)
- Hirotaka Suga
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Smith RB, Henstrom DK, Karnell LH, Chang KC, Goldstein DP, Funk GF. Scapula osteocutaneous free flap reconstruction of the head and neck: Impact of flap choice on surgical and medical complications. Head Neck 2007; 29:446-52. [PMID: 17163464 DOI: 10.1002/hed.20540] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The scapula osteocutaneous free flap is frequently used to reconstruct complex head and neck defects given its tissue versatility. Because of minimal atherosclerotic changes in its vascular pedicle, this flap also may be used as a second choice when other osseous flaps are not available because of vascular disease at a preferred donor site. METHODS We performed a retrospective chart review evaluating flap outcome as well as surgical and medical complications based upon the flap choice. RESULTS The flap survival rate was 97%. The surgical complication rate was similar for the 21 first-choice flaps (57.1%) and the 12 second-choice flaps (41.7%; p = .481). However, patients having second-choice flaps had a higher rate of medical complications (66.7%) than those with first-choice flaps (28.6%; p = .066). Age and the presence of comorbidities were associated with increased medical complications. All patients with comorbidities that had a second-choice flap experienced medical complications, with most being severe. CONCLUSIONS The scapula osteocutaneous free flap has a high success rate in head and neck reconstruction. Surgical complications occur frequently regardless of whether the flap is used as a first or second choice. However, medical complications are more frequent and severe in patients undergoing second-choice flaps.
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Affiliation(s)
- Russell B Smith
- Department of Otolaryngology/Head and Neck Surgery, University of Iowa, Iowa City, IA, USA.
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Clark JR, Vesely M, Gilbert R. Scapular angle osteomyogenous flap in postmaxillectomy reconstruction: Defect, reconstruction, shoulder function, and harvest technique. Head Neck 2007; 30:10-20. [PMID: 17636540 DOI: 10.1002/hed.20649] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Maxillary reconstruction continues to challenge in terms of optimal aesthetic and functional outcomes. The aim of this study was to describe the utility of the scapular angle osteomyogenous flap in a series of maxillectomy patients and to examine the donor site morbidity. METHODS This is a retrospective series of 14 patients undergoing maxillectomy and either primary or secondary reconstruction. The scapular angle can be oriented vertically and horizontally. Aesthetic, functional, and operative morbidity is described. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to examine shoulder and upper limb morbidity. RESULTS Perioperative morbidity occurred in 4 patients. There were no free flap failures. Functional and aesthetic outcomes were acceptable with all patients having intelligible speech and none requiring nutritional supplementation. The DASH was completed by 12 of 14 patients. The mean and median DASH scores were 10.6 and 13, respectively. All patients gained full range of shoulder movement by 6 months after surgery. CONCLUSIONS The scapular angle flap is well suited for maxillary reconstruction and donor site morbidity is low.
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Affiliation(s)
- Jonathan R Clark
- Department of Otolaryngology, Head and Neck Surgery, Princess Margaret Hospital, Toronto, Canada
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Liu YM, Chen GF, Yan JL, Zhao SF, Zhang WM, Zhao S, Chen L. Functional reconstruction of maxilla with pedicled buccal fat pad flap, prefabricated titanium mesh and autologous bone grafts. Int J Oral Maxillofac Surg 2006; 35:1108-13. [PMID: 17097269 DOI: 10.1016/j.ijom.2006.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 09/05/2006] [Accepted: 09/13/2006] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the use of pedicled buccal fat pad flap (PBFPF), prefabricated titanium mesh and autologous bone graft in maxillary reconstruction. Seventeen patients with a unilateral class I-III maxillary defect were involved. Preoperatively, a solid model was manufactured based on virtual maxillectomy and reconstruction of the abnormal maxilla. Intraoperatively, PBFPF was applied to repair the soft-tissue defect, serving as nasal lining and the receiving bed for bone grafts. Titanium mesh was prefabricated on the solid model and then, together with bone grafts from iliac crest, fixed to residual bones to reconstruct the hard-tissue defect. Postoperative aesthetic appearance and function were followed up. No exposure of titanium mesh, leakage or oronasal regurgitation occurred. Of the patients with a class I or II defect 91% (10/11) and of those with a class III defect 50% (3/6) gained a good appearance. Fifteen patients were articulate. Eleven patients received dental rehabilitation and had a normal diet. PBFPF with prefabricated titanium mesh and autologous bone grafts is a reliable option for reconstruction of unilateral maxillary defects of class I and II, but this method alone should be used cautiously in defects of class III and beyond.
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Affiliation(s)
- Y-M Liu
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Rd. Jiefang 88, Hangzhou 310009, China
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Abstract
Non-union of the long bones may have severe consequences, particularly when combined with other post-traumatic sequelae, such as tendon adhesions, reflex sympathetic dystrophy and infection, among others. In these cases, it is important to treat the delayed union or non-union first or at the same time with the other problems in order to achieve adequate function. Once the normal bony healing process has been slowed or stopped, it is necessary to provide both stability to the fracture site, as well as a biological stimulus for the fibrocartilagenous callus to finish the healing process. Vascularised grafts, such as the free fibula, offer not only structural support, but also promote bone healing. The later is achieved by trabecular bone formation, as well as vascular sprouting from pedicle vessels.
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Affiliation(s)
- Panayotis N Soucacos
- Department of Orthopaedic Surgery, University of Athens, School of Medicine, K.A.T. Accident Hospital, 2 Nikis Street, 145 61 Kifisia, Athens, Greece.
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Abstract
Reconstruction following extensive resection of the maxilla has been a challenging problem in the field of head and neck cancer surgery. At our institutes, maxillectomy defects have been restored based on the principles of repair involving the important concept of maxillary buttress reconstruction. Reconstruction of the zygomaticomaxillary buttress (ZMB), including the orbital floor, is essential for prevention of the malpositioning of the eyeglobe in preservation of the orbital contents. ZMB reconstruction is also important to provide a good contour of malar prominence. Pterygomaxillary buttress (PMB) reconstruction provides sufficient support for the fitting of a dental prosthesis. In patients with extensive resection of buccal soft tissue, a PMB and nasomaxillary buttress (NMB) should be reconstructed to prevent superior and posterior deviation of the alar base and oral commissure. We advocate that critical assessment of skeletal defects, as well as associated soft-tissue defects, following various types of maxillectomies is essential for a rational approach to achieve satisfactory clinical results.
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Affiliation(s)
- Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 14 Nishi 7, Sapporo 060-8638, Japan.
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Bidros RS, Metzinger SE, Guerra AB. The Thoracodorsal Artery Perforator-Scapular Osteocutaneous (TDAP-SOC) Flap for Reconstruction of Palatal and Maxillary Defects. Ann Plast Surg 2005; 54:59-65. [PMID: 15613885 DOI: 10.1097/01.sap.0000139561.64564.d7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite technical advances over the past 3 decades, subtotal, total, and extended total maxillectomy defects remain challenging reconstructive problems. In particular, postoncologic resection of the maxilla results in complex 3-dimensional defects of the midface, which cause severe functional and esthetic deformities. Such defects generally require composite tissue flaps for reconstruction. Rebuilding the palate and maxilla is especially challenging because it requires reconstitution of the facial buttresses, occlusion, replacement of bony hard palate, and the thin intraoral and intranasal lining which normally constitute the soft palate. Various methods of reconstruction have been applied to this area in search of an ideal soft tissue-bone flap to restore the bony framework of the maxilla and palate while providing an internal lining. Osteocutaneous and osteomuscular flaps such originating from the scapular, iliac, peroneal, and radial vascular systems have been attempted with good success. We devised an osteocutaneous flap based on the scapular vascular system, which provided bone and soft tissue to successfully reconstruct the palate and maxilla in 2 patients. The skin paddle received its blood supply from the major perforating vessels of the thoracodorsal artery, and the scapular bone was nourished by the angular vessels. Although free tissue transfer using thoracodorsal perforator flaps has been described, this flap has not been previously reported in the literature as an osteocutaneous tissue transfer. With the use of rigid fixation, excellent results have been obtained with this technique for palatal and maxillary reconstruction.
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Affiliation(s)
- Rafi Sirop Bidros
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Kelly CP, Moreira-Gonzalez A, Ali MA, Topf J, Persiani RJ, Jackson IT, Wiens J. Vascular Iliac Crest With Inner Table of the Ilium as an Option in Maxillary Reconstruction. J Craniofac Surg 2004; 15:23-8. [PMID: 14704557 DOI: 10.1097/00001665-200401000-00010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Reconstruction of large maxillary defects has been a long-standing challenge to the reconstructive surgeon. Total maxillary reconstruction is desirable but often not possible; ideally, this would provide all the anatomical structural support, function, and esthetics missing because of the defect. A case is presented in which all the criteria for total maxillary reconstruction have been fulfilled. The patient is a 60-year-old man who had wide excision of his maxilla for ameloblastoma, followed by temporal bone flap reconstruction, which failed. He presented to our institution for further evaluation and possible treatment options; these were discussed with the patient and the multidisciplinary team that deals with congenital and acquired deformities in the head and neck area. An iliac crest free flap that included the inner table of the ilium based on the deep circumflex iliac artery was used for the reconstruction. The procedure is described, including restoration of a nasal lining. Osseointegrated implants were used for dental rehabilitation. Ameloblastoma is briefly discussed. The goals of maxillary rehabilitation and obstacles to obtaining those goals are presented. Options available for maxillary reconstruction are discussed, along with some of their advantages and disadvantages, as is the reason why the iliac crest free flap with the inner table of the ilium was chosen. An iliac crest free flap with microvascular anastomosis to facial vessels was used to reconstruct a large maxillary defect. Osseointegrated implants were used to facilitate dental rehabilitation. Our patient has excellent restoration of oronasal function with a satisfactory esthetic result.
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Affiliation(s)
- Christopher P Kelly
- Institute for Craniofacial and Reconstructive Surgery, Providence Hospital, Southfield, Michigan 48075, USA
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Yamamoto Y, Kawashima K, Sugihara T, Nohira K, Furuta Y, Fukuda S. Surgical management of maxillectomy defects based on the concept of buttress reconstruction. Head Neck 2004; 26:247-56. [PMID: 14999800 DOI: 10.1002/hed.10366] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Few published large series have described a surgical approach to maxillary skeletal reconstruction on the basis of the extent of maxillectomy. METHODS We have reviewed a 10-year experience with 38 consecutive maxillary reconstructions with respect to maxillectomy defects, reconstructive procedures, reconstructed buttresses, and functional and aesthetic outcomes. RESULTS Maxillectomy defects were classified into three categories on the basis of the buttress concept. Buttress reconstruction was most frequently performed in category III maxillary defects (56%), followed by category I (50%) and category II (20%). The vascularized composite autograft included the rectus abdominis myocutaneous free flap combined with costal cartilage, and the latissimus dorsi myocutaneous free flap combined with the V-shaped scapula is an effective method for reliable reconstruction of both skeletal and soft tissues. CONCLUSIONS A critical assessment for skeletal defects and associated soft tissue defects is essential for an adequate approach to solve complex problems in maxillary reconstruction. On the basis of retrospective analysis of this series, a reconstructive algorithm for surgical management of maxillectomy defects is proposed.
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Affiliation(s)
- Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 14 Nishi 7 Kita-ku, Sapporo, 060-8638, Japan.
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Hardin JC. Reconstruction of maxilla with free latissimus dorsi-scapular osteomusculocutaneous flap. Plast Reconstr Surg 2003; 111:965; author reply 965-6. [PMID: 12560748 DOI: 10.1097/00006534-200302000-00102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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