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Hidaka T, Miyamoto S, Furuse K, Fukunaga Y, Oshima A, Matsuura K, Higashino T. Evaluation of aesthetic outcomes of mandibular reconstruction using artificial intelligence. Head Neck 2024. [PMID: 38698733 DOI: 10.1002/hed.27797] [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: 11/26/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Although vascularized bone graft (VBG) transfer is the current standard for mandibular reconstruction, reconstruction with a mandibular reconstruction plate (MRP) and with a soft-tissue flap (STF) alone remain crucial options for patients with poor general conditions. However, objective aesthetic outcome evaluations for these methods are limited. METHODS In a retrospective analysis of 65 patients (VBG, 33; MRP, 19; and STF, 13), mandibular asymmetry value was calculated for each patient's photograph using facial recognition AI, with a higher value indicating worse asymmetry. RESULTS The MRP group had a value comparable to the VBG group regardless of mandibular defect types. The STF group had a significantly higher value than the VBG group. CONCLUSIONS Regarding cosmesis, STF was inferior to VBG, whereas MRP was comparable to VBG, even for anterior defects for which rigid reconstruction is mandatory. However, MRP's risks of plate-related complications limit its use to cases where VBG is contraindicated or with poor prognosis. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Takeaki Hidaka
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shimpei Miyamoto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, The University of Tokyo, Hongo, Japan
| | - Kiichi Furuse
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yutaka Fukunaga
- Department of Plastic Surgery, Naruto Hospital, Naruto, Japan
| | - Azusa Oshima
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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Wu RT, Lin JAJ, Su CCL, Wei FC. Sequential free fibula transfers: Quality of life and systematic review. Microsurgery 2024; 44:e31184. [PMID: 38747121 DOI: 10.1002/micr.31184] [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: 11/28/2023] [Revised: 03/04/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Successive osteoseptocutaneous fibula transfers for jaws reconstruction are rare but important options. This study contributes patient-reported and clinical outcomes, as well as systematically reviews all existing reports. METHODS All sequential fibula transfers performed by the senior author were reviewed from a prospectively managed database, including University of Washington quality of life (UWQoL). Systematic review was conducted in PubMed and Cochrane databases for similar publications. RESULTS Eighteen patients (average age 51.5 years) received sequential fibulas (mean 4.7 years between reconstructions). Secondary fibulas more often had benign indications (72.2% vs. 33.3%, p = .04), most commonly osteoradionecrosis (38.9%). At a mean follow-up of 30.5 months, the average interincisal distance increased from 21.8 to 27.6 mm, and 92.3% tolerated an oral diet following the second fibula. Eight patients completed the UW-QoL before and after the second fibula, and three prior to the first fibula. Composite physical function was significantly decreased from 96.7 prefibula reconstruction to 63.3 following the first (p < .001) and 64.2 after the second fibula (p < .001). There were no differences in other domains. The systematic review yielded six articles reporting 56 patients (mean 39 months between fibulas). Secondary fibulas were performed for repeat malignancy (45%) and osteoreadionecrosis (39%), resulting in elevated tube feeding from 20% following the first to 39% following the second, but overall high quality of life in two studies. CONCLUSIONS Sequential osteoseptocutaneous fibula reconstructions of jaws are often performed for benign indications such as osteoradionecrosis. Overall function and QoL are comparable with those following the first fibula transfer.
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Affiliation(s)
- Robin T Wu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Reconstructive Microsurgery, Medical College, Chang Gung University, Taoyuan, Taiwan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Hospital, Stanford, California, USA
| | - Jennifer An-Jou Lin
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Reconstructive Microsurgery, Medical College, Chang Gung University, Taoyuan, Taiwan
| | - Charlie Chun-Lin Su
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Reconstructive Microsurgery, Medical College, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Chan Wei
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Reconstructive Microsurgery, Medical College, Chang Gung University, Taoyuan, Taiwan
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Taylor EM, Vorstenbosch J, Morrison E, Janssen PL, Kronstadt KL, Randazzo J, Rosen EB, Cordeiro PG, Shahzad F, Ganly I, Matros E. Making the Case for Virtual Surgical Planning: Bilateral Sequential Fibula Flaps with Immediate Dental Implants for Maxillectomy. Plast Reconstr Surg 2023; 152:707e-711e. [PMID: 36780347 PMCID: PMC11305406 DOI: 10.1097/prs.0000000000010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
SUMMARY Oncologic maxillectomy defects requiring bony reconstruction are among the most challenging head and neck cases because of the complex three-dimensional geometry of the midface. Virtual surgical planning technology is advantageous in these cases because it provides superior positional precision and accuracy compared with traditional techniques and facilitates prosthodontic rehabilitation. Maxillary cancer recurrence after an initial fibula flap reconstruction presents a unique challenge. The authors report the first two cases of sequential fibula flaps after second or recurrent cancer of the maxilla. Virtual surgical planning facilitated resection with adequate tumor margins, optimized anatomic positioning of the fibula construct with three-dimensional printed plates, and enabled immediate functional dental implant placement.
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Affiliation(s)
- Erin M. Taylor
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Joshua Vorstenbosch
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Edwin Morrison
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pierce L. Janssen
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kenneth L. Kronstadt
- Division of Maxillofacial Prosthetics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph Randazzo
- Division of Maxillofacial Prosthetics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Evan B. Rosen
- Dental Oncology and Maxillofacial Prosthetics, Miami Cancer Institute, Miami, FL
| | - Peter G Cordeiro
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Farooq Shahzad
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ian Ganly
- Division of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Evan Matros
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Molteni G, Gazzini L, Sacchetto A, Nocini R, Comini LV, Arietti V, Locatello LG, Mannelli G. Mandibular reconstruction in head and neck cancer: which is the gold standard? Eur Arch Otorhinolaryngol 2023; 280:3953-3965. [PMID: 37269408 DOI: 10.1007/s00405-023-08050-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aim of this study is to perform a systematic review to compare the outcomes of the different surgical options for mandibular reconstruction in head and neck cancer. MATERIAL AND METHODS 93 articles were selected. Four groups were identified: titanium plate without flaps, titanium plate covered by soft tissue flap, bone tissue flaps and double flaps. We compared patients' characteristics, site of mandibulectomy, type of reconstruction and complications. RESULTS 4697 patients were reported. The groups were not homogeneous regarding the type of defect and the treatment history. A significant difference in terms of post-operative complications was found between group 1 and group 2 (p < 0.00001), and between group 2 and group 3 (p < 0.00001). Total complications rate for group 4 was significantly higher when compared to group 3 (p < 0.00001), but no significant difference was found with group 2. CONCLUSION These results suggest that mandibular reconstruction using a microvascular bone flap is the best surgical option in patients without significant comorbidities.
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Affiliation(s)
- Gabriele Molteni
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Head and Neck Department, University Hospital of Verona, Verona, Italy
- Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Luca Gazzini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otorhinolaryngology-Head and Neck Surgery Department, San Maurizio Hospital, Bolzano, Italy
| | - Andrea Sacchetto
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria.
- Department of Otolaryngology, Ospedale San Bortolo, AULSS 8 Berica, Vicenza, Italy.
| | - Riccardo Nocini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Lara Valentina Comini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otorhinolaryngology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Valerio Arietti
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Luca Giovanni Locatello
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Otorhinolaryngology, Sant'Antonio Abate Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| | - Giuditta Mannelli
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Dunlap Q, Hairston H, Gardner JR, Hagood J, Turner M, King D, Sunde J, Vural E, Moreno MA. Comparing donor site morbidity in osteocutaneous radial forearm versus fibula free flap for mandibular reconstruction. Am J Otolaryngol 2023; 44:103946. [PMID: 37329698 DOI: 10.1016/j.amjoto.2023.103946] [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: 05/02/2023] [Accepted: 06/03/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE The osteocutaneous radial forearm free flap has gained popularity as a less morbid option for oromandibular reconstruction compared to the fibular free flap. However, there is a paucity of data regarding direct outcome comparison between these techniques. METHODS Retrospective chart review of 94 patients who underwent maxillomandibular reconstruction intervened from July 2012-October 2020 at the University of Arkansas for Medical Sciences. All other bony free flaps were excluded. Endpoints retrieved encompassed demographics, surgical outcomes, perioperative data, and donor site morbidity. Continuous data points were analyzed using independent sample t-Tests. Qualitative data was analyzed using Chi-Square tests to determine significance. Ordinal variables were tested using the Mann-Whitney U test. RESULTS The cohort was equally male and female, with a mean age of 62.6 years. There were 21 and 73 patients in the osteocutaneous radial forearm free flap and fibular free flap cohorts, respectively. Excluding age, the groups were otherwise comparable, including tobacco use, and ASA classification. Bony defect (OC-RFFF = 7.9 cm, FFF = 9.4 cm, p = 0.021) and skin paddle (OC-RFFF = 54.6 cm2, FFF = 72.21 cm2, p = 0.045) size were larger in the fibular free flap group. However, no significant difference was found between cohorts with respect to skin graft. There was no statistically significant difference between cohorts regarding the rate of donor site infection, tourniquet time, ischemia time, total operative time, blood transfusion, or length of hospital stay. CONCLUSIONS No significant difference in perioperative donor site morbidity was found between patients undergoing fibular forearm free flap and osteocutaneous radial forearm flap for maxillomandibular reconstruction. Osteocutaneous radial forearm flap performance was associated with significantly older age, which may represent a selection bias.
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Affiliation(s)
- Quinn Dunlap
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Hayden Hairston
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - James Reed Gardner
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Joshua Hagood
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Merit Turner
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Deanne King
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Jumin Sunde
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Emre Vural
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Mauricio Alejandro Moreno
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
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Liu K, Zhang W, Wang Y, Xiang DW, Shi HB, Liu QL. Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report. Medicine (Baltimore) 2020; 99:e23590. [PMID: 33327322 PMCID: PMC7738134 DOI: 10.1097/md.0000000000023590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Cutaneous perforators of peroneal vessels are divided into proximal and distal perforators on the basis of perforator distributions and musculocutaneous or septocutaneous properties. The traditional fibular osteocutaneous free flap is raised over the distal two-thirds of the fibula with a skin paddle based on distal perforators, which is affixed to the posterior crural septum. However, the skin pedicle may not be available due to anatomic variations or intraoperative injuries. Herein, because of the absence of distal perforators, we reserved and expropriated proximal perforators originating from the musculocutaneous branch of the superior part of the peroneal artery before it divided into nutrient and arcuate arteries and successfully harvested a separate osteal fibula and proximal perforator skin paddle with a single vascular pedicle-peroneal vessel. PATIENT CONCERNS A 62-year-old man with a 6-month history of mandibular swelling and soft tissue invasion was referred to us. DIAGNOSIS Panoramic radiography and computed tomography showed an irregular radiolucent lesion of the mandibular body, and histopathological analysis confirmed a follicular-pattern ameloblastoma. INTERVENTIONS The diseased mandible and soft tissue were resected and reconstructed with a vascularized fibular osteal flap with the proximal perforator skin paddle. OUTCOMES The mandibular contour was successfully restored; the skin paddle in the mouth was in good condition after 8 months of follow-up. LESSONS The proximal perforator is reliable and practical for supplying a skin paddle and has significant potential for future applications. We recommend reserving the proximal perforator skin paddle as a backup flap when planning to raise a fibula flap, since unavailability or injury of the traditional fibular skin island based on distal perforators occurs frequently. This approach can avoid the exploration for a second donor site, save surgical time, and reduce surgical complexity. Moreover, we anticipate more frequent use of the proximal perforator flap in the future because of its flexibility and large volume, and since it can be combined with the osteal fibula or fibular osteocutaneous flap. However, an understanding of the traits of the proximal perforator and determination of its peroneal origin by computed tomography angiography is crucial for predesigning fibular osteal flaps with a proximal perforator skin paddle.
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Affiliation(s)
- Kang Liu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun
| | - Wei Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun
| | - Yue Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun
- Department of Oral and Maxillofacial Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, PR China
| | - Dan-Wei Xiang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun
| | - Hai-Bo Shi
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun
| | - Qi-Lin Liu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun
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Free Flap Outcomes of Microvascular Reconstruction after Repeated Segmental Mandibulectomy in Head and Neck Cancer Patients. Sci Rep 2019; 9:7951. [PMID: 31138880 PMCID: PMC6538601 DOI: 10.1038/s41598-019-44467-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 05/17/2019] [Indexed: 11/25/2022] Open
Abstract
This is the first study to investigate the impact of a second fibula flap or a soft tissue flap combined with bridging plate for a repeated segmental mandibulectomy reconstruction on flap outcomes in head and neck cancer patients. A retrospective comparative analysis (2007–2016) of 61 patients who underwent a second segmental mandibulectomy was performed. 20 patients underwent a fibula flap reconstruction whereas 41 had a soft tissue flap and plate reconstruction. No significant difference was seen in the operative time, total hospital stay, flap loss, re-exploration rates, plate exposure rate, or recipient site infection rate. On multivariate analysis, patients reconstructed with a soft tissue flap and bridging plate (odds ratio (OR) 3.997; 95% confidence interval (CI), 1.046–15.280, p = 0.043) and complications developed in previous surgery (OR 4.792; 95% CI, 1.120–20.493, p = 0.035) were shown to be independent predictors of a prolonged nasogastric tube dependence. The utilization of a soft tissue flap with plate is associated with comparative results of acute complication rate within 1 week, recipient site infection rate, and plate exposure rate to free fibula flaps alone. Free fibula flaps may result in a decreased risk for prolonged tube dependence compared to free soft tissue flap reconstructions.
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Miyamoto S, Higashino T, Sakuraba M. Mandibular reconstruction in elderly patients. J Surg Oncol 2018; 117:1744-1751. [PMID: 29761514 DOI: 10.1002/jso.25059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/08/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The choice of reconstructive technique for a segmental mandibular defect in elderly patients is controversial. The aim of this study was to establish an algorithm for selecting a method of mandibular reconstruction in elderly patients. METHODS We retrospectively evaluated 121 patients aged ≥65 years who underwent immediate microvascular mandibular reconstruction after oncologic resection. Patients were divided into three groups based on method of reconstruction: vascularized bone graft (n = 49), mandibular reconstruction plate and soft tissue flap (n = 22), and soft-tissue flap (n = 50). We compared perioperative outcomes among groups and investigated factors affecting the choice of reconstructive technique. RESULTS Rates of postoperative complications did not differ significantly among groups. Mandibular reconstruction plate was indicated only for anterior mandibular defects. Soft-tissue flap was indicated for posterior mandibular defects in patients aged ≥75 years or with a poor postoperative Eichner index. CONCLUSIONS Mandibular reconstruction plate and soft-tissue flap can be good alternatives to vascularized bone graft in the elderly. Our algorithm uses defect type, patient age, and postoperative Eichner index to determine reconstructive technique.
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Affiliation(s)
- Shimpei Miyamoto
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takuya Higashino
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Minoru Sakuraba
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan
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Using a Second Free Fibula Osteocutaneous Flap after Repeated Mandibulectomy Is Associated with a Low Complication Rate and Acceptable Functional Outcomes. Plast Reconstr Surg 2017; 140:381-389. [DOI: 10.1097/prs.0000000000003523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Free Hand Perforator Concept in Osteocutaneous Free Fibula Flap Through Posterior Approach. J Craniofac Surg 2017; 28:559-563. [DOI: 10.1097/scs.0000000000003342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Barry CP, Brown J, Hanlon R, Shaw R. Tailored approach to oromandibular reconstruction in patients with compromised lower limb vessels. Head Neck 2017; 39:916-920. [DOI: 10.1002/hed.24709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 11/01/2016] [Accepted: 12/09/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Conor P. Barry
- Liverpool Head and Neck Cancer Unit; Aintree University Hospital; Liverpool United Kingdom
- National Maxillofacial Unit; St. James's Hospital; Dublin Ireland
- Dublin Dental University Hospital; Dublin Ireland
| | - James Brown
- Liverpool Head and Neck Cancer Unit; Aintree University Hospital; Liverpool United Kingdom
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - Rebecca Hanlon
- Liverpool Head and Neck Cancer Unit; Aintree University Hospital; Liverpool United Kingdom
| | - Richard Shaw
- Liverpool Head and Neck Cancer Unit; Aintree University Hospital; Liverpool United Kingdom
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
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Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55:113-126. [DOI: 10.1016/j.bjoms.2016.12.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
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Reiser V, Alterman M, Shuster A, Kleinman S, Shlomi B, Yanko-Arzi R, Zaretski A, Amir A, Fliss DM. V-stand--a versatile surgical platform for oromandibular reconstruction using a 3-dimensional virtual modeling system. J Oral Maxillofac Surg 2015; 73:1211-26. [PMID: 25981838 DOI: 10.1016/j.joms.2014.12.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 12/16/2014] [Accepted: 12/23/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The challenge of oromandibular reconstruction (OMR) after oncologic resections has been repeatedly addressed in the literature. Although final oncologic margins can be decided only during surgery, various attempts have been made to create an ideal and accurate platform for OMR. The purpose of this article is to present the V-stand, a versatile surgical platform for OMR using a 3-dimensional (3D) virtual modeling system. MATERIALS AND METHODS Seventeen patients requiring an OMR were included in the study. A presurgical computed tomogram was obtained and virtual resection and reconstruction with a free fibular flap were planned using 3D virtual surgery software. The mandible was reconstructed intraoperatively using the V-stand, which served as a template for the lower border of the mandible and the lateral aspects of the stand were fixed to the proximal mandibular segments using 2-mm titanium screws. RESULTS Patients' average age was 53 years (5 to 72 yr). Median follow-up was 19 months (2 to 35 months). All reconstructed mandibles resulted in good function and esthetics. CONCLUSIONS The V-stand offers a safe and time-efficient method for OMR. It provides an excellent means for accurate spatial positioning of a fibular free flap. The V-stand preserves the original dimensions of the reconstructed mandible and can overcome surgical ablation modifications because it is not dependent on the precision of the resection, but rather provides a mold for the entire mandible.
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Affiliation(s)
- Vadim Reiser
- Attending Physician, Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Alterman
- Attending Physician, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel.
| | - Amir Shuster
- Attending Physician, Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shlomi Kleinman
- Attending Physician, Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Benjamin Shlomi
- Unit Head, Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ravit Yanko-Arzi
- Attending Physician, Department of Reconstructive and Aesthetic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Arik Zaretski
- Attending Physician, Department of Reconstructive and Aesthetic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Aharon Amir
- Department Head, Department of Plastic Surgery, Carmel Medical Center, Haifa, Israel
| | - Dan M Fliss
- Professor, Department Head, Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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14
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Broyles JM, Abt NB, Shridharani SM, Bojovic B, Rodriguez ED, Dorafshar AH. The fusion of craniofacial reconstruction and microsurgery: a functional and aesthetic approach. Plast Reconstr Surg 2014; 134:760-769. [PMID: 25357035 DOI: 10.1097/prs.0000000000000564] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reconstruction of large, composite defects in the craniofacial region has evolved significantly over the past half century. During this time, there have been significant advances in craniofacial and microsurgical surgery. These contributions have often been in parallel; however, over the past 10 years, these two disciplines have begun to overlap more frequently, and the techniques of one have been used to advance the other. In the current review, the authors aim to describe the available options for free tissue reconstruction in craniofacial surgery. METHODS A review of microsurgical reconstructive options of aesthetic units within the craniofacial region was undertaken with attention directed toward surgeon flap preference. RESULTS Anatomical areas analyzed included scalp, calvaria, forehead, frontal sinus, nose, maxilla and midface, periorbita, mandible, lip, and tongue. Although certain flaps such as the ulnar forearm flap and lateral circumflex femoral artery-based flaps were used in multiple reconstructive sites, each anatomical location possesses a unique array of flaps to maximize outcomes. CONCLUSIONS Craniofacial surgery, like plastic surgery, has made tremendous advancements in the past 40 years. With innovations in technology, flap design, and training, microsurgery has become safer, faster, and more commonplace than at any time in history. Reconstructive microsurgery allows the surgeon to be creative in this approach, and free tissue transfer has become a mainstay of modern craniofacial reconstruction.
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Affiliation(s)
- Justin M Broyles
- Baltimore, Md. From the Department of Plastic Surgery, The Johns Hopkins University School of Medicine; and the Division of Plastic Surgery, R Adams Cowley Shock Trauma Center
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