1
|
Bottini GB, Joos V, Steiner C, Zeman-Kuhnert K, Gaggl A. Advances in Microvascular Reconstruction of the Orbit and Beyond: Considerations and a Checklist for Decision-Making. J Clin Med 2024; 13:2899. [PMID: 38792440 PMCID: PMC11122336 DOI: 10.3390/jcm13102899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
This paper aims to discuss the microvascular reconstruction of the orbit and adjacent regions and to propose a checklist to aid the reconstructive surgeon in this challenging undertaking. The discussion is based on a literature review that includes 32 retrospective case series, 5 case reports published in the last 34 years in PubMed, and 3 textbook chapters. Additionally, it relies on the senior author's expertise, described in a case series, and two case reports published elsewhere. Classifications and treatment algorithms on microvascular orbit reconstruction generally disregard patient-related factors. A more holistic approach can be advantageous: patient-related factors, such as age, comorbidities, prognosis, previous interventions, radiotherapy, and the wish for maximal dental rehabilitation and a prosthetic eye, have the same importance as defect-related considerations and can inform the choice of a reconstructive option. In this manuscript, we examine defect- and patient-related factors and new technologies, provide a checklist, and examine future directions. The checklist is intended as a tool to aid in the decision-making process when reconstructing the orbital region with microvascular flaps.
Collapse
Affiliation(s)
- Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Veronika Joos
- Private Practice for Dentistry and Oral and Maxillofacial Surgery, 5026 Salzburg, Austria
| | - Christoph Steiner
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Katharina Zeman-Kuhnert
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Alexander Gaggl
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| |
Collapse
|
2
|
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.
| |
Collapse
|
3
|
Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
|
4
|
Parham MJ, Ding Y, Wang DS, Jiang AY, Buchanan EP. Pediatric Craniofacial Tumor Reconstruction. Semin Plast Surg 2023; 37:265-274. [PMID: 38098683 PMCID: PMC10718654 DOI: 10.1055/s-0043-1776330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Effective management of pediatric craniofacial tumors requires coordinated input from medical, oncologic, and surgical specialties. Reconstructive algorithms must consider limitations in pediatric donor tissue and account for future growth and development. Immediate reconstruction is often focused on filling dead space, protecting underlying structures, and ensuring skeletal symmetry. Staged reconstruction occurs after the patient has reached skeletal maturity and is focused on restoring permanent dentition. Reconstructive options vary depending on the location, size, and composition of resected tissue. Virtual surgical planning (VSP) reduces the complexity of pediatric craniofacial reconstruction and ensures more predictable outcomes.
Collapse
Affiliation(s)
- Matthew J. Parham
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Yang Ding
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Daniel S. Wang
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Austin Y. Jiang
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P. Buchanan
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Austin, Texas
| |
Collapse
|
5
|
Adeyemo AA, Ogunkeyede SA, Daniel A, Lasisi AO. Paediatric paranasal sinus fibrous dysplasia. Trop Doct 2023; 53:117-120. [PMID: 36112944 DOI: 10.1177/00494755221125080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibrous dysplasia in the bony walls of a paranasal sinus is a developmental tumour that is associated with a marked facial deformity. Delay in hospital presentation contributes to the destructive resection techniques employed and the management outcome. Our study looks at the factors for delay in hospital presentation and the management outcome by a retrospective review between January 1997 and December 2018. Of 43 children (M: F 1:1.2) with a mean age of 12 ± 1.75 years, the maxillary bones were mostly affected. All underwent surgical resection with good management outcomes except for maxillectomy. Tumour recurrence was noted in five and there was no mitotic cell at histology. The clinical symptoms of fibrous dysplasia vary in severity and age of onset, often with late hospital presentation already with complications. Health education is needed to reverse this trend.
Collapse
Affiliation(s)
- A A Adeyemo
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria
| | - S A Ogunkeyede
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria.,Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A Daniel
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria.,Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A O Lasisi
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria.,Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
6
|
Swendseid B, Philips RHW, Carey RM, Cannady SB, Sweeny L, Wax MK, Luginbuhl AJ, Curry JM. Postoperative analysis of osseous midface reconstructions: The value of imaging and a novel scoring system for complexity and operative success. Head Neck 2023; 45:237-242. [PMID: 36300998 PMCID: PMC10092237 DOI: 10.1002/hed.27228] [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: 06/14/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few standardized methods exist for evaluating the postoperative outcomes of osteocutaneous free flaps. We propose an anatomic-based scoring system for midface free flap reconstruction. METHODS One hundred and twelve patients across four institutions underwent osteocutaneous reconstruction of the midface. Postoperative scans were scored based on the number of independent osseous subunits reconstructed (Subunit Score), the number of different bony appositions with bony contact (Contact Score), and the number of osseous segments in anatomic position (Position Score). These were added together to create a Total Score. RESULTS Osteocutaneous radial forearm flaps had the lowest Subunit Score (p = 0.001). Fibula flaps had the highest Contact Score (p = 0.0008) and Position Score (p = 0.001). Virtual surgical planning was associated with an increased Subunit Score (p = 0.02) and Total Score (p = 0.04). CONCLUSIONS We propose a novel scoring system for osseous midface reconstruction based on postoperative imaging scans. This can help guide management decisions and create a common language to compare outcomes.
Collapse
Affiliation(s)
- Brian Swendseid
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.,Department of Otolaryngology - Head and Neck Surgery, Cooper University Health, Camden, New Jersey, USA
| | - Ramez H W Philips
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven B Cannady
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Larissa Sweeny
- Department of Otolaryngology - Head and Neck Surgery, University of Miami, Miami, Florida, USA
| | - Mark K Wax
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Adam J Luginbuhl
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Orbital Extenteration Defects: Ablative and Reconstructive Flowchart Proposal. J Craniofac Surg 2022; 34:893-898. [PMID: 36217235 DOI: 10.1097/scs.0000000000009052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Orbital exenteration is a radical and disfiguring operation. It is still under debate the absence of correlation between the term describing the resulting orbital defect and the type of reconstruction. Authors' goal was to propose a consistent and uniform terminology for Orbital Exenteration surgery in anticipation of patients' tailored management. Twenty-five patients who underwent orbital exenteration between 2014 and 2020 were reviewed. A parallel comprehensive literature review was carried on. Five different types of orbital exenteration where outlined. Multiple reconstructive procedures were enclosed. An algorithm for orbital reconstruction was proposed based on anatomic boundaries restoration. Eyelid removal was first considered as an independent reconstructive factor, and both orbital roof and floor were indicated as independent reconstructive goals, which deserve different defect classification. In our opinion, this algorithm could be a useful tool for patient counseling and treatment selection, which might allow a more tailored patient care protocol. LEVEL OF EVIDENCE Level III.
Collapse
|
8
|
Free Your Mind, Not Your Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4384. [PMID: 35720204 PMCID: PMC9200385 DOI: 10.1097/gox.0000000000004384] [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: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
Abstract
The pedicled flap has been a mainstay of soft tissue reconstruction since the earliest days of plastic surgery. Advances in surgical technology and skill have led to an erosion in the use of pedicled flaps in favor of increasingly popular free tissue transfers. Still, regional flaps without microvascular anastomosis remain a valuable reconstructive tool. Although still requiring microsurgical skills, these flaps are of particular benefit in patients with few or poor quality recipient vessels, in those who cannot tolerate antiplatelet therapy, and in those who cannot tolerate the often-extended anesthesia time necessitated by microvascular anastomosis. Furthermore, pedicled flaps may significantly reduce total cost of a reconstruction procedure with similar outcomes. In this case series, we report challenging scenarios where microsurgical approaches may have been typical choices but were instead reconstructed by pedicled options with desired outcomes. Difficult soft tissue defects were successfully reconstructed with a variety of pedicled flaps. Soft tissue transfers to the abdomen, flank, shoulder, and back are presented. None of the reconstructions required microvascular anastomosis.
Collapse
|
9
|
Mattine S, Payne KFB. The evolving role of the superficial temporal vessels as anastomotic recipients in challenging microvascular reconstruction of the upper two-thirds of the face. J Plast Reconstr Aesthet Surg 2022; 75:3330-3339. [PMID: 35710778 DOI: 10.1016/j.bjps.2022.04.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
Abstract
Free-tissue transfer is now the standard of care in reconstructing head and neck defects. Microvascular reconstruction of the upper two-thirds of the face, particularly following recurrent malignant disease, however, remains a challenge. Retrospective review of all patients undergoing microsurgical reconstruction for defects of the upper two-thirds of the face between 2015 and 2019 revealed 17 free-tissue transfers where the superficial temporal vessels (STVs) were used as recipient vessels. Perioperative data, including return to theatre (RTT) and flap success rates were evaluated. Three patients required reoperation for vascular compromise. One of these patients ultimately lost the flap resulting in flap survival of 94%. This flap failure was, however, secondary to external factors distant to the flap and the anastomosis. In this patient, subsequent attempt at microvascular reconstruction was carried out successfully using contralateral neck vessels and vein grafts. We demonstrate the STVs are safe and reliable in microsurgical reconstruction for a variety of defects. Close proximity to the resection, reconstructing with flaps with a short pedicle, negating the need for neck access and/or high-risk anastomosis in a previously irradiated/operated vessel depleted neck are all highlighted indications. The pre-auricular/temporal access is familiar to the reconstructive surgeon and has excellent post-operative aesthetic results. We discuss key advantages of this approach and highlight potential complications and learning points - underlining the benefit of this approach for the head and neck reconstructive surgeon.
Collapse
Affiliation(s)
- Samuel Mattine
- Consultant Head and Neck Microvascular Reconstructive Surgeon, Worcestershire Royal Hospital, Hawthorne Suite, Charles Hasting Way, Worcester, WR5 1DD, United Kingdom.
| | | |
Collapse
|
10
|
Bottini GB, Hutya V, Kummer D, Steiner C, Zeman-Kuhnert K, Wittig J, Gaggl A. Microvascular reconstruction of the orbit and adjacent regions: A case series. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
11
|
Petrides GA, Dunn M, Charters E, Venchiarutti R, Cheng K, Froggatt C, Mukherjee P, Wallace C, Howes D, Leinkram D, Singh J, Nguyen K, Hubert Low TH, Ch'ng S, Wykes J, Clark JR. Health-related quality of life in maxillectomy patients undergoing dentoalveolar rehabilitation. Oral Oncol 2022; 126:105757. [PMID: 35121398 DOI: 10.1016/j.oraloncology.2022.105757] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Surgical resection of the maxilla impairs aesthetics, speech, swallowing, and mastication. Maxillary reconstruction is increasingly performed with virtual surgical planning (VSP) to enhance functional dental rehabilitation with a conventional denture or osseointegrated implants. The aim of this study was to determine whether dental status and VSP is associated with health-related quality of life (HRQOL) and function in patients who have undergone maxillectomy. MATERIALS AND METHODS A cross-sectional study was conducted among patients who underwent free flap reconstruction or obturation of the maxilla between July 2009 and December 2020. The FACE-Q Head and Neck Cancer (FACE-Q) module, M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) were used to evaluate HRQOL. RESULTS Forty-three patients (response rate 59%) completed questionnaires and 48% underwent dental rehabilitation. In Okay Class II and III defects, adjusting for the effect of radiotherapy and time from surgery, there was a positive association between denture status and FACE-Q smiling (p = 0.020), eating (p = 0.012), smiling (p = 0.015), and MDADI global (p = 0.015), emotional (p = 0.027), functional (p = 0.028), and composite (p = 0.029) scores. VSP was associated with FACE-Q swallowing (p = 0.005), drooling (p = 0.030), eating (p = 0.008), smiling (p = 0.021), MDADI global (p = 0.017), emotional (p = 0.041), functional (p = 0.040), composite (p = 0.038), and SHI total scores (p = 0.042). CONCLUSIONS Dentoalveolar rehabilitation and VSP were associated with higher HRQOL scores relating to eating and drinking, smiling, and speaking.
Collapse
Affiliation(s)
- George A Petrides
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Masako Dunn
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Emma Charters
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Rebecca Venchiarutti
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Kai Cheng
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Catriona Froggatt
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Payal Mukherjee
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Christine Wallace
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, Corner of Hawkesbury Road and, Darcy Road, Westmead NSW 2145, Australia
| | - Dale Howes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; School of Dentistry, Faculty of Medicine and Health, University of Sydney, 2 Chalmers St, Surry Hills, NSW 2010, Australia
| | - David Leinkram
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Jasvir Singh
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Kevin Nguyen
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia; Department of Plastic Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia.
| |
Collapse
|
12
|
Katsnelson JY, Tyrell R, Karadsheh MJ, Manstein E, Egleston B, Deng M, Baltodano PA, Shafqat MS, Patel SA. Postoperative Complications Associated with the Choice of Reconstruction in Head and Neck Cancer: An Outcome Analysis of 4,712 Patients from the ACS-NSQIP Database. J Reconstr Microsurg 2021; 38:343-360. [PMID: 34404103 DOI: 10.1055/s-0041-1733922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Microsurgical free flaps have largely supplanted pedicled flaps as the gold standard for head and neck cancer reconstruction. However, incidence of postoperative complications after accounting for patient comorbidities based on choice of reconstruction has not been well-defined in the literature in recent years. METHODS Patients undergoing head and neck reconstruction were identified in the 2011-2016 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database and stratified into groups by free flap, myocutaneous pedicled flap, and other reconstruction. Demographics were analyzed and covariates balanced using overlap propensity score-based weighting. Logistic regression was used for binary outcomes and Gamma generalized linear model was used for length of stay. RESULTS A total of 4,712 patients met inclusion criteria out of which 1,297 patients (28%) underwent free flap, 208 patients (4%) pedicled flap, and 3,207 patients (68%) had other, or no reconstruction performed. After adjusting for patient and disease-specific factors, pedicled flap reconstruction was associated with a higher risk of deep vein thrombosis (odds ratio [OR] = 2.64, confidence interval [CI] 1.02-6.85, p = 0.045), sepsis (OR = 2.95, CI 1.52-5.71, p = 0.001), and infection (OR = 2.03, CI 1.39-2.96, p <0.001) compared with free flap reconstruction. Free flaps had the longest mean operative time compared with the other two groups (unadjusted 578 vs. 440 vs. 326, p <0.001). Pedicled flaps had a lower incidence of bleeding requiring transfusion (adjusted OR = 0.65, CI 0.50-0.85, p = 0.002), and lower incidence of prolonged mechanical ventilation (adjusted OR = 0.33, CI 0.12-0.92, p = 0.034) compared with free flaps. There was no difference in rates of reoperation, hospital readmission, or hospital length-of-stay between pedicled and free flaps. CONCLUSION Myocutaneous pedicled flaps are associated with higher overall short-term postoperative complications compared with free flaps in head and neck reconstruction, which demonstrate a more favorable morbidity profile without significantly impacting hospital readmission, reoperation, or length-of-stay.
Collapse
Affiliation(s)
- Jacob Y Katsnelson
- Department of Surgery, Abington-Jefferson Health, Abington, Pennsylvania
| | - Richard Tyrell
- Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Murad J Karadsheh
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Ely Manstein
- Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Brian Egleston
- Biostatistics and Bioinformatics Facility, Temple University Health System, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mengying Deng
- Biostatistics and Bioinformatics Facility, Temple University Health System, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Pablo A Baltodano
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - M Shuja Shafqat
- Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania.,Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sameer A Patel
- Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania.,Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| |
Collapse
|
13
|
Petrides GA, Hicks G, Dunn M, Froggatt C, Wallace C, Howes D, Leinkram D, Low THH, Ch'ng S, Wykes J, Palme CE, Clark JR. Dentoalveolar outcomes in maxillary reconstruction: A retrospective review of 85 maxillectomy reconstructions. ANZ J Surg 2021; 91:1472-1479. [PMID: 34124825 DOI: 10.1111/ans.17001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although microvascular free flaps are often used to reconstruct maxillary defects, dentoalveolar rehabilitation is arguably less common despite its importance to midface function and aesthetics. The aim of this study is to review the contemporary management of maxillary defects in a single quaternary referral institution to identify factors that assist or impede dentoalveolar rehabilitation. METHODS A retrospective review of maxillary reconstructions performed between February 2017 and December 2020 was performed. Patient characteristics, defect classification, operative techniques, complications and dentoalveolar outcomes were recorded. RESULTS A total of 85 maxillary reconstructions were performed in 73 patients. Of the 64 patients where dental rehabilitation was required, 31 received a functional denture (48%) with 24 (38%) being implant-retained. Significant predictors of successful rehabilitation included the use of virtual surgical planning (VSP; 86% vs. 25%, p < 0.001), preoperative prosthodontic assessment (82% vs. 21%, p < 0.001), prefabrication (100% vs. 40%, p = 0.002) and use of the zygomatic implant perforator flap technique (100% vs. 39%, p = 0.001). Preoperative prosthodontic consultation was associated with 21-fold increase in the odds of rehabilitation (odds ratio 20.9, 95% confidence interval 6.54-66.66, p < 0.005). CONCLUSION Preoperative prosthodontic evaluation, VSP and reconstructive techniques developed to facilitate implant placement are associated with increased dental rehabilitation rates. Despite using an institutional algorithm, functional dentures are frequently prevented by factors including soft tissue constraints, disease recurrence and patient motivation.
Collapse
Affiliation(s)
- George A Petrides
- Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Gabrielle Hicks
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Catriona Froggatt
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Christine Wallace
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, NSW Health, Sydney, New South Wales, Australia
| | - Dale Howes
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Leinkram
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| |
Collapse
|
14
|
Vascularized Composite Parietal Bone Flap for Immediate Reconstruction of a Hemi-Maxillectomy Defect in an Infant. J Craniofac Surg 2021; 31:2334-2338. [PMID: 33136885 DOI: 10.1097/scs.0000000000006786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Surgical resection of maxillary tumors can result in defects that can be difficult to reconstruct by conventional means due to the complex functional and anatomic nature of the midface and lack of regional bone flap options in the head and neck. Many reconstructive methods have been used to repair maxillary defects, but the ideal technique for the reconstruction of hemi-maxillectomy defects in growing pediatric patients has yet to be determined. METHODS The authors present a rare pediatric patient with melanotic neuroectodermal tumor of infancy resulting in a hemi-maxillectomy defect after resection that was reconstructed using a pedicled vascularized composite flap consisting of temporalis muscle, pericranium, and parietal bone. RESULTS The patient achieved successful long-term bony reconstruction of his right maxilla with this flap. Stable skeletal fixation with adequate orbital support was maintained over a >3-year follow-up period. CONCLUSION A vascularized composite parietal bone flap is a reliable reconstructive option for reconstruction of large maxillectomy defects providing low donor-site morbidity, adequate globe support, excellent long-term skeletal stability, and malar symmetry in rapidly growing pediatric patients. Successful reconstruction for a rare patient with maxillary melanotic neuroectodermal tumor of infancy requiring hemi-maxillectomy was demonstrated with >3-year follow-up.
Collapse
|
15
|
Heterotopic Ossification of the Vascular Pedicle after Maxillofacial Reconstructive Surgery Using Fibular Free Flap: Introducing New Classification and Retrospective Analysis. J Clin Med 2020; 10:jcm10010109. [PMID: 33396904 PMCID: PMC7794830 DOI: 10.3390/jcm10010109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 01/08/2023] Open
Abstract
Heterotopic ossification (HO) is one of the described phenomena after maxillofacial reconstructive surgery using fibular free flap (FFF) at the reception-site. The aim of this study was to determine the radiological incidence and form of HO along the fibular vascular pedicle as well as the rate of clinical symptoms if present. CT-scans of 102 patients who underwent jaw reconstructive surgery by using FFF from January 2005 to December 2019 were evaluated concerning the presence of HO. Subsequently, the patient files were evaluated to identify the cases with clinical signs and complications related to the presence of HO. A radiological classification of four different HO types was developed. Out of 102 patients, 29 (28.43%) presented radiological findings of HO. Clinical symptoms were recorded in 10 cases (9.8%) (dysphagia (n = 5), trismus (n = 3), bony masses (n = 2)) and from these only five (4.9%) needed surgical removal of calcified structures. HO occurs significantly in younger patients (mean 52.3 year). In maxillary reconstructions, HO was radiologically visible six months earlier than after mandibular reconstruction. Furthermore, HO is observed after every third maxilla and every fourth mandible reconstruction. This study developed for the first time a classification of four distinct HO patterns. HO types 1 and 2 were mostly observed after mandible reconstruction and type 4 predominantly after maxilla reconstruction.
Collapse
|
16
|
Vahidi N, Lee TS, Daggumati S, Shokri T, Wang W, Ducic Y. Osteoradionecrosis of the Midface and Mandible: Pathogenesis and Management. Semin Plast Surg 2020; 34:232-244. [PMID: 33380908 DOI: 10.1055/s-0040-1721759] [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: 10/22/2022]
Abstract
Radiation therapy is an important and commonly used treatment modality for head and neck cancers. Osteoradionecrosis (ORN) is a potential debilitating complication of treatment, which most commonly affects the mandible. Management strategies are tailored to the severity of disease. Medical management including oral rinses, irrigations, antibiotics, and pharmacological treatments is viable for mild-to-moderate ORN. More severe disease is best addressed with a combination of medical management and surgical intervention aimed at aggressively removing devitalized tissue until bleeding bone is encountered and reconstructing the soft tissue and bone defect. Reconstruction with either regional vascularized flaps or vascularized osteocutaneous free flaps in case of larger full-thickness bone defects (greater than 6 cm) or anterior mandible (medial to mental foramen) is most appropriate. Maxillary ORN complications can present with a wide range of functional problems and facial disfigurement. Life-threatening and time-sensitive problems should be treated first, such as skull base bone coverage or correction of severe ectropion, to avoid blindness from exposure keratopathy. Then, less time-sensitive issues can be addressed next, such as nasal obstruction, velopharyngeal insufficiency, and chronic tearing. It may require a combination of specialists from different disciplines to address various issues that can arise from maxillary ORN.
Collapse
Affiliation(s)
- Nima Vahidi
- Department of Otolaryngology, Virginia Commonwealth University, Richmond, Virginia
| | - Thomas S Lee
- Department of Otolaryngology, Virginia Commonwealth University, Richmond, Virginia
| | - Srihari Daggumati
- Department of Otolaryngology, Virginia Commonwealth University, Richmond, Virginia
| | - Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastics, Fort Worth, Texas
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastics, Fort Worth, Texas.,Department of Otolaryngology, University of Rochester, Rochester, New York
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastics, Fort Worth, Texas
| |
Collapse
|
17
|
Mayo-Yáñez M, Rodríguez-Pérez E, Chiesa-Estomba CM, Calvo-Henríquez C, Rodríguez-Lorenzo A. Deep inferior epigastric artery perforator free flap in head and neck reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2020; 74:718-729. [PMID: 33334702 DOI: 10.1016/j.bjps.2020.11.008] [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] [Received: 04/30/2020] [Revised: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Perforator flaps yield the best results for the patient with the least morbidity, and they should be considered the gold standard in head and neck reconstruction. Although deep inferior epigastric perforator (DIEP) flap is considered as the gold standard in breast reconstruction, its use in head and neck reconstructive surgery does not seem so widespread. The objective of this study is to conduct a systematic review of the use, applications and results of the DIEP flap in the head and neck area. METHODS Search was conducted in different indexed databases (PubMed/MEDLINE, the Cochrane Library, Scielo and Web of Science) and through meta-searcher Trip Database with deep inferior epigastric perforator flap AND head neck keywords. Studies on animal and human experiments published in peer-reviewed journals, where investigators assessed the use of DIEP flap, according to the Koshima criteria, in the head and neck area were considered. RESULTS A total of 31 articles and 185 flaps with 95% of survival were found. Thrombosis or venous stasis is the most frequent cause of flap loss and 16.1% presented some type of complication, the most frequent being the dehiscence. The most use was in the reconstruction of glossectomy defect secondary to squamous cell carcinoma (30.51%), being able potentially to re-establish sensory innervation in oral cavity. The assessment of risk bias (National Institutes of Health) highlights the lack of uniformity, with no standardisation of the outcome variable collection and monitoring. DISCUSSION By virtue of its versatility, reliable vascular supply and high flap survival rate, the DIEP flap reconstruction could be an option in complicated 3-dimensional head and neck defects while maintaining the standard of low donor site morbidity.
Collapse
Affiliation(s)
- Miguel Mayo-Yáñez
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), As Xubias 84, 15006 A Coruña, Galicia, Spain; Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), 15782 Santiago de Compostela, Galicia, Spain; Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.
| | - Esther Rodríguez-Pérez
- Plastic, Aesthetic and Reconstructive Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Galicia, Spain
| | - Carlos Miguel Chiesa-Estomba
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France; Otorhinolaryngology - Head and Neck Surgery Department, Hospital Universitario Donostia, 20014 Donostia, Gipuzkoa, Spain
| | - Christian Calvo-Henríquez
- Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), 15782 Santiago de Compostela, Galicia, Spain; Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France; Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario Santiago de Compostela (CHUS), 15706 Santiago de Compostela, Galicia, Spain
| | - Andrés Rodríguez-Lorenzo
- Plastic and Maxillofacial Surgery Department, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Surgical Sciences (IKV), Uppsala University, 751 05 Uppsala, Sweden
| |
Collapse
|
18
|
Crystal DT, Curiel DA, Abdul-Hamed S, Blankensteijn LL, Ibrahim AMS, Lee BT, Lin SJ. Outcomes of microvascular bone flaps versus osteocutaneous flaps in head and neck reconstruction. Microsurgery 2020; 40:731-740. [PMID: 32729977 DOI: 10.1002/micr.30634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/14/2020] [Accepted: 06/29/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Surgical resection of head and neck (H&N) neoplasms requiring osseous reconstruction have underdefined complication profiles. This study aimed to characterize postoperative outcomes of patients with H&N neoplasia undergoing osteocutaneous flap (OCF) or bare bone flap (BBF) reconstructions. MATERIALS AND METHODS Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) 2005-2017 databases. Queried for diagnosis and procedural codes extracted patients with H&N neoplasms undergoing BBF or OCF reconstruction. Postoperative complications were evaluated. Multivariable regression generated adjusted odds ratios. RESULTS A cohort of 746 patients were identified. Of reconstructions, 24.9% (n = 186/746) were BBFs while 75.1% (n = 560/746) were OCFs. 58.1% of the BBF cohort and 59.9% of the OCF cohort experienced an all-cause complication (p = .654). Sub-stratified, 24.2% of BBF and 17.5% of OCF patients experienced a wound complication (p = .045). Regression analysis demonstrated no difference in risk for medical complications between cohorts. However, patients receiving OCFs had a decreased likelihood of developing a wound complication (OR 0.652; 95%CI 0.430-0.989; p = .044) compared to patients receiving BBFs. CONCLUSION The incidence of complications following osseous reconstruction of the H&N is considerable. Although several complication outcomes do not seem to differ between BBF or OCF reconstructions, OCFs is associated with a decreased likelihood of wound complications.
Collapse
Affiliation(s)
- Dustin T Crystal
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Curiel
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Senan Abdul-Hamed
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise L Blankensteijn
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed M S Ibrahim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard T Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Abstract
Palatomaxillary reconstruction presents a unique challenge for the reconstructive surgeon. The maxillofacial skeleton preserves critical aerodigestive functions-it provides a stable hard palate to support mastication and separate the nasal and oral cavities, and buttress support to provide adequate midface contour. Free tissue transfer has become a routine part of the reconstructive ladder in managing palatomaxillary defects. While there is a wide variety of options for bony reconstruction within the head and neck, the fibula and the scapula, and their variations, have become two of the most commonly used options for midface reconstruction. This review will discuss the advantages and disadvantages of both in specific regard to reconstruction of the palatomaxillary area.
Collapse
Affiliation(s)
- Arvind K. Badhey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohemmed N. Khan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
21
|
Mirror Image Based Three-Dimensional Virtual Surgical Planning and Three-Dimensional Printing Guide System for the Reconstruction of Wide Maxilla Defect Using the Deep Circumflex Iliac Artery Free Flap. J Craniofac Surg 2020; 30:1829-1832. [PMID: 31058721 DOI: 10.1097/scs.0000000000005577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A patient was diagnosed with squamous cell carcinoma of the maxillary sinus and consequently underwent a unilateral total maxillectomy and reconstruction using an anterolateral thigh (ALT) free flap. Soft tissue transplantation without a bone graft at the large maxillary defect site caused a midfacial collapse, which worsened, especially after radiotherapy. The 3-dimensional positioning of the composite flap for wide maxillary reconstruction is aesthetically important. To achieve ideal symmetry and aesthetics, a mirror image was created using the normal contralateral side. Through computer simulation, the function and symmetry of the virtually reconstructed maxilla was evaluated, and the surgical guide was made using a 3D printing system. Based on the prepared surgical guide, a deep circumflex iliac artery (DCIA) free flap was harvested, and its implementation in the reconstruction ultimately led to satisfactory results. Utilization of mirror image based virtual surgical planning and a 3D printing guide is a significantly effective method for maxilla reconstruction with DCIA flaps.
Collapse
|
22
|
Swendseid BP, Roden DF, Vimawala S, Richa T, Sweeny L, Goldman RA, Luginbuhl A, Heffelfinger RN, Khanna S, Curry JM. Virtual Surgical Planning in Subscapular System Free Flap Reconstruction of Midface Defects. Oral Oncol 2019; 101:104508. [PMID: 31864958 DOI: 10.1016/j.oraloncology.2019.104508] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/25/2019] [Accepted: 12/01/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Reconstruction of the midface has many inherent challenges, including orbital support, skull base reconstruction, optimizing midface projection, separation of the nasal cavity and dental rehabilitation. Subscapular system free flaps (SF) have sufficient bone stock to support complex reconstruction and the option of separate soft tissue components. This study analyzes the effect of virtual surgical planning (VSP) in SF for midface on subsite reconstruction, bone segment contact and anatomic position. MATERIALS AND METHODS Retrospective cohort of patients with midface defects that underwent SF reconstruction at a single tertiary care institution. RESULTS Nine cases with VSP were compared to fourteen cases without VSP. VSP was associated with a higher number of successfully reconstructed subunits (5.9 vs 4.2, 95% CI of mean difference 0.31-3.04, p = 0.018), a higher number of successful bony contact between segments (2.2 vs 1.4, 95% CI of mean difference 0.0-1.6, p = 0.050), and a higher percent of segments in anatomic position (100% vs 71%, 95% CI of mean difference 2-55%, p = 0.035). When postoperative bone position after VSP reconstruction was compared to preoperative scans, the difference in anteroposterior, vertical and lateral projection compared to the preoperative 'ideal' bone position was <1 cm in 82% of measurements. There were no flap losses. CONCLUSION VSP may augment SF reconstruction of the midface by allowing for improved subunit reconstruction, bony segment contact and anatomically correct bone segment positioning. VSP can be a useful adjunct for complex midface reconstruction and the benefits should be weighed against cost.
Collapse
Affiliation(s)
- Brian P Swendseid
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA.
| | - Dylan F Roden
- Rutgers University, Department of Otolaryngology, Newark, NJ, USA
| | - Swar Vimawala
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Tony Richa
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Larissa Sweeny
- Louisiana State University Health Science Center, Department of Otolaryngology - Head & Neck Surgery, New Orleans, LA, USA
| | - Richard A Goldman
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Adam Luginbuhl
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Ryan N Heffelfinger
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Shachika Khanna
- Thomas Jefferson University, Department of Oral and Maxillofacial Surgery, Philadelphia, PA, USA
| | - Joseph M Curry
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| |
Collapse
|
23
|
Use of Anterolateral Thigh Flap and Fibula Flap in Oncologic Maxillary Reconstruction: An Algorithm Approach. Ann Plast Surg 2019; 84:S17-S25. [PMID: 31833884 DOI: 10.1097/sap.0000000000002176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maxillary defects after oncologic resection can lead to not only cosmetic deformity but also functional problem. Reconstruction of maxillary defects remains the most challenging endeavor for plastic surgeons. An algorithm to guide plastic surgeons in selecting either the anterolateral thigh flap or the fibula flap for oncologic maxillary reconstruction has not been well established. METHODS Patients who underwent oncologic maxillectomy and free flap reconstruction from August 2012 to April 2018 were enrolled for retrospective chart review. Their operative findings and postoperative outcomes were analyzed as a case series. The reconstructive plan was decided using the 4 essential components in sequence: the anterior maxillary arch, orbital floor, eyeball, and oro-sinonasal communication, which are the main considerations in the established classification systems. Accordingly, when the anterior maxillary arch was lost or when the orbital floor was lost with eyeball preservation, a fibula flap was used. Otherwise, an anterolateral thigh flap was used. RESULTS Various maxillectomy defects were successfully reconstructed using an anterolateral thigh flap and a fibula flap. The defect types and corresponding reconstruction were fit into our proposed algorithm and classification. The corresponding outcomes were satisfactory. CONCLUSION The proposed algorithm by using the anterolateral thigh flap and the fibula flap for oncologic maxillary reconstruction is feasible, simple, and effective.
Collapse
|
24
|
Tang N, Tao P, Liew J, Iseli TA, Wiesenfeld D, MacGill K, Ramakrishnan A. Palatal fistulas complicating osseomyocutaneous reconstruction of oncological maxillectomy defects. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01533-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Olsson AB, Dillon J, Kolokythas A, Schlott BJ. Reconstructive Surgery. J Oral Maxillofac Surg 2019; 75:e264-e301. [PMID: 28728733 DOI: 10.1016/j.joms.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
26
|
|
27
|
Patel SY, Meram AT, Kim DD. Soft Tissue Reconstruction for Head and Neck Ablative Defects. Oral Maxillofac Surg Clin North Am 2019; 31:39-68. [PMID: 30449526 DOI: 10.1016/j.coms.2018.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Soft tissue reconstruction of head and neck ablative defects is a broad, challenging, and subjective topic. The authors outline goals to keep in mind when deciding on a primary reconstructive option for defects created by oncologic resection. Factors considered in local, regional, and distant flap selection are discussed. Based on the goals of reconstruction and factors involved in flap selection, a defect-based reconstructive algorithm is developed to help choose the ideal reconstructive option. The authors also discuss indications, pearls, pitfalls, and challenges in the harvest and inset of commonly used soft tissue flaps for head and neck reconstructive surgery.
Collapse
Affiliation(s)
- Stavan Y Patel
- Department of Oral and Maxillofacial Surgery/Head and Neck Surgery, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Andrew T Meram
- Department of Oral and Maxillofacial Surgery/Head and Neck Surgery, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Dongsoo D Kim
- Department of Oral and Maxillofacial Surgery/Head and Neck Surgery, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 71103, USA
| |
Collapse
|
28
|
Miyamoto S, Arikawa M, Fujiki M. Deep inferior epigastric artery perforator flap for maxillary reconstruction. Laryngoscope 2018; 129:1325-1329. [DOI: 10.1002/lary.27646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/22/2018] [Accepted: 09/04/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Shimpei Miyamoto
- Division of Plastic and Reconstructive SurgeryNational Cancer Center Hospital Tokyo Japan
| | - Masaki Arikawa
- Division of Plastic and Reconstructive SurgeryNational Cancer Center Hospital Tokyo Japan
| | - Masahide Fujiki
- Division of Plastic and Reconstructive SurgeryNational Cancer Center Hospital Tokyo Japan
| |
Collapse
|
29
|
Marttila E, Thorén H, Törnwall J, Viitikko A, Wilkman T. Complications and loss of free flaps after reconstructions for oral cancer. Br J Oral Maxillofac Surg 2018; 56:835-840. [DOI: 10.1016/j.bjoms.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
|
30
|
Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Have a basic understanding of virtual planning, rapid prototype modeling, three-dimensional printing, and computer-assisted design and manufacture. 2. Understand the principles of combining virtual planning and vascular mapping. 3. Understand principles of flap choice and design in preoperative planning of free osteocutaneous flaps in mandible and midface reconstruction. 4. Discuss advantages and disadvantages of computer-assisted design and manufacture in reconstruction of advanced oncologic mandible and midface defects. SUMMARY Virtual planning and rapid prototype modeling are increasingly used in head and neck reconstruction with the aim of achieving superior surgical outcomes in functionally and aesthetically critical areas of the head and neck compared with conventional reconstruction. The reconstructive surgeon must be able to understand this rapidly-advancing technology, along with its advantages and disadvantages. There is no limit to the degree to which patient-specific data may be integrated into the virtual planning process. For example, vascular mapping can be incorporated into virtual planning of mandible or midface reconstruction. Representative mandible and midface cases are presented to illustrate the process of virtual planning. Although virtual planning has become helpful in head and neck reconstruction, its routine use may be limited by logistic challenges, increased acquisition costs, and limited flexibility for intraoperative modifications. Nevertheless, the authors believe that the superior functional and aesthetic results realized with virtual planning outweigh the limitations.
Collapse
|
31
|
Ong HS, Yu M, Liu JN, Gil CS, Wan K, Zhang CP, Xu LQ. Modified maxillary reconstruction technique for Brown's class III defects by subdividing a rhomboid shaped iliac crest into 2 subunits. Head Neck 2018; 40:1824-1833. [PMID: 29638021 DOI: 10.1002/hed.25169] [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: 07/25/2017] [Revised: 11/09/2017] [Accepted: 02/14/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Men and women share a common maxillary morphology with heterogeneity in size. This indicated that our technique of reconstruction with a rhomboid-shaped iliac crest bone flap incorporating a 30° vertical wedge osteotomy may be widely used for Brown's class III maxillectomy defect reconstruction among a population with class I skeletal profile. The reconstruction of Brown's class III maxillary defects is extremely challenging. The purpose of this study was to closely study the maxilla geometrically in order to establish a standardized maneuver, which facilitates conversion of the iliac bone flap into a natural maxilla's contours. METHODS We evaluated the geometries of 40 adult maxillas. The perimeter lengths of perinasal and infraorbital subunits were analyzed, in addition to the intersecting angle (δ) of both subunits. Sex variation was evaluated using the Student's t test. RESULTS In the 80 studied unilateral maxillas (40 maxillas from 18 men and 22 women), there were no significant sex differences for δ (P = .1527). In addition, both sexes shared common morphological features, hence, in surgical reconstruction, the δ can be constantly set at 150°. Perimeter of bone segments had a greater intersubject variability (coefficient of variation [CV] of approximately 4.5-11). From both cadaveric dissections and clinical applications, our results have shown that our standard maneuver was reproducible and reliable in reestablishing natural facial contours. CONCLUSION Our standard maneuver can serve as a universal guideline, with individualized perimeter manipulations, to yield an aesthetically natural and functional outcome.
Collapse
Affiliation(s)
- Hui Shan Ong
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Miao Yu
- 2nd Dental Center, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Jian Nan Liu
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Carlos Salcedo Gil
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Kenneth Wan
- Department of Oral and Maxillofacial Surgery, Royal Perth Hospital and Oral Health Centre Western Australia, University of Western Australia, Perth, Western Australia
| | - Chen Ping Zhang
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Li Qun Xu
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
32
|
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.
Collapse
|
33
|
Baek W, Song SY, Roh TS, Lee WJ. Microsurgical reconstruction of posttraumatic large soft tissue defects on face. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.12.724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wooyeol Baek
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Yong Song
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Tai Suk Roh
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Lee
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
34
|
Inferiorly Pedicled Nasolabial Flap for Reconstruction of Anterior Maxilla Defects Class I and II. J Craniofac Surg 2017; 29:457-459. [PMID: 29239921 DOI: 10.1097/scs.0000000000004203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to present the use of inferiorly pedicled nasolabial flap (IPNF) in the reconstruction of anterior maxilla defects class I and II. METHODS Seven patients, 4 females and 3 males, aging from 38 to 75 (mean = 55.9) years old, from 2014 to 2017 reconstructed anterior part of maxilla with or without oronasal communication were included in this study. Five patients diagnosed with squamous cell carcinoma, 1 patient presented with epithelial-myoepithelial carcinoma, and 1 patient had ameloblastoma. The IPNFs were harvested in 7 patients. Follow-up data were collected for a period ranging from 9 to 26 months. Speech, mastication, and aesthetic outcomes were evaluated with a questionnaire in interview. RESULTS All patients healed without infection, flap loss, and flap failure. Five patients without prothetic treatment had little pronunciation problem (score: 1 to 3 points), while 2 patients with removable partial denture had excellent speech clarity (score: 1 to 2 points). All patients had no problem with mastication (score: 1 to 2 points). Aesthetic outcomes were acceptable in all patients (score: 1 to 3 points). CONCLUSION The IPNF is a good option for reconstruction of anterior maxilla defects class I and II.
Collapse
|
35
|
Microvascular Tissue Transfers for Midfacial and Anterior Cranial Base Reconstruction. J Craniofac Surg 2017; 28:659-663. [DOI: 10.1097/scs.0000000000003448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
36
|
Total Maxillary Reconstruction With a Bi-Paddle Double-Barrel Osteocutaneous Fibular Flap and Arteriovenous Saphenous Loop After a Globe-Sparing Total Maxillectomy Due to Osteosarcoma. J Craniofac Surg 2017; 28:193-196. [DOI: 10.1097/scs.0000000000003245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
37
|
Kuuskeri M, O’Neill AC, Hofer SO. Unfavorable Results After Free Tissue Transfer to Head and Neck. Clin Plast Surg 2016; 43:639-51. [DOI: 10.1016/j.cps.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Chang EI, Hanasono MM. State-of-the-art reconstruction of midface and facial deformities. J Surg Oncol 2016; 113:962-70. [DOI: 10.1002/jso.24150] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Edward I. Chang
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Matthew M. Hanasono
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| |
Collapse
|
39
|
Repair of a Critical Porcine Tibial Defect by Means of Allograft Revitalization. Plast Reconstr Surg 2016; 136:461e-473e. [PMID: 26397265 DOI: 10.1097/prs.0000000000001637] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The authors previously described the generation of vascularized bone in a pig model, using a hemimandibular allograft scaffold, adipose-derived stem cells, recombinant human bone morphogenetic protein-2, and periosteum. This study tests the hypothesis that this "allograft revitalization" technique is as effective as vascularized autograft for repairing critical bony defects. METHODS Three groups of pigs had 3-cm defects created in their bilateral tibial diaphyses for repair using rigid fixation and one of three modalities. Negative control tibias were repaired with allograft tibia alone. To simulate repair using vascularized autograft, the osteotomized bone in positive control animals was left in situ, with the posterior periosteum intact. Experimental animals' defects were repaired with allograft tibia packed with autologous adipose-derived stem cells and recombinant human bone morphogenetic protein-2, with native periosteum intact. After 8 weeks, unilateral midgraft osteotomies were performed to assess graft healing potential. Serial radiographs and terminal micro-computed tomography and histology enabled evaluation of healing. RESULTS At week 7 after ostectomy, no negative control tibias had healed (zero of six) whereas most positive control (five of six) and all experimental tibias (six of six) had healed. Unilateral midgraft osteotomies were performed at 8 weeks to assess graft ability to heal. As expected, no negative control tibias (three of three) had radiographic union 7 weeks later. However, all positive control (two of two; p = 0.05) and experimental (three of three; p = 0.01) tibias had healed their repeated osteotomies by this time. CONCLUSION Similar to vascularized autograft, revitalized allograft successfully repaired a critical tibial defect, including after refracture, suggesting that this technique may be an alternative to osseous free flaps.
Collapse
|
40
|
Designing patient-specific 3D printed craniofacial implants using a novel topology optimization method. Med Biol Eng Comput 2015; 54:1123-35. [PMID: 26660897 DOI: 10.1007/s11517-015-1418-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
Large craniofacial defects require efficient bone replacements which should not only provide good aesthetics but also possess stable structural function. The proposed work uses a novel multiresolution topology optimization method to achieve the task. Using a compliance minimization objective, patient-specific bone replacement shapes can be designed for different clinical cases that ensure revival of efficient load transfer mechanisms in the mid-face. In this work, four clinical cases are introduced and their respective patient-specific designs are obtained using the proposed method. The optimized designs are then virtually inserted into the defect to visually inspect the viability of the design . Further, once the design is verified by the reconstructive surgeon, prototypes are fabricated using a 3D printer for validation. The robustness of the designs are mechanically tested by subjecting them to a physiological loading condition which mimics the masticatory activity. The full-field strain result through 3D image correlation and the finite element analysis implies that the solution can survive the maximum mastication of 120 lb. Also, the designs have the potential to restore the buttress system and provide the structural integrity. Using the topology optimization framework in designing the bone replacement shapes would deliver surgeons new alternatives for rather complicated mid-face reconstruction.
Collapse
|
41
|
Optimizing Hybrid Occlusion in Face-Jaw-Teeth Transplantation: A Preliminary Assessment of Real-Time Cephalometry as Part of the Computer-Assisted Planning and Execution Workstation for Craniomaxillofacial Surgery. Plast Reconstr Surg 2015. [PMID: 26218382 DOI: 10.1097/prs.0000000000001455] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aesthetic and functional outcomes surrounding Le Fort-based, face-jaw-teeth transplantation have been suboptimal, often leading to posttransplant class II/III skeletal profiles, palatal defects, and "hybrid malocclusion." Therefore, a novel technology-real-time cephalometry-was developed to provide the surgical team instantaneous, intraoperative knowledge of three-dimensional dentoskeletal parameters. METHODS Mock face-jaw-teeth transplantation operations were performed on plastic and cadaveric human donor/recipient pairs (n = 2). Preoperatively, cephalometric landmarks were identified on donor/recipient skeletons using segmented computed tomographic scans. The computer-assisted planning and execution workstation tracked the position of the donor face-jaw-teeth segment in real time during the placement/inset onto recipient, reporting pertinent hybrid cephalometric parameters from any movement of donor tissue. The intraoperative data measured through real-time cephalometry were compared to posttransplant measurements for accuracy assessment. In addition, posttransplant cephalometric relationships were compared to planned outcomes to determine face-jaw-teeth transplantation success. RESULTS Compared with postoperative data, the real-time cephalometry-calculated intraoperative measurement errors were 1.37 ± 1.11 mm and 0.45 ± 0.28 degrees for the plastic skull and 2.99 ± 2.24 mm and 2.63 ± 1.33 degrees for the human cadaver experiments. These results were comparable to the posttransplant relations to planned outcome (human cadaver experiment, 1.39 ± 1.81 mm and 2.18 ± 1.88 degrees; plastic skull experiment, 1.06 ± 0.63 mm and 0.53 ± 0.39 degrees). CONCLUSION Based on this preliminary testing, real-time cephalometry may be a valuable adjunct for adjusting and measuring "hybrid occlusion" in face-jaw-teeth transplantation and other orthognathic surgical procedures.
Collapse
|
42
|
A Comprehensive Strategy for Reconstruction of a Missing Midface. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e446. [PMID: 26301135 PMCID: PMC4527620 DOI: 10.1097/gox.0000000000000376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 04/02/2015] [Indexed: 11/27/2022]
Abstract
The loss of midface structures always leads to significant functional and cosmetic deficits, and the reconstruction work remains a challenge for surgeons. We report a rare case with severe midfacial defects involving the maxilla, nasal bone, and zygoma. This patient was treated with a comprehensive approach that included distraction osteogenesis, computer-aided surgery, a fibula bone graft, dental implantation, orthognathic surgery, and rhinoplasty. The treatment procedures required 4 years to complete, and a dramatically improved facial contour and stable occlusion were achieved. The results demonstrated the importance of a multidisciplinary approach and computer-aided design when treating severe maxillofacial deformities. Other important elements of the treatment process were the meticulous physical examination, the selection of an optimal treatment sequence, the skill of the surgeons, and more importantly, the patient-oriented mindset.
Collapse
|
43
|
Chen SH, Hung KS, Lee YC. Maxillary reconstruction with a double-barrel osteocutaneous fibular flap and arteriovenous saphenous loop after a globe-sparing total maxillectomy-A Case Report. Microsurgery 2015; 37:334-338. [DOI: 10.1002/micr.22441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Szu-han Chen
- Division of Plastic and Reconstructive Surgery Department of Surgery; National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University; Tainan Taiwan
| | - Kuo-shu Hung
- Division of Plastic and Reconstructive Surgery Department of Surgery; National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University; Tainan Taiwan
| | - Yao-chou Lee
- Division of Plastic and Reconstructive Surgery Department of Surgery; National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University; Tainan Taiwan
| |
Collapse
|
44
|
Thoma A, Gupta M, Archibald S. Maxillary reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
45
|
Costa H, Zenha H, Sequeira H, Coelho G, Gomes N, Pinto C, Martins J, Santos D, Andresen C. Microsurgical reconstruction of the maxilla: Algorithm and concepts. J Plast Reconstr Aesthet Surg 2015; 68:e89-e104. [PMID: 25778873 DOI: 10.1016/j.bjps.2014.12.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 12/04/2014] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The main purpose of this article is to highlight free tissue transfers as the first-choice method for three-dimensional (3D) maxillary reconstruction, particularly in providing enough bone for palate and maxillary arch reconstruction and consequently an implant-retained prosthesis. To achieve this, the myosseous free iliac crest was selected whenever possible as the first choice inside the reconstructive algorithm and free flap armamentarium. A new maxillectomy classification and algorithm reconstruction are proposed. Technical modifications and improvements accomplished over time are discussed, considering palate, dental implants and prosthesis, nasal sidewall, cranial base and dura, as well as recipient vessels. We present functional and aesthetic outcomes of the senior author's past 24-year experience (H. C.) with complex midface reconstructions. MATERIAL AND METHODS The authors report and analyse a 24-year experience with 57 midface defects in 54 patients (30 males and 24 females). A total of 57 maxillary defects - classified as Class I (limited maxillectomy) = 12, Class II (subtotal maxillectomy) = 15, Class III (total maxillectomy) = 19 and Class IV (orbitomaxillectomy) = 11 - were analysed regarding sex, age, tumour recurrence, free flap, reconstruction and necrosis. In addition, functional outcomes were evaluated regarding diet, speech, globe position and vision, while aesthetic outcomes were evaluated by patient and surgeon scores. RESULTS A total of 52 free flaps were performed in 47 patients; three patients were operated upon twice; and two other patients needed two sequentially linked flow-through flaps. The free flap survival was 96% with two total flap losses (4%). The other seven patients were fitted with a soft tissue-retained obturator prosthesis. CONCLUSIONS Microsurgical vascularised osteomyocutaneous free flaps are actually the gold standard for reconstruction of complex defects following maxillectomy. This algorithm is based on the anatomofunctional defect of the maxilla and it facilitates flap selection, which is a must.
Collapse
Affiliation(s)
- Horácio Costa
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal.
| | - Horácio Zenha
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Hugo Sequeira
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Gustavo Coelho
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Nuno Gomes
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Cristina Pinto
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - João Martins
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Diana Santos
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Carolina Andresen
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| |
Collapse
|
46
|
Restoration of the donor face after facial allotransplantation: digital manufacturing techniques. Ann Plast Surg 2015; 72:720-4. [PMID: 24835867 DOI: 10.1097/sap.0000000000000189] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Current protocols for facial transplantation include the mandatory fabrication of an alloplastic "mask" to restore the congruency of the donor site in the setting of "open casket" burial. However, there is currently a paucity of literature describing the current state-of-the-art and available options. METHODS During this study, we identified that most of donor masks are fabricated using conventional methods of impression, molds, silicone, and/or acrylic application by an experienced anaplastologist or maxillofacial prosthetics technician. However, with the recent introduction of several enhanced computer-assisted technologies, our facial transplant team hypothesized that there were areas for improvement with respect to cost and preparation time. RESULTS The use of digital imaging for virtual surgical manipulation, computer-assisted planning, and prefabricated surgical cutting guides-in the setting of facial transplantation-provided us a novel opportunity for digital design and fabrication of a donor mask. The results shown here demonstrate an acceptable appearance for "open-casket" burial while maintaining donor identity after facial organ recovery. CONCLUSIONS Several newer techniques for fabrication of facial transplant donor masks exist currently and are described within the article. These encompass digital impression, digital design, and additive manufacturing technology.
Collapse
|
47
|
Abstract
Maxillary reconstruction is still an evolving art when compared to the reconstruction of the mandible. The defects of maxilla apart from affecting the functions of the speech, swallowing and mastication also cause cosmetic disfigurement. Rehabilitation of the form and function in patients with maxillary defects is either by using an obturator prosthesis or by a surgical reconstruction. Literature is abundant with a variety of reconstructive methods. The classification systems are also varied, with no universal acceptance of any one of them. The oncologic safety of these procedures is still debated, and conclusive evidence in this regard has not emerged yet. Management of the orbit is also not yet addressed properly. Tissue engineering, that has been hyped to be one of the possible solutions for this vexing reconstructive problem, has not come out with reliable and reproducible results so far. This review article discusses the rationale and oncological safety of the reconstructing the maxillary defects, critically analyzes the classification systems, offers the different reconstructive methods and touches upon the controversies in this subject. The management of the retained and exenterated orbit associated with maxillectomy is reviewed. The surgical morbidity, complications and the recent advances in this field are also looked into. An algorithm, based on our experience, is presented.
Collapse
Affiliation(s)
- Subramania Iyer
- Department of Plastic, Reconstructive and Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Plastic, Reconstructive and Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| |
Collapse
|
48
|
Mitsimponas KT, Iliopoulos C, Stockmann P, Bumiller L, Nkenke E, Neukam FW, Schlegel KA. The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: A retrospective analysis of 130 reconstructions performed over a period of 5 years in a single Department. J Craniomaxillofac Surg 2014; 42:536-43. [DOI: 10.1016/j.jcms.2013.07.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/05/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022] Open
|
49
|
Rahpeyma A, Khajehahmadi S. Reconstruction of the maxilla by submental flap. ANZ J Surg 2014; 85:873-7. [DOI: 10.1111/ans.12638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Surgery; Oral and Maxillofacial Diseases Research Center; School of Dentistry; Mashhad University of Medical Sciences; Mashhad Iran
| | - Saeedeh Khajehahmadi
- Oral and Maxillofacial Pathology; Dental Research Center; School of Dentistry; Mashhad University of Medical Sciences; Mashhad Iran
| |
Collapse
|
50
|
Vega LG, Gielincki W, Fernandes RP. Zygoma implant reconstruction of acquired maxillary bony defects. Oral Maxillofac Surg Clin North Am 2013; 25:223-39. [PMID: 23642670 DOI: 10.1016/j.coms.2013.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The reconstruction of acquired maxillary bony defects after pathologic ablation, infectious debridement, avulsive trauma, or previously failed reconstructions with zygoma implants represents a treatment alternative that is safe, predictable, and cost-effective. Still the single most important factor for treatment success of these complex reconstructions is the implementation of a team approach between the surgeon and the restorative dentist. The focus of this article is to review the surgical and prosthetic nuances to successfully reconstruct acquired maxillary defects with zygoma implants.
Collapse
Affiliation(s)
- Luis G Vega
- Oral and Maxillofacial Residency Program, Health Science Center at Jacksonville, University of Florida, Jacksonville, FL 32209, USA.
| | | | | |
Collapse
|