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Best DL, Farsio F, Lee KC, Aguirre A, Frias V, Markiewicz MR. Aggressive presentation of ameloblastic fibro-odontoma: a clinical-pathological enigma. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:e125-e130. [PMID: 38575451 DOI: 10.1016/j.oooo.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 04/06/2024]
Abstract
Ameloblastic fibro-odontoma (AFO) is a rare, gnathic, benign, mixed odontogenic tumor that commonly presents in the first or second decade of life as a unilocular and rarely multilocular radiolucency with variable amounts of calcified material. Tumor progression is typically indolent, and generally accepted treatment is surgical enucleation and curettage. This case report describes an atypical presentation in a 14-year-old male with a multilocular, aggressive AFO requiring hemimandibulectomy with immediate osseous and dental "Jaw-in-a-Day" reconstruction. This report highlights the debate regarding whether AFO is a true neoplasm or an early-stage hamartoma in the continuum of complex odontoma formation. Regardless of the pathogenesis, maxillofacial surgeons and pathologists should be cognizant of the potential for AFO to develop locally aggressive behavior with considerable morbidity.
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Affiliation(s)
- David L Best
- Pediatric Craniomaxillofacial Surgery, Department of Oral and Maxillofacial Surgery, John R. Oishei Children's Hospital, Buffalo, NY; Department of Oral and Maxillofacial Surgery, University at Buffalo, Buffalo, NY.
| | - Farangis Farsio
- Department of Oral and Maxillofacial Surgery, University at Buffalo, Buffalo, NY
| | - Kevin C Lee
- Department of Oral and Maxillofacial Surgery, University at Buffalo, Buffalo, NY; Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Alfredo Aguirre
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY
| | - Vladimir Frias
- Department of Oral Oncology. Associate Professor of Oncology. Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, University at Buffalo, Buffalo, NY; Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY; School of Dental Medicine, University at Buffalo, Buffalo, NY; Department of Neurosurgery, Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Craniofacial Center of Western New York, John Oishei Children's Hospital, Department of Oral and Maxillofacial Surgery, Department of Pediatric Plastic Surgery, Buffalo, NY
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2
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Wolfaardt JF, Brecht LE, Taft RM, Grant GT. The future of maxillofacial prosthodontics in North America: The role of advanced digital technology and artificial intelligence - A discussion document. J Prosthet Dent 2024; 131:1253.e1-1253.e34. [PMID: 38744560 DOI: 10.1016/j.prosdent.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 05/16/2024]
Abstract
STATEMENT OF PROBLEM Maxillofacial prosthodontists were advanced digital technology (ADT) adopters early in the new Millennium. The past two decades saw a range of digital enablers emerge including digital imaging (internal and surface), digital surgical planning, digital functional assessment, subtractive and additive manufacturing, navigation, and robotics among others. Artificial Intelligence (AI) is the latest ADT arrival that will be a challenging disruptive technology. ADT has served as a profound change agent in maxillofacial prosthodontics. The intent was to explore the process and level of ADT engagement in maxillofacial prosthodontics. PURPOSE The purpose was twofold. Firstly, to explore maxillofacial prosthodontic engagement of ADT. Secondly, to develop a discussion document to assist the American Academy of Maxillofacial Prosthetics (AAMP) with establishing a collective awareness and considered opinion on the future of maxillofacial prosthodontics in the digital era. MATERIAL AND METHODS AAMP member interest in ADT was assessed through analysis of AAMP annual congress programs and publications in the Journal of Prosthetic Dentistry (JPD). The history of the maxillofacial prosthodontic journey to the digital era was undertaken with a selective literature review. The perceptions maxillofacial prosthodontists hold on ADT engagement was assessed through a survey of AAMP members. Developing an understanding of the influence AI was conducted with a review of pertinent literature. RESULTS From 2011-2020, an annual mean of 38% of papers published in the JPD involved clinical use of ADT. From 2017-2019, 44% of invited presentations at AAMP annual congresses included clinical use of ADT. The journey to the digital era distinguished three periods with formative and consolidation periods influencing the innovation digital era. The AAMP member survey had a 59% response rate and studied 10 domains through 31 questions. Of the respondents, 89% thought ADT important to the future of maxillofacial prosthodontics. CONCLUSIONS The discussion document will assist the AAMP in developing a collective consciousness and considered opinion on ADT in the future of maxillofacial prosthodontics. Members of the AAMP have a developed interest in clinical applications of ADT. A great challenge is that no formal education, training, or clinical competency requirements for ADT could be identified. Clinical competency requirements are important to prepare maxillofacial prosthodontics for the inevitability of a digital era future. The discussion document poses the fundamental question of whether maxillofacial prosthodontists will remain as passive end users of ADT and AI or will they become engaged knowledge workers that have determined clinical competency in ADT and AI in patient care. Without this knowledge worker role, maxillofacial prosthodontists may experience difficulty being part of the inevitable ADT-AI driven future.
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Affiliation(s)
- Johan F Wolfaardt
- Professor Emeritus, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Lawrence E Brecht
- Adjunct Clinical Associate Professor, Department of Prosthodontics, Director of Maxillofacial Prosthetics, Jonathan & Maxine Ferencz Advanced Education Program in Prosthodontics, New York University College of Dentistry, New York, NY; and Director, Maxillofacial Prosthetics, Department of Otolaryngology, Division of Oral & Maxillofacial Surgery, Lenox Hill Hospital-Northwell Health, New York, NY
| | - Robert M Taft
- Professor Emeritus, Uniformed Services University, Bethesda, Md
| | - Gerald T Grant
- Professor and Associate Dean, Advanced Digital Technologies and Innovation, University of Louisville School of Dentistry, Louisville, Ky
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Kudva A, Srikanth G, Singh A, Chitra A, Suryanarayan RK, Francis M. Reconstruction of Maxillary Defects Using Virtual Surgical Planning and Additive Manufacturing Technology: A Tertiary Care Centre Experience. J Maxillofac Oral Surg 2024; 23:644-652. [PMID: 38911428 PMCID: PMC11190103 DOI: 10.1007/s12663-023-02005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/16/2023] [Indexed: 06/25/2024] Open
Abstract
Introduction Maxillary reconstruction is often a challenging task for the surgeons because of the complex anatomy. However, with the advances in virtual surgical planning (VSP) and 3D printing technology there is a new avenue for the surgeons which offers a suitable alternative to conventional flap-based reconstructions. Patients and Methods In this article, we have described 4 case scenarios which were managed with the help of VSP and additive manufacturing technology for complex maxillary reconstruction procedures. Use of the technologies aided the clinician in achieving optimal outcomes with regards to form, function and esthetics. Discussion Virtual surgical planning (VSP) has gained a lot of impetus in past 1 decade. These aides the surgeon in determining the extent of disease and also carry out the treatment planning. In addition to VSP, the concept of additive manufacturing provides a viable alternative to the conventional reconstruction modalities for maxillary defect rehabilitation. Increased accuracy, rehabilitation of normal anatomical configuration, appropriate dental rehabilitation, decreased intra-operative time and post-operative complications are some of the advantages. In addition, patient-specific implants eliminate the need for a separate donor site. Apart from the treatment of pathologies, they also can be used for reconstruction of post-traumatic defect, where endosteal implant placement is not possible. Conclusion These modalities show promising results for reconstruction of complex maxillary defects.
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Affiliation(s)
- Adarsh Kudva
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - G. Srikanth
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Anupam Singh
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - A. Chitra
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Ramya K. Suryanarayan
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Mugdha Francis
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
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Zhou KX, Patel M, Shimizu M, Wang E, Prisman E, Thang T. Development and validation of a novel craniofacial statistical shape model for the virtual reconstruction of bilateral maxillary defects. Int J Oral Maxillofac Surg 2024; 53:146-155. [PMID: 37391321 DOI: 10.1016/j.ijom.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 07/02/2023]
Abstract
Bilateral maxillary defects are a challenge for fibula free flap reconstruction (FFFR) surgery due to limitations in virtual surgical planning (VSP) workflows. While meshes of unilateral defects can be mirrored to virtually reconstruct missing anatomy, Brown class c and d defects lack a contralateral reference and associated anatomical landmarks. This often results in poor placement of osteotomized fibula segments. This study was performed to improve the VSP workflow for FFFR using statistical shape modeling (SSM) - a form of unsupervised machine learning - to virtually reconstruct premorbid anatomy in an automated, reproducible, and patient-specific manner. A training set of 112 computed tomography scans was sourced from an imaging database by stratified random sampling. The craniofacial skeletons were segmented, aligned, and processed via principal component analysis. Reconstruction performance was validated on a set of 45 unseen skulls containing various digitally generated defects (Brown class IIa-d). Validation metrics demonstrated promising accuracy: mean 95th percentile Hausdorff distance of 5.47 ± 2.39 mm, mean volumetric Dice coefficient of 48.8 ± 14.5%, compactness of 7.28 × 105 mm2, specificity of 1.18 mm, and generality of 8.12 × 10-6 mm. SSM-guided VSP will allow surgeons to create patient-centric treatment plans, increasing FFFR accuracy, reducing complications, and improving postoperative outcomes.
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Affiliation(s)
- K X Zhou
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
| | - M Patel
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - M Shimizu
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Oral and Maxillofacial Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - E Wang
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - E Prisman
- Division of Otolaryngology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Thang
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Kang YF, Ge YJ, Lv XM, Ding MK, Shan XF, Cai ZG. One-stage jaw reconstruction and prosthetic rehabilitation with an iliac flap: a case report and literature review. Maxillofac Plast Reconstr Surg 2024; 46:3. [PMID: 38231325 PMCID: PMC10794675 DOI: 10.1186/s40902-024-00413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND One-stage jaw reconstruction with fibular flap and prosthetic rehabilitation restores bony and dental continuity simultaneously. It was also called as "jaw-in-a-day (JIAD)" technique. However, bone volume and height of fibular flap may be insufficient for dental implant insertion. The provision of a considerable amount of bone makes an iliac flap the ideal choice in these cases. We present the first case report to document the use of one-stage jaw reconstruction and prosthetic rehabilitation with the iliac flap. CASE PRESENTATION We modified the conventional JIAD workflow to make it suitable for iliac flap. Two cases were presented who both underwent segmental mandibulectomy for ameloblastoma. Virtual surgical planning was performed in all cases. The iliac crest was positioned upward to provide cortical bone for achieving primary stability of dental implants. Similar to the "all-on-4" procedure, the iliac bone was placed 12 to 15 mm below the occlusal plane to create adequate space for the implant-retained prosthesis. Immediate implant-based dental rehabilitation was performed at same stage. The surgery was successful in all cases without any short-term complications. In the first postoperative week, patients were given a liquid diet through a nasal feeding tube. The liquid diet is advised until 1 month after the surgery. Thereafter, a soft diet is recommended. Patients were advised to resume routine mastication and normal diet 3 months after the surgery. Peri-implantitis occurred in one patient, and additional gingival graft was required. Postoperative function and esthetics were satisfactory at the last follow-up visit. CONCLUSIONS One-stage jaw reconstruction and prosthetic rehabilitation with the iliac flap are safe and useful for restoring postoperative function and esthetics. It should be used in more cases with a longer follow-up in further studies.
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Affiliation(s)
- Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China
| | - Yan-Jun Ge
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao-Ming Lv
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China
| | - Meng-Kun Ding
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China.
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China.
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6
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Sukato DC, Kerr R, Aghaloo T, Yu JW, Blackwell KE, Jayanetti J. The Implant-borne Articulation Splint in Fibula Free Flap Mandibular Reconstruction: A Technical Note. J Craniofac Surg 2023; 34:2455-2459. [PMID: 37800941 DOI: 10.1097/scs.0000000000009751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 10/07/2023] Open
Abstract
Computer-aided design and computer-aided manufacturing and digitally simulated surgeries have revolutionized maxillomandibular reconstruction. In particular, this technology has increased the accuracy and facilitated the process of dental implantation in fibula free flaps. Despite the efficacy of virtual planning, there is a minor degree of translational difference between digital and intraoperative measurements, which may affect the precision of implant and fibula orientations. This is especially concerning during the last stage of fibula insetting, where the graft segments have the potential to roll, yaw, or pitch. The objective of this study is to describe an advanced prosthodontic technique that ensures the fibula grafts and implants remain in a restorable position during final insetting. We describe the technique and workflow of the implant-borne articulation splint through a case presentation and demonstrate results at 4 months postoperative and postradiotherapy. Given the degree of investment placed in virtual planning, free flap reconstruction, and endosteal implants, a technique that ensures optimal restorability of each implant is pivotal. Larger studies are still required to fully elucidate the cost-effectiveness and long-term results of the implant-borne articulation splint.
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Affiliation(s)
- Daniel C Sukato
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland
| | - Rhorie Kerr
- Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA
| | - Tara Aghaloo
- UCLA School of Dentistry, Section of Oral and Maxillofacial Surgery, Los Angeles, CA
| | - Jason W Yu
- University of Colorado Health, Plastic and Reconstructive Surgery, Aurora, CO
| | - Keith E Blackwell
- Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA
| | - Jay Jayanetti
- Section of Maxillofacial Prosthetics, UCLA School of Dentistry, Los Angeles, CA
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7
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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8
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Shuck JW, Largo RD, Hanasono MM, Chang EI. Evolution of Medical Modeling and 3D Printing in Microvascular Midface Reconstruction: Literature Review and Experience at MD Anderson Cancer Center. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1762. [PMID: 37893480 PMCID: PMC10608668 DOI: 10.3390/medicina59101762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
Reconstruction of the midface represents a challenge for reconstructive microsurgeons given the formidable task of restoring both aesthetics and functionality. In particular, preservation of proper globe positioning and maintaining normal vision are as important as restoring the proper projection of the midface and enabling a patient to speak and eat as normally as possible. The introduction of virtual surgical planning (VSP) and medical modeling has revolutionized bony reconstruction of the craniofacial skeleton; however, the overwhelming majority of studies have focused on mandibular reconstruction. Here, we introduce some novel advances in utilizing VSP for bony reconstruction of the midface. The present review aims (1) to provide a review of the literature on the use of VSP in midface reconstruction and (2) to provide some insights from the authors' early experience.
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Affiliation(s)
| | | | | | - Edward I. Chang
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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9
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Frias V, Al Afif A, Markiewicz MR. Immediate Free Fibula Flap After Maxillectomy With Simultaneous Full-arch Dental Implant-Supported Prosthetic Rehabilitation of the Midface and Mandible: The "Super Reconstruction Concept". J Craniofac Surg 2023; 34:2153-2156. [PMID: 37643124 DOI: 10.1097/scs.0000000000009695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Immediate reconstruction and dental rehabilitation for ablative defects of the head and neck in one surgery is now a commonly used technique among reconstructive surgeons. Often patients are edentulous or partially edentulous in the jaw opposing that with pathology. In this case, only rehabilitating the dental arch affected by pathology would not render the patient with a functional occlusion. We introduce the "super reconstruction" concept which includes not only rehabilitating the dental arch affected by pathology but also the opposing arch, giving the patient a fully functional occlusion at the time of ablative surgery. This concept is described through a case of a patient with a T4aN0M0 squamous cell carcinoma of the maxilla who underwent total maxillectomy, immediate fibula flap reconstruction of the maxilla with, and full arch dental implant placement into the maxilla and opposing mandible with prosthetic rehabilitation.
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Affiliation(s)
- Vladimir Frias
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center
| | - Ayham Al Afif
- Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center
| | - Michael R Markiewicz
- Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center
- Department of Oral and Maxillofacial Surgery, Associate Dean for Hospital Affairs, School of Dental Medicine, University at Buffalo
- Department of Neurosurgery, Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences
- Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY
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10
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Bevans S, Hammer D. Tenants of Mandibular Reconstruction in Segmental Defects. Otolaryngol Clin North Am 2023:S0030-6665(23)00066-X. [PMID: 37246030 DOI: 10.1016/j.otc.2023.04.009] [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: 05/30/2023]
Abstract
The premises of mandibular reconstruction are the restoration of occlusion and mandibular contour for the purpose of preserving the facial identity, oral airway, and effective speech and mastication. Establishing functional occlusion is the primary tenant in all mandibular reconstruction. In cases of segmental defects, particularly in dentate regions of the mandible, there has been a paradigm shift over the past two decades in how surgeons are approaching the restoration of load-bearing mandibular continuity with capacity for dental implantation. Here we discuss considerations for deciding the most effective method of reconstruction in segmental defects.
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Affiliation(s)
- Scott Bevans
- Department of Otolaryngology, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, HI 96818, USA; Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Daniel Hammer
- Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Oral Maxillofacial Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
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11
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Jones EA, Huang AT. Virtual Surgical Planning in Head and Neck Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00070-1. [PMID: 37221116 DOI: 10.1016/j.otc.2023.04.013] [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: 05/25/2023]
Abstract
Virtual surgical planning is a revolutionary tool for the head and neck reconstructive surgeon. As with any tool, there are strengths and weaknesses. The strengths include shorter operative time, shorter ischemic time, streamlined dental rehabilitation, facilitation of complex reconstruction, non-inferior and possibly superior accuracy, and increased durability. The weaknesses are increased up-front costs, potential delays to operative management, limited flexibility on the day of surgery, and loss of familiarity with conventionally planned surgery.
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Affiliation(s)
- Evan A Jones
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, 1977 Butler Boulevard, Suite E5.200, Houston, TX 77030, USA
| | - Andrew T Huang
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, 1977 Butler Boulevard, Suite E5.200, Houston, TX 77030, USA.
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12
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Tamaki A, Zender CA. Free Flap Donor Sites in Head and Neck Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00047-6. [PMID: 37173238 DOI: 10.1016/j.otc.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Microvascular free tissue transfer, also referred to as free flaps surgery, is a reconstructive technique that has become a foundational component of complex head and neck reconstruction. There have been considerable advancements in the field over the last 30 years including the number and variety of free flaps. Each of these free flaps has unique characteristics that must be considered for the defect when selecting a donor site. Here, the authors focus on the most common free flaps used in head and neck reconstruction.
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Affiliation(s)
- Akina Tamaki
- Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, LKS 5045, Cleveland, OH 44106, USA.
| | - Chad A Zender
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati Medical Center, 231 Albert Sabin Way, MSB 6408, Cincinnati, OH 45229, USA
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13
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Nyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, Agrawal A, Old MO, Seim NB, Carrau RL, Rocco JW, VanKoevering KK. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol 2022; 132:105976. [PMID: 35809506 DOI: 10.1016/j.oraloncology.2022.105976] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 01/12/2023]
Abstract
Microvascular free flap reconstruction has remained the standard of care in reconstruction of large tissue defects following ablative head and neck oncologic surgery, especially for bony structures. Computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensionally (3D) printed models and devices offer novel solutions for reconstruction of bony defects. Conventional free hand techniques have been enhanced using 3D printed anatomic models for reference and pre-bending of titanium reconstructive plates, which has dramatically improved intraoperative and microvascular ischemia times. Improvements led to current state of the art uses which include full virtual planning (VP), 3D printed osteotomy guides, and patient specific reconstructive plates, with advanced options incorporating dental rehabilitation and titanium bone replacements into the primary surgical plan through use of these tools. Limitations such as high costs and delays in device manufacturing may be mitigated with in house software and workflows. Future innovations still in development include printing custom prosthetics, 'bioprinting' of tissue engineered scaffolds, integration of therapeutic implants, and other possibilities as this technology continues to rapidly advance. This review summarizes the literature and serves as a summary guide to the historic, current, advanced, and future possibilities of 3D printing within head and neck oncologic surgery and bony reconstruction. This review serves as a summary guide to the historic, current, advanced, and future roles of CAD/CAM and 3D printing within the field of head and neck oncologic surgery and bony reconstruction.
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Affiliation(s)
- Sarah C Nyirjesy
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Margaret Heller
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Natalia von Windheim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amelia Gingras
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Stephen Y Kang
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Enver Ozer
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amit Agrawal
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Matthew O Old
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Nolan B Seim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Ricardo L Carrau
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - James W Rocco
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Kyle K VanKoevering
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States.
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Abstract
SUMMARY Defects involving the midface and maxilla pose unique challenges to reconstructive surgeons. The maxilla serves as the central keystone of the face and interfaces with various other facial subunits to affect form and function. Reconstructive methods range from prosthetics to free tissue transfer, and the indications for different options are reviewed here. Finally, special considerations including management of the orbit, dental rehabilitation, and future directions are discussed.
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15
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Clinico-Pathological Characteristics, Management, and Outcome of Benign Intraosseous Maxillary Tumors in Adolescents: A Prospective Study. J Craniofac Surg 2022; 33:e620-e626. [PMID: 35762625 DOI: 10.1097/scs.0000000000008695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Benign intraosseous maxillary tumors, although uncommon among the adolescents, represent a major challenge to the maxillofacial surgeons. Treatment ranges from conservative surgery to radical resection and reconstruction. Maxillary defect reconstruction in adolescents is uncommon. it can be achieved by prosthetic obturators, local and regional flaps, and free-tissue transfer. AIM OF THE WORK To investigate the clinical and pathological patterns, treatment, and outcome of benign intraosseous maxillary tumors in adolescents. PATIENTS AND METHODS A 10-years prospective study included patients between 12-18 years who presented with benign intraosseous maxillary tumors and surgically treated (conservative surgery or radical resection) with immediate reconstruction. Cases were followed up to assess functional and aesthetic outcomes and detect complications. RESULTS Study included 38 patients; 63.2% had non-odontogenic tumors and 36.8% had odontogenic tumors. The most common non-odontogenic tumor was central giant cell granuloma (31.6%). The most common odontogenic tumors were adenomatoid odontogenic tumor and ameloblastoma (10.5% each). Treatment included Conservative surgery (55.3%) and radical resection (44.7%). Reconstruction was performed in 17 cases by temporalis muscle flap (9.83%), obturator (2.46%), and free fibula flap (1.64%). All cases gained accepted functional and esthetic results. CONCLUSIONS Non-odontogenic tumors were more common than odontogenic tumors. Central giant cell granulomas and ossifying fibromas were the most common non-odontogenic tumors. Ade-nomatoid odontogenic tumor and ameloblastoma were the most common odontogenic tumors. Maxillary reconstructions with tem-poralis muscle flap and obturator were simple and satisfactory. Microsurgical reconstruction had high success rates. Aesthetic, and functional results were satisfactory when appropriate reconstruction was performed.
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16
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Le JM, Gigliotti J, Ying Y, Kase MT, Morlandt AB. Computer-Assisted Microvascular Free Flap Reconstruction and Implant Rehabilitation of the Maxilla-Treatment of a Rare Post-orthognathic Complication. J Maxillofac Oral Surg 2022; 21:82-87. [PMID: 35400916 PMCID: PMC8934816 DOI: 10.1007/s12663-020-01492-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022] Open
Abstract
Orthognathic surgery is generally a safe and predictable procedure. Major postoperative complications are rare and often non-life threatening. An example of a rare complication associated with the LeFort I osteotomy is avascular necrosis of the maxilla (ANM). While cases of ANM have been described in the literature, the majority involves only a portion or segment of the maxillary complex and is commonly treated with conservative measures such as strict oral hygiene, hyperbaric oxygen therapy and local debridement. Occasionally, larger segments of osteonecrosis may require extensive reconstruction such as bone grafting with local soft tissue flaps. Here, we present a patient that underwent a single-stage microvascular free tissue reconstruction with concomitant placement of dental implants and a patient-specific implant (PSI) for post-orthognathic ANM.
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Affiliation(s)
- John M. Le
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Jordan Gigliotti
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Yedeh Ying
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Michael T. Kase
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Anthony B. Morlandt
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
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17
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Modified Reconstruction of Brown II Defects With Anterolateral Thigh Flaps Following Tumor Resection. J Craniofac Surg 2022; 33:e509-e513. [PMID: 35132034 DOI: 10.1097/scs.0000000000008536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Maxillary defects reconstructed with flaps usually cause nasalomaxillary fistula, discomfort oral lining, and poor function of denture. To resolve these problems, this study introduces a modified method of anterolateral thigh flap (ALTF) with skin and myofascial paddles to reconstruct nasal and oral lining of maxillary defects. METHODS This study retrospectively reviewed 66 consecutive patients of Brown II maxillary defects following tumor resection reconstructed with ALTFs of modified or conventional methods. In modified group, oral lining was reconstructed with myofascial paddle and nasal lining was reconstructed with skin paddle. The functional and aesthetic outcomes, and the scores based on the University of Washington quality of life questionnaire were assessed. RESULTS All flaps were successful in reconstruction of Brown II maxillary defects. No nasalomaxillary fistula and obstruction of the nasal cavity were found in modified ALTFs group. The functions of removable denture were better in modified ALTFs group. There was no significant difference about tumor recurrence, range of mouth opening, and aesthetic outcomes between the 2 groups. CONCLUSIONS The modified method of ALTF with skin and myofascial piddle to reconstruct Brown IIa and IIb defects following tumor resection is simple and reliable, which improves the oral comfortability and function of denture, and avoids obstruction of the nasal cavity.
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18
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Butterworth CJ, Lowe D, Rogers SN. The Zygomatic Implant Perforated (ZIP) flap reconstructive technique for the management of low-level maxillary malignancy - clinical & patient related outcomes on 35 consecutively treated patients. Head Neck 2021; 44:345-358. [PMID: 34825746 DOI: 10.1002/hed.26933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/13/2021] [Accepted: 11/01/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The zygomatic implant perforated (ZIP) flap technique provides immediate reconstruction and rapid dental rehabilitation for low-level malignant tumors. METHODS Patients who underwent ZIP flap reconstruction between December 2015 and February 2021 were followed prospectively. RESULTS Thirty-five consecutively treated patients were studied with 16 undergoing surgery alone and 19 undergoing surgery followed by radiotherapy. The median time to fit the prosthesis was 29 days with all patients requiring adjuvant radiotherapy receiving their fixed dental prosthesis prior to its commencement. Vascularized flap (100%), zygomatic implant (98.4%), and prosthesis (97%) survival were excellent and the ZIP flap protocol was highly rated by patient-related outcome measures especially for the chewing domain. CONCLUSIONS The ZIP flap technique provides an excellent means of providing an autogenous oronasal seal and a foundation for immediate cortically anchored fixed dental rehabilitation. CLINICAL SIGNIFICANCE This technique provides rapid and robust rehabilitation for patients presenting with low-level maxillary malignancy despite the use of radiotherapy.
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Affiliation(s)
- Chris J Butterworth
- Department of Oral and Maxillofacial Surgery, Liverpool University Hospital Foundation Trust, Liverpool, UK.,Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Simon N Rogers
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.,Liverpool University Hospital Foundation Trust, Liverpool, UK
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Ong A, Williams F, Tokarz E, Shokri T, Hammer D, Ducic Y. Jaw in a Day: Immediate Dental Rehabilitation during Fibula Reconstruction of the Mandible. Facial Plast Surg 2021; 37:722-727. [PMID: 34380165 DOI: 10.1055/s-0041-1732478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Reconstructing mandibular defects presents challenges to dental rehabilitation related to altered bone and soft tissue anatomy. Dental implants are the most reliable method to restore the lost dentition. Immediate dental implants have been placed for many years but with unacceptably low rates of dental/prosthetic success. Current virtual technology allows placement of both fibulas and guided implants in restoratively driven positions that also allow immediate dental rehabilitation. Inexpensive three-dimensional printing platforms can create provisional dental prostheses placed at the time of surgery. This article reviews our digital and surgical workflow to create an immediate dental prosthesis to predictably restore the dentition during major jaw reconstruction with fibula free flaps.
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Affiliation(s)
- Adrian Ong
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastic Surgery, Fort Worth, Texas
| | - Fayette Williams
- Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, Texas
| | - Ellen Tokarz
- Department of Otolaryngology Head and Neck Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Tom Shokri
- Department of Otolaryngology, Baylor All Saints Medical Center at Fort Worth, Fort Worth, Texas
| | - Daniel Hammer
- Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego, San Diego, California
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastic Surgery, Fort Worth, Texas
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20
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the evolution of three-dimensional computer-aided reconstruction and its current applications in craniofacial surgery. 2. Recapitulate virtual surgical planning, or computer-assisted surgical simulation, workflow in craniofacial surgery. 3. Summarize the principles of computer-aided design techniques, such as mirror-imaging and postoperative verification of results. 4. Report the capabilities of computer-aided manufacturing, such as rapid prototyping of three-dimensional models and patient-specific custom implants. 5. Evaluate the advantages and disadvantages of using three-dimensional technology in craniofacial surgery. 6. Critique evidence on advanced three-dimensional technology in craniofacial surgery and identify opportunities for future investigation. SUMMARY Increasingly used in craniofacial surgery, virtual surgical planning is applied to analyze and simulate surgical interventions. Computer-aided design and manufacturing generates models, cutting guides, and custom implants for use in craniofacial surgery. Three-dimensional computer-aided reconstruction may improve results, increase safety, enhance efficiency, augment surgical education, and aid surgeons' ability to execute complex craniofacial operations. Subtopics include image analysis, surgical planning, virtual simulation, custom guides, model or implant generation, and verification of results. Clinical settings for the use of modern three-dimensional technologies include acquired and congenital conditions in both the acute and the elective settings. The aim of these techniques is to achieve superior functional and aesthetic outcomes compared to conventional surgery. Surgeons should understand this evolving technology, its indications, limitations, and future direction to use it optimally for patient care. This article summarizes advanced three-dimensional techniques in craniofacial surgery with cases highlighting clinical concepts.
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21
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Simplifying Bony Midface Reconstruction with Patient-specific Titanium Plates. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3555. [PMID: 33912374 PMCID: PMC8078310 DOI: 10.1097/gox.0000000000003555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/29/2020] [Indexed: 11/26/2022]
Abstract
Virtual surgical planning and patient-specific osteosynthesis plates provide reconstructive surgeons with the ability to proceed with facial reconstruction of expanding complexity. Moreover, these advances have been shown to reduce the energy, effort, and operating time while helping guide the surgeon toward anatomically correct results. The currently available literature regarding custom-milled plates pertains mostly to reconstructive surgery of the mandible. This small 3-patient series illustrates the use of patient-specific titanium plating to simplify complex reconstruction of the midface. Composite defects requiring multiple bony and soft tissue segments are difficult to reconstruct intraoperatively without prior planning. Custom plates and associated cutting guides based on patient-specific anatomy allow for a more streamlined, stepwise protocol for assembly of intricate constructs. Custom-manufactured hardware will precisely fit bony contours and minimize additional manipulation of both the bone and plate, maximally preserving internal strength and allowing for improved stability, dental occlusion, and spatial positioning. In addition to these mechanical benefits, the ease of mind and overall cost reduction through a reduction in procedural time are significant advantages offered by pre-designed plates. We hope that this series illustrates the value of custom-printed plates for midface reconstruction.
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22
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Wolfaardt JF, Brecht LE, Taft RM. The future of maxillofacial prosthodontics in North America: Part I-Journey to the present. J Prosthet Dent 2021; 127:345-350. [PMID: 33431175 DOI: 10.1016/j.prosdent.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
STATEMENT OF PROBLEM Understanding how maxillofacial prosthodontists are perceiving changes in head and neck care and the impact of advanced digital technologies on maxillofacial prosthodontics is important. However, no studies could be identified that specifically addressed these subjects. PURPOSE The purpose of this review of selected literature was to identify issues that guided the development of maxillofacial prosthodontics and the concerns that persist. The review also considered contemporary influences that will affect the future of maxillofacial prosthodontics. The conclusions of the review were used to interpret the results of the exploratory survey reported in Part II. MATERIAL AND METHODS The review of selected literature was related to the development of maxillofacial prosthodontics in North America between 1950 and 2018. Literature that was considered relevant to the purpose of the review was included. RESULTS The review yielded 37 references of interest: 34 peer-reviewed publications, 1 guideline, 1 historical publication, and 1 website. Periods in the development of maxillofacial prosthodontics in North America were identified as formation, consolidation, and innovation. CONCLUSIONS It was concluded that concerns in subspecialty programs and clinical practice had origins in the formation and consolidation periods. These persisting concerns extended into the innovation period. Contemporary influences in head and neck surgery will continue to affect the future of maxillofacial prosthodontics. Advanced digital technologies appeared to be central to driving change. Understanding the evolution of maxillofacial prosthodontics was an important first step in providing context when interpreting the results of a survey of maxillofacial prosthodontists reported as Part II of this work.
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Affiliation(s)
- Johan F Wolfaardt
- Professor Emeritus, Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Lawrence E Brecht
- Adjunct Clinical Associate Professor, Department of Prosthodontics, Director of Maxillofacial Prosthetics, Jonathan & Maxine Ferencz Advanced Education Program in Prosthodontics, NYU College of Dentistry, New York, NY; Director of Maxillofacial Prosthetics, Division of Oral & Maxillofacial Surgery, Department of Otolaryngology, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Robert M Taft
- Professor, Comprehensive Dentistry Department, University of Texas Health San Antonio School of Dentistry, San Antonio, Texas
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23
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Garrido-Martínez P, Peña-Cardelles JF, Pozo-Kreilinger JJ, Esparza-Gómez G, Montesdeoca-García N, Cebrián-Carretero JL. Jaw in a day: Osseointegration of the implants in the patient's leg before reconstructive surgery of a maxilla with ameloblastoma. A 4-year follow-up case report. J Clin Exp Dent 2021; 13:e81-e87. [PMID: 33425236 DOI: 10.4317/jced.57823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 11/05/2022] Open
Abstract
Background To describe a clinical case of a cancer patient who underwent ablative tumor surgery, including treatment planning, surgical resection and subsequent implant rehabilitation. Case Report A 61-year-old patient with a diagnosis of multicystic follicular ameloblastoma in the maxilla, in which it was necessary a multidisciplinary approach and two surgical steps. In the first surgical intervention osseointegrated implants (OII) were placed in the fibula, until their osseointegration period of 8 weeks was complete. Afterwards, in the second surgery, the micro-vascularized free fibular flap bearing the implants was transplanted into the oral cavity, in order to perform simultaneous reconstruction and early rehabilitation. The final prosthetic rehabilitation consisted in a hybrid prosthesis fabricated using CAD CAM technology. Results The latest advances in medical research have improved our understanding of the oral cavity's regenerative capacity after oncological treatment. This, aided by the advances in digital 3D technologies, has allowed meticulous treatment planning prior surgery. Conclusions The functional and esthetic reconstructions described in these two case reports were made possible by coordinating multidisciplinary approaches involving dentists and oral and maxillofacial surgeons. Advances in medicine have improved understanding of the regenerative capacity of the oral region following oncologic treatment, facilitating meticulous advance planning, while advances in digital 3D technologies for planning make it possible to reduce the number of surgical sessions and the time taken for the patient to recover both the esthetics and function of the stomatognathic system. Key words:Oral rehabilitation, oral cancer, oral surgery.
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Affiliation(s)
- Pablo Garrido-Martínez
- DDS, MsC, phD. Associate Professor, Department of Prosthesis, Faculty of Dentistry, University Alfonso X el Sabio, Madrid. Department of Oral and Maxillofacial Surgery, Hospital La Luz, Madrid
| | - Juan-Francisco Peña-Cardelles
- DDS, MsC. Professor of the Postgraduate Program in Oral Surgery and Implantology. Universidad Rey Juan Carlos, Madrid, Spain
| | - José-Juan Pozo-Kreilinger
- MD, DDS, phD. Associate Professor of Medicine. Department of Pathology. Universidad Autónoma de Madrid, Madrid. Hospital Universitario La Paz, Madrid
| | - Germán Esparza-Gómez
- MD, DDS, phD. Professor Titular, Faculty of Odontology, Universidad Complutense de Madrid, Madrid
| | | | - José-Luis Cebrián-Carretero
- DMD, DDS, phD. Chief, Department of Oral and Maxillofacial Surgery, Hospital La Luz, Madrid Chief of Section, Department of Oral and Maxillofacial Surgery, Hospital Universitario La Paz, Madrid
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24
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The use of medical modeling in microvascular free tissue transfer reconstruction with osseointegrated implantation in complex midface defects. Oral Oncol 2020; 110:104982. [DOI: 10.1016/j.oraloncology.2020.104982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022]
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25
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Johal M, Leinkram D, Wallace C, Clark JR. The Sydney Modified Alberta Reconstruction Technique (SM-ART) for dental rehabilitation following mandibulectomy or maxillectomy. Int J Oral Maxillofac Surg 2020; 50:615-618. [PMID: 33069518 DOI: 10.1016/j.ijom.2020.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/11/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
The Sydney Modification of the Alberta Mandibular Reconstruction technique (SM-ART) is a hybrid of the Rohner method and the Alberta Reconstructive Technique (ART). SM-ART differs from ART in three ways, notably the use of custom plates, intraoral placement of implants via three-dimensionally printed guides and a skin graft buried deep into the skin paddle of the fibula flap in the first stage of the reconstruction.
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Affiliation(s)
- M Johal
- St George & Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
| | - D Leinkram
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia
| | - C Wallace
- Central Clinical School, Faculty of Health and Medical Sciences, University of Sydney, Australia; Westmead Oral Restorative Sciences, Sydney, Australia
| | - J R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, Faculty of Health and Medical Sciences, University of Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
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26
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Put' VA, Solodkiy VG, Reshetov IV, Il'ichev EA, Podstavnev VG. [Implant-prosthetic rehabilitation of a patient with an extensive maxillofacial defect]. STOMATOLOGII︠A︡ 2020; 99:87-91. [PMID: 33034183 DOI: 10.17116/stomat20209905187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The paper presents a clinical case demonstrating the necessity for scarce dental implants surgery in tissues affected by multiply surgical and radiological procedures. The patient underwent 13 interventions, 4 reconstructive procedures and 3 courses of radiotherapy resulting in extensive facial defect. An orthopedic construction was fixed in a defect on mechanically stable single-stage implants with screw-retained orthopedic platform and trans-zygomatic implants on the contralateral side. The method is based on virtual diagnostics and choice of materials for 3D-prototyping of a framework to fill the defect and serve as supportive element for fixation and stabilization of obturator and facial mask.
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Affiliation(s)
- V A Put'
- First Moscow State Medical University named after I.M. Sechenov of Ministry of Health of Russian Federation (Sechenov University), Moscow, Russia
| | - V G Solodkiy
- First Moscow State Medical University named after I.M. Sechenov of Ministry of Health of Russian Federation (Sechenov University), Moscow, Russia
| | - I V Reshetov
- First Moscow State Medical University named after I.M. Sechenov of Ministry of Health of Russian Federation (Sechenov University), Moscow, Russia
| | - E A Il'ichev
- First Moscow State Medical University named after I.M. Sechenov of Ministry of Health of Russian Federation (Sechenov University), Moscow, Russia
| | - V G Podstavnev
- First Moscow State Medical University named after I.M. Sechenov of Ministry of Health of Russian Federation (Sechenov University), Moscow, Russia
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27
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Qaisi M, Boukheir MA, Shah B, Murphy J. The Predictive Hole Technique: A Technical Note. J Oral Maxillofac Surg 2020; 79:722-727. [PMID: 33010217 DOI: 10.1016/j.joms.2020.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
We describe a novel technique in which predictive holes, normally unique to patient-specific plates, may be utilized with off the shelf stock plates. This allows for the numerous benefits of predictive holes in mandibular reconstruction while negating the added cost of a custom milled plate. Three case examples are presented for technique illustration.
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Affiliation(s)
- Mohammed Qaisi
- Professor of Oral & Maxillofacial Surgery, Midwestern University, Program Director, Division of Oral & Maxillofacial Surgery, Adjunct Attending Physician, Division of Otolaryngology, Cook County Health, Chicago, IL.
| | - Mohamed Ali Boukheir
- Chief Resident, Division of Oral & Maxillofacial Surgery, Cook County Health, Chicago, IL
| | - Biraj Shah
- Assistant Professor of Oral & Maxillofacial Surgery, Midwestern University, Attending Physician, Division of Oral & Maxillofacial Surgery, Cook County Health, Chicago, IL
| | - James Murphy
- Associate Professor of Oral & Maxillofacial Surgery, Midwestern University, Attending Physician, Division of Oral & Maxillofacial Surgery, Adjunct Attending Physician, Division of Otolaryngology, Cook County Health, Chicago, IL
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28
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Khatib B, Cheng A, Sim F, Bray B, Patel A. Challenges With the Jaw in a Day Technique. J Oral Maxillofac Surg 2020; 78:1869.e1-1869.e10. [DOI: 10.1016/j.joms.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
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29
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Seier T, Hingsammer L, Schumann P, Gander T, Rücker M, Lanzer M. Virtual planning, simultaneous dental implantation and CAD/CAM plate fixation: a paradigm change in maxillofacial reconstruction. Int J Oral Maxillofac Surg 2020; 49:854-861. [DOI: 10.1016/j.ijom.2019.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/29/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
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30
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Vosselman N, Alberga J, Witjes MHJ, Raghoebar GM, Reintsema H, Vissink A, Korfage A. Prosthodontic rehabilitation of head and neck cancer patients-Challenges and new developments. Oral Dis 2020; 27:64-72. [PMID: 32343862 PMCID: PMC7818410 DOI: 10.1111/odi.13374] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 01/23/2023]
Abstract
Head and neck cancer treatment can severely alter oral function and aesthetics, and reduce quality of life. The role of maxillofacial prosthodontists in multidisciplinary treatment of head and neck cancer patients is essential when it comes to oral rehabilitation and its planning. This role should preferably start on the day of first intake. Maxillofacial prosthodontists should be involved in the care pathway to shape and outline the prosthetic and dental rehabilitation in line with the reconstructive surgical options. With the progress of three‐dimensional technology, the pretreatment insight in overall prognosis and possibilities of surgical and/or prosthetic rehabilitation has tremendously increased. This increased insight has helped to improve quality of cancer care. This expert review addresses the involvement of maxillofacial prosthodontists in treatment planning, highlighting prosthodontic rehabilitation of head and neck cancer patients from start to finish.
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Affiliation(s)
- Nathalie Vosselman
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Jamie Alberga
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Max H J Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Harry Reintsema
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Anke Korfage
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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Patel A, Harrison P, Cheng A, Bray B, Bell RB. Fibular Reconstruction of the Maxilla and Mandible with Immediate Implant-Supported Prosthetic Rehabilitation: Jaw in a Day. Oral Maxillofac Surg Clin North Am 2019; 31:369-386. [PMID: 31164268 DOI: 10.1016/j.coms.2019.03.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The fibula free flap is a workhorse flap used to reconstruct ablative, osseous defects in the upper and lower jaws. Traditionally, the fibula free flap is inset into the defect freehand; dental implants are placed secondarily; and final prosthetic rehabilitation often occurs more than 1 year after ablative surgery. Virtual surgical planning and rapid prototyping of cutting guides and guide stents for head and neck reconstruction have facilitated improved accuracy in fibular transfer. This article describes the Jaw in a Day technique, allowing maxillary or mandibular resection, fibular free flap reconstruction, immediate implant placement, and prosthetic rehabilitation in a single operation.
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Affiliation(s)
- Ashish Patel
- The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney Street, Suite 300, Portland, OR 97209, USA; Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA. https://twitter.com/PatelMDDDS
| | - Phillip Harrison
- The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney Street, Suite 300, Portland, OR 97209, USA; Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA
| | - Allen Cheng
- The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney Street, Suite 300, Portland, OR 97209, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA
| | - Brian Bray
- The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney Street, Suite 300, Portland, OR 97209, USA; Private Practice, Portland Prosthodontics, 5050 Northeast Hoyt Street, Suite 640, Portland, OR 97213, USA
| | - R Bryan Bell
- The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney Street, Suite 300, Portland, OR 97209, USA; Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA.
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Immediate Dental Implantation in Oncologic Jaw Reconstruction: Workflow Optimization to Decrease Time to Full Dental Rehabilitation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2100. [PMID: 30859051 PMCID: PMC6382230 DOI: 10.1097/gox.0000000000002100] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022]
Abstract
Full dental rehabilitation following segmental mandibulectomy or maxillectomy for oncologic tumor ablation should be the goal for every patient. But despite advances in technology and reconstructive techniques, many patients do not achieve timely or complete oral rehabilitation. Recognizing this fault, we recently adopted an innovative workflow to increase the number of patients undergoing dental restoration, irrespective of tumor pathology or need for adjuvant radiotherapy. Preoperatively, every osseous jaw reconstruction undergoes virtual surgical planning to incorporate the placement of endosseous implants into the fibula osteocutaneous free flap. The dental implants are then placed intraoperatively at the time of tumor ablation and reconstruction. Four-to-six weeks following the initial surgery, the patient returns to the operating room for vestibuloplasty and exposure of the dental implants. Within 3 days of the vestibuloplasty, a temporary dental prosthesis is placed in the dental clinic, and the patient can then begin radiation therapy if needed. Following adjuvant radiation therapy, the temporary prosthesis can be replaced with a permanent one. At our institution, this innovative workflow has allowed for earlier aesthetic restoration of the jaw and greatly expanded the number of patients able to achieve oral rehabilitation. Herein, we describe this innovative workflow and provide technical pearls for successful execution.
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Zweifel D, Bredell M, Essig H, Gander T, Lanzer M, Rostetter C, Rücker M, Studer S. Total virtual workflow in CAD-CAM bony reconstruction with a single step free fibular graft and immediate dental implants. Br J Oral Maxillofac Surg 2018; 56:859-863. [DOI: 10.1016/j.bjoms.2018.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
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Fanelli CA, Sawatari Y. The Millimeter Mindset: The Dental Underpinnings of an Inborn Surgical Advantage. J Oral Maxillofac Surg 2018; 76:1385-1386. [PMID: 29678486 DOI: 10.1016/j.joms.2018.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Christopher A Fanelli
- Resident, Division of Oral and Maxillofacial Surgery, University of Miami, Miller School of Medicine/Jackson Health System, Miami, FL.
| | - Yoh Sawatari
- Program Director and Professor, Division of Oral and Maxillofacial Surgery, University of Miami, Miller School of Medicine/Jackson Health System, Miami, FL
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Fernandes N, van den Heever J, Sykes L. Immediate Implant Placement and Provisionalization Following Tumor-Resective Surgery in the Midfacial Region: A Case Series. J Prosthodont 2017; 27:476-481. [PMID: 29044894 DOI: 10.1111/jopr.12686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 11/30/2022] Open
Abstract
Surgical and prosthodontic restoration of the midfacial region following tumor resection has always posed a considerable challenge, as this area serves crucial functional and esthetic roles. Being diagnosed and subsequently treated for facial tumors can have an immense psychosocial impact on a patient, as the resulting defects are often disfiguring, and lead to an inability to masticate, swallow, and speak clearly. Provision of an immediate facial and dental prosthesis at the time of surgery can limit these side effects and help reduce mental duress on these patients and their families, as well as aid in the process of rehabilitation. Rapid prototyping (RP) and 3D printing, as this paper shows, assists presurgical planning of the tumor resection, as well as the manufacture of maxillofacial and dental prostheses. Often these defects are extensive, so prosthesis retention is aided by zygomatic implants placed at the time of surgical resection. When placed at this time, and prior to radiation therapy, these craniofacial implants have improved survival rates. Thus, this treatment modality can improve postoperative recovery considerably, while at the same time allowing for cleaning and monitoring of the resected site for tumor recurrence.
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Affiliation(s)
- Nelson Fernandes
- Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Jacobus van den Heever
- Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Leanne Sykes
- Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, University of Pretoria, South Africa
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Butterworth CJ, Rogers SN. The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy. Int J Implant Dent 2017; 3:37. [PMID: 28756563 PMCID: PMC5534193 DOI: 10.1186/s40729-017-0100-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/23/2017] [Indexed: 11/26/2022] Open
Abstract
This aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid post-operative prosthodontic rehabilitation with a fixed dental prosthesis following low-level maxillectomy for malignant disease. The technique involves the use of a zygomatic oncology implant perforated micro-vascular soft tissue flap (ZIP flap) for the primary management of maxillary malignancy with surgical closure of the resultant maxillary defect and the installation of osseointegrated support for a zygomatic implant-supported maxillary fixed dental prosthesis. The use of this technique facilitates extremely rapid oral and dental rehabilitation within a few weeks of resective surgery, providing rapid return to function and restoring appearance following low-level maxillary resection, even in cases where radiotherapy is required as an adjuvant treatment post-operatively. The ZIP flap technique has been adopted as a standard procedure in the unit for the management of low-level maxillary malignancy, and this report provides a detailed step-by-step approach to treatment and discusses modifications developed over the treatment of an initial cohort of patients.
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Affiliation(s)
- C J Butterworth
- Department of Oral & Maxillofacial Surgery, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK.
| | - S N Rogers
- Department of Oral & Maxillofacial Surgery, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
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Dattani A, Richardson D, Butterworth CJ. A novel report on the use of an oncology zygomatic implant-retained maxillary obturator in a paediatric patient. Int J Implant Dent 2017; 3:9. [PMID: 28349495 PMCID: PMC5368100 DOI: 10.1186/s40729-017-0073-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/26/2017] [Indexed: 10/09/2023] Open
Abstract
This report details the use of zygomatic oncology osseointegrated implants to support and retain a maxillary obturator in a 13-year-old male patient who underwent a right-sided hemi-maxillectomy (Brown Class 2b) (Brown and Shaw, Lancet Oncol 11:1001-8, 2010) for a myxoid spindle cell carcinoma. At the time of maxillary resection, two zygomatic oncology implants were inserted into the right zygomatic body and subsequently utilised to provide in-defect support and retention for a bar-retained maxillary acrylic obturator prosthesis, which restored the patient's aesthetics and function to a very high level. Close follow-up over 2 years demonstrated ongoing excellent function and disease control with no deleterious effects on facial or dento-alveolar growth clinically. This is the first clinical report of its kind in the published literature detailing the use of a zygomatic implant-retained obturator in a paediatric patient.
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Affiliation(s)
- Amit Dattani
- Oral and Maxillofacial Surgery, Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
| | - David Richardson
- Maxillofacial Surgery, Regional Craniofacial Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Chris J Butterworth
- Maxillofacial Prosthodontics, Regional Maxillofacial Unit, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK.
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