This article describes our special considerations in virtual surgical planning for secondary maxillary reconstruction with vascularised fibular osteomyocutaneous flap and our revised surgical design for maxillary reconstruction.
Eleven patients with different maxillary defects according to Brown’s revised classification underwent virtual surgical planning for secondary accurate reconstruction. For different horizontal class defects, the fibular was osteomised to match the maxillary alveolar arch by using the mirror image of the contralateral alveolar ridge or the curve of the mandibular arch and dentition.
Maxillary reconstruction was performed with the guidance of preoperative virtual planning and using fibular osteotomy and reposition guide templates to replicate the virtual planning intra-operatively. Virtual surgical planning was replicated intra-operatively in all patients. The fibulae were osteotomised into four segments in three patients with the horizontal class d2 defect and three segments in eight patients with the horizontal class b–d1 defects, respectively. The overall success rate for 11 flaps was 100%. Good bony unions and wound closure were observed and intelligible speech was achieved in 11 patients. Maximum incisal opening ranged from 3.0 to 4.0 cm. All patients tolerated a regular diet postoperatively. Postoperative midfacial appearance was good in all patients.
We recommend that the horizontal class d defect in Brown’s revised classification of maxilla and midface be divided into two sub-types according to whether it involves the contralateral canine or not. Special considerations in virtual surgical planning are helpful to perform accurate secondary maxillary reconstruction with a vascularised fibular osteomyocutaneous flap.
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- Lateral lip-splitting approach for total and subtotal maxillectomy.J Oral Maxillofac Surg. 2009; 67: 1197
- Virtual planning of composite mandibular reconstruction with free fibula bone graft.J Craniofac Surg. 2005; 16: 1137
- A new method for computer-aided operation planning for extensive mandibular reconstruction.Plast Reconstr Surg. 2006; 117: 2431
- The occlusion-adjusted prefabricated 3D mirror image templates by computer simulation: the image-guided navigation system application in difficult cases of head and neck reconstruction.Ann Plast Surg. 2009; 63: 517
- Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction.J Oral Maxillofac Surg. 2009; 67: 2115
- A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular reconstruction with free fibula osseous flaps.Int J Oral Maxillofac Surg. 2009; 38: 187
- Importance of computer-aided design and manufacturing technology in the multidisciplinary approach to head and neck reconstruction.J Craniofac Surg. 2010; 21: 1277
- Midfacial reconstruction using virtual planning, rapid prototype modeling, and stereotactic navigation.Plast Reconstr Surg. 2002; 126: 2010
- Reconstruction of the maxilla and midface: introducing a new classification.Lancet Oncol. 2010; 11: 1001
- The radial forearm osteocutaneous “sandwich” free flap for reconstruction of the bilateral subtotal maxillectomy defect.Ann Plast Surg. 1998; 40: 397
- Reconstruction following radical maxillectomy with flaps supplied by the subscapular artery.J Craniomaxillofac Surg. 2000; 28: 153
- Scapular angle osteomypgenous flap in postmaxillectomy reconstruction: defect, reconstruction, shoulder function and harvest technique.Head Neck. 2008; 30: 10
- Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy.Br J Oral Maxillofac Surg. 2002; 40: 183
- Osteomyocutaneous peroneal artery perforator flap for reconstruction of composite maxillary defects.Head Neck. 2006; 28: 297
- Preservation of contour in periorbital and midfacial craniofacial microsurgery: reconstruction of the soft-tissue elements and skeletal buttresses.Plast Reconstr Surg. 2008; 121: 1738
- Microvascular free flap reconstructive options in patients with partial and total maxillectomy defects.Arch Facial Plast Surg. 2000; 2: 91
- A classification system and algorithm for reconstruction of maxillectomy and midfacial defects.Plast Reconstr Surg. 2000; 105: 2331
Published online: January 24, 2012
Accepted: December 24, 2011
Received: September 21, 2011
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.