Summary
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: January 24, 2012
Accepted:
December 24,
2011
Received:
September 21,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
