Computer-Assisted Microvascular Free Flap Reconstruction and Implant Rehabilitation of the Maxilla—Treatment of a Rare Post-orthognathic Complication

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 postorthognathic ANM.

Meet the Founding Resident Ambassador: John M. Le, DDS, MD

“…John M. Le, DDS, MD (Fig 1) and his colleagues in the Department of Oral and Maxillofacial Surgery at the University of Alabama at Birmingham have made a serious impact on global OMS specialty. [4][5][6][7][8][9][10][11][12][13][14][15] Moreover, their article contribution to our journal in 2020 made a huge influence by attracting an international community of readers to our journal, making us enormously proud. The masterpiece was dedicated to the use of zygomatic implants for restoration of complex nasal defects.…”

Meet the Founding Resident Ambassador: John M. Le, DDS, MD

“…John M. Le, DDS, MD (Fig 1) and his colleagues in the Department of Oral and Maxillofacial Surgery at the University of Alabama at Birmingham have made a serious impact on global OMS specialty. [4][5][6][7][8][9][10][11][12][13][14][15] Moreover, their article contribution to our journal in 2020 made a huge influence by attracting an international community of readers to our journal, making us enormously proud. The masterpiece was dedicated to the use of zygomatic implants for restoration of complex nasal defects.…”

Untitled

“…John M. Le, DDS, MD (Fig 1) and his colleagues in the Department of Oral and Maxillofacial Surgery at the University of Alabama at Birmingham have made a serious impact on global OMS specialty. [4][5][6][7][8][9][10][11][12][13][14][15] Moreover, their article contribution to our journal in 2020 made a huge influence by attracting an international community of readers to our journal, making us enormously proud. The masterpiece was dedicated to the use of zygomatic implants for restoration of complex nasal defects.…”

January’s 2022 Full Issue PDF

“…Therefore, for long-spanning Class II defects, the vascularized osteocutaneous fibula free flap serves as an excellent reconstructive option as it can both obturate the dead space as well as house osseointegrated implants for dental rehabilitation. 20 For Class V defects, either a pedicled or soft tissue free flap can obturate the dead space. However, for this specific type of defect class, the anatomical boundary of the defect provides the ideal retention for an orbital prosthesis.…”

Meet the Founding Resident Ambassador: John M. Le, DDS, MD

“…John M. Le, DDS, MD (Fig 1) and his colleagues in the Department of Oral and Maxillofacial Surgery at the University of Alabama at Birmingham have made a serious impact on global OMS specialty. [4][5][6][7][8][9][10][11][12][13][14][15] Moreover, their article contribution to our journal in 2020 made a huge influence by attracting an international community of readers to our journal, making us enormously proud. The masterpiece was dedicated to the use of zygomatic implants for restoration of complex nasal defects.…”

Untitled

“…John M. Le, DDS, MD (Fig 1) and his colleagues in the Department of Oral and Maxillofacial Surgery at the University of Alabama at Birmingham have made a serious impact on global OMS specialty. [4][5][6][7][8][9][10][11][12][13][14][15] Moreover, their article contribution to our journal in 2020 made a huge influence by attracting an international community of readers to our journal, making us enormously proud. The masterpiece was dedicated to the use of zygomatic implants for restoration of complex nasal defects.…”

January’s 2022 Full Issue PDF

“…Therefore, for long-spanning Class II defects, the vascularized osteocutaneous fibula free flap serves as an excellent reconstructive option as it can both obturate the dead space as well as house osseointegrated implants for dental rehabilitation. 20 For Class V defects, either a pedicled or soft tissue free flap can obturate the dead space. However, for this specific type of defect class, the anatomical boundary of the defect provides the ideal retention for an orbital prosthesis.…”

Meet the Founding Resident Ambassador: John M. Le, DDS, MD

“…John M. Le, DDS, MD (Fig 1) and his colleagues in the Department of Oral and Maxillofacial Surgery at the University of Alabama at Birmingham have made a serious impact on global OMS specialty. [4][5][6][7][8][9][10][11][12][13][14][15] Moreover, their article contribution to our journal in 2020 made a huge influence by attracting an international community of readers to our journal, making us enormously proud. The masterpiece was dedicated to the use of zygomatic implants for restoration of complex nasal defects.…”

Untitled

“…John M. Le, DDS, MD (Fig 1) and his colleagues in the Department of Oral and Maxillofacial Surgery at the University of Alabama at Birmingham have made a serious impact on global OMS specialty. [4][5][6][7][8][9][10][11][12][13][14][15] Moreover, their article contribution to our journal in 2020 made a huge influence by attracting an international community of readers to our journal, making us enormously proud. The masterpiece was dedicated to the use of zygomatic implants for restoration of complex nasal defects.…”

January’s 2022 Full Issue PDF

“…Therefore, for long-spanning Class II defects, the vascularized osteocutaneous fibula free flap serves as an excellent reconstructive option as it can both obturate the dead space as well as house osseointegrated implants for dental rehabilitation. 20 For Class V defects, either a pedicled or soft tissue free flap can obturate the dead space. However, for this specific type of defect class, the anatomical boundary of the defect provides the ideal retention for an orbital prosthesis.…”