Large orbital defect reconstruction in the setting of globe‐sparing maxillectomy: The titanium hammock and layered fibula technique

Trosman, Samuel J.; Haffey, Timothy M.; Couto, Rafael A.; Fritz, Michael A.

doi:10.1002/micr.30199

Cited by 20 publications

(38 citation statements)

References 23 publications

(33 reference statements)

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“…There are several methods to restore palatal and maxillary defects [2][3][4]. Previous studies comparing the obturator and microvascular free flap reconstruction techniques have reported variable results.…”

Section: Introductionmentioning

confidence: 99%

Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap

Byun

Lim

Yang

et al. 2020

JCM

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Introduction. The objective of this study was to evaluate a surgical technique and to present the results of delayed reconstruction of palatomaxillary defects using fibula free flap (FFF). Methods. A review was conducted for nine patients who underwent palatomaxillary reconstruction using FFF. Primary disease, type of reconstruction, defect area, fibula segment length and number of osteotomies, radiotherapy, and implant installation after FFF reconstruction were analyzed. Results. All nine patients underwent delayed reconstruction. The fibula shaft was osteotomized into two segments in seven patients and three segments in one patient with bilateral Brown’s revised classification IV/d defect. One case was planned by using a computer-aided design computer-aided manufacturing (CAD/CAM) system with a navigation system. The mean length of the grafted fibula bone was 68.06 mm. Dental implant treatment was performed in six patients. Six patients received radiation therapy, and there were no specific complications related to the radiation therapy. In one case, the defect was reconstructed with FFF flow-through from a radial forearm free flap. Conclusion. This clinical study demonstrated that the fibula flap is an ideal donor-free flap in a palatomaxillary defect. Delayed reconstruction using an FFF can reduce the complication and failure rates.

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Section: Introductionmentioning

confidence: 99%

Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap

Byun

Lim

Yang

et al. 2020

JCM

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“…Redundant mesh material must be trimmed and the wound must be debrided thoroughly. 8,16 In our patients, locoregional flaps or secondary free flaps were used to close the exposed area, ensuring adequate soft tissue coverage of the titanium meshes. Unfortunately, mesh exposure recurred in two patients (Fig.…”

Section: Discussionmentioning

confidence: 99%

Long‐term Effect of Individualized Titanium Mesh in Orbital Floor Reconstruction After Maxillectomy

et al. 2021

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The aim of this study was to determine the clinical outcomes and long-term stability of individualized titanium mesh combined with free flap for orbital floor reconstruction after maxillectomy and to identify the risk factors for titanium mesh exposure.Material and Methods: The data of 66 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2011 and 2019 were retrospectively reviewed. Postoperative ophthalmic function and success of aesthetic restoration were assessed. Titanium mesh exposure was recorded and the risk factors were identified.Results: Mean follow-up was for 24.8 months (range, 6-92 months). Ophthalmic function was successfully restored in 63/66 patients. Aesthetic restoration was not considered satisfactory by 10 patients. Titanium mesh exposure occurred in six patients (exposure rate, 9.1%). Preoperative radiotherapy was identified as an independent risk factor for mesh exposure (OR = 28.8, P = 0.006). Previous surgery, postoperative radiotherapy, pathological type of the primary lesion, the type of tissue flap applied, and the use of intraoperative navigation were not significant risk factors. Six patients with titanium mesh exposure underwent second surgery, but mesh exposure recurred in two patients due to insufficient soft tissue coverage.Conclusion: Individualized titanium mesh with free flap can effectively restore maxilla-orbital defects. Preoperative radiotherapy is an independent predictor of postoperative titanium mesh exposure. Adequate soft tissue coverage of the mesh may reduce the risk of mesh exposure.

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“…High-energy trauma, extended ablative surgery, or congenital malformations of the midface can lead to the occurrence of zygoma defects, which result in severe facial disfigurement and functional disability. [ 1 2 5 11 ] A 3D reconstruction of the zygoma is one of the most challenging procedures in craniofacial surgery due to its complex anatomy with a unique combination of concave and convex surfaces; low osteogenic capacity; and proximity to the maxillary sinus, eye globe, orbit, and cranial base. [ 3 4 13 18 21 ]…”

Section: Onclusionmentioning

confidence: 99%

“…[ 1 2 3 4 ] Different approaches to zygoma reconstruction have been described in the literature. [ 5 6 ] They include nonvascularized autologous bone grafting, free tissue transfer on microvascular anastomosis, preformed titanium plates and meshes, custom-made patient-specific implants (PSIs), or a combination of the above methods. [ 1 7 8 9 ] In recent decades, the autologous bone grafting procedures have been considered the gold standard for reconstruction of midface bone defects.…”

Section: Introductionmentioning

confidence: 99%

Application of patient-specific implants as alternative approach to zygoma defect management - A retrospective study

Kustro

Chepurnyi

Zhukovtseva

et al. 2021

Ann Maxillofac Surg

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Introduction: Zygoma defects are a challenging clinical problem and are frequently connected with the alteration of facial harmony, horizontal asymmetry of the face, and significant functional deficit. The application of patient-specific implants (PSIs) has the potential to improve the effectiveness of zygoma defect management. The aim of this study was to evaluate the anatomic, esthetic, and functional outcomes of PSI application for zygoma reconstruction. Materials and Methods: A retrospective study was conducted on data from 11 patients with zygoma defects who underwent a reconstruction procedure in which a PSI was applied and was followed for >1 year after surgery with the evaluation of esthetic and functional outcomes. Precision of PSI position and anatomy reconstruction was estimated by superimposition of the models with automatic point-to-point measurement and determination of the existing deviations between models. Results: The mean follow-up period in our study was 21.6 ± 6.2 months (range 14–39 months). No major complications occurred in the postoperative period: There were no clinical or computed tomography symptoms of maxillary sinusitis, implant-related infection, or implant exposure. The mean deviation between the planned and real positions of PSIs in our series was 0.72 ± 0.41 mm. The mean deviation between the reconstructed zygomatic complex and the mirrored intact side in our series was 1.45 ± 0.7 mm. The mean volume difference between the intact and damaged orbits was 1.7 ± 0.8 mm 3 . Discussion: The results of the present study support the wider clinical application of PSIs in orbital and zygoma reconstructions, as it is an effective option to achieve precise reconstruction of the complex zygoma anatomy.

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Large orbital defect reconstruction in the setting of globe‐sparing maxillectomy: The titanium hammock and layered fibula technique

Abstract: This technique provides excellent restoration of eye position and function and also allows for implant-based prosthetic rehabilitation. It has become our procedure of choice for orbitomaxillary reconstruction.

Cited by 20 publications

References 23 publications

Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap

Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap

Long‐term Effect of Individualized Titanium Mesh in Orbital Floor Reconstruction After Maxillectomy

Application of patient-specific implants as alternative approach to zygoma defect management - A retrospective study

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