Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions

Abstract

Background This study virtually compares patient‐specific fibular and scapular reconstructions for maxillectomies. Methods Nine maxillectomy defects were created on 10 maxillas and virtually reconstructed with patient‐specific fibulas and scapulas. Reconstructions were compared for restoring midface cephalometrics, dental implantability, and pedicle length. Results Of 90 maxillectomy defects, the vertically oriented scapula provided improved orbital floor and maxillary height reconstructions (p < 0.001), albeit at the cost of dental implantability compared to the fibula (p < 0.001). In two defects crossing the midline, the fibula, allowing for more osteotomies, provided improved maxillary projection. In the remaining three defects crossing the midline, the horizontally oriented scapula was comparable to the fibula. Fibular and scapular reconstructions were amenable for dental implantation and had similar pedicle lengths, although favoring scapula in extensive defects. Conclusion Fibular and scapular reconstructions of maxillectomy defects provide unique strengths. This virtual analysis can guide a goal‐oriented reconstruction based on defect type and patient‐specific goals.

Technical refinements of the scapular tip‐free flap for mandibular reconstruction

“…Although the implantability criteria were met in up to 95% of patients in recent reports, dental implants may continue to pose a problem (Lanzer et al, 2015). STFF bone, in terms of height and especially thickness, is undoubtedly inferior to fibula (Nguyen et al, 2021) and iliac crest bone (Wilkman et al, 2019). Moreover, as bone modeling is less precise than for the other two flaps, the quality of dental rehabilitation (in terms of bone position for prosthetic placement) is often suboptimal.…”

Evolution of Medical Modeling and 3D Printing in Microvascular Midface Reconstruction: Literature Review and Experience at MD Anderson Cancer Center

“…The scapula represents an alternative option for bony reconstruction and can provide both vascularized bone as well as soft tissue [31,32]. A portion of the latissimus dorsi muscle, a skin paddle based off a thoracodorsal artery perforator, or a parascapular skin paddle, can be harvested to create a chimeric flap, allowing for complex reconstruction of midface defects (Figure 2).…”

Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy

“…In the case with an unreliable cutaneous perforator or nonpliable lateral calf skin, a fibula free flap can be used to restore the neoalveolus and midface volume, and a second fasciocutaneous flap can be used as a double closure technique to close the palate. 1 6 36 37 38 39 40 Fig. 1 shows a patient who required a complete maxillectomy with orbital exenteration and cranialization of the frontal sinus for an extensive mucosal melanoma.…”

“…The height of the fibula is on average approximately 13 to 15 mm, giving a reliable stock of bone for endosseous implantation. 36 The tibialis posterior and soleus muscle can be harvested to assist with dead space obliteration, but its mobility is typically limited. Also, it is important to take into consideration the pliability of the lateral calf skin to reconstruct the palate.…”