Midfacial Reconstruction â€“ A Systematic Review

Emara, Aalaa; ElFetouh, Adel Abou; Hakam, Maha; Mostafa, Basma

doi:10.3889/oamjms.2016.067

Cited by 8 publications

(6 citation statements)

References 36 publications

(53 reference statements)

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“…Free flaps, pedicled faps and vascular flaps have all been reported for such cases with varying degrees of success. All these procedures carry an added cost of hospital stay, higher mortality/morbidity rates and higher costs [30] . With the rapidly evolving computer assisted designing, printing and surgery; their application in the field of maxillofacial reconstruction has also greatly developed.…”

Section: Discussionmentioning

confidence: 99%

10 year experience with patient-specific midfacial reconstruction - A single-center study

Emara

Helmy

Nassar

et al. 2022

Egyptian Dental Journal

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Complex midfacial reconstructions have greatly improved in quality with the introduction of computer aided/guided surgeries, 3D printing and Patient-specific implants (PSI). Our study reports a 10-year follow up of midfacial reconstruction patients receiving different PSI for reconstruction. Methodology:During the period between 2011-2020 patients with midfacial defects requiring reconstruction with PSI were pooled together and the data analysed. The CTs, intraoperative notes and postoperative follow up notes were gathered. All surgeries were planned in a similar manner with the differences being in the material used and extents of defects; titanium PSIs for defects with alveolar segment involvement and Poly-ether-ether-ketone (PEEK) onlay for defects with zygomatic involvement causing cheek prominence deficiencies.Results: Although intraoperative positioning was accurate when compared to the virtual planning in all our patients, several of them suffered soft tissue dehiscence specially those receiving Titanium PSIs.Conclusions: From our experience PEEK seems to be more versatile and suitable for maxillofacial reconstructions but will need further modifications in methods of printing and reinforcement. Further research with larger sample sizes and different fabrication methods are needed to assess the techniques further.

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Section: Discussionmentioning

confidence: 99%

10 year experience with patient-specific midfacial reconstruction - A single-center study

Emara

Helmy

Nassar

et al. 2022

Egyptian Dental Journal

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“…The scapula has been used for maxillary reconstruction and offers several advantages when compared to other reconstructive options. In reconstructing a hemimaxillectomy defect, the advantage of the scapular tip free tissue transfer is the shape of the osseous component of the ap and how it mirrors the shape of the resected maxilla and palate [3,4].…”

Section: Introductionmentioning

confidence: 99%

Aesthetic Reconstruction of Onco-surgical Maxillary Defects Using Free Scapular Flap with and without CAD/CAM Customized Osteotomy Guide

Alwadeai

aroomi

Shindy

et al. 2022

Preprint

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Background: Reconstruction of the maxillary defects following tumor ablation remains to be a challenge for surgeons. Virtual Surgical Planning (VSP), intraoperative cutting guides and stereolithographic models provides the head and neck reconstructive surgeon with powerful tools for complex reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular free flap has not been as widely reported. The aim of this study was to compare aesthetic results and operation time of free scapular flap, with and without computer-aided design and computer-aided manufacturing (CAD/CAM) customized osteotomy guide, for reconstruction of maxillary defects.Methods: In this prospective randomized controlled clinical trial study, we randomly assigned 22 patients with maxillary defects who were scheduled to undergo maxillary reconstruction with either free scapular flap with CAD/CAM customized osteotomy guide; study group (n = 11) or free scapular flap without CAD/CAM customized osteotomy guide; control group (n =11). All patients were followed up for 3 months. The aesthetic outcome, operation and ischemic times were evaluated and compared.Results: Aesthetic outcomes were evaluated objectively by means of differential surface area (sagittal and axial) measurement, which showed improved aesthetic outcome (contour symmetry) in the study group with a mean of (241.39±113.74), compared to patients in control group with a mean of (358.70±143.99). There were significant differences between the two groups (P< 0.05). Aesthetic outcomes were also evaluated subjectively by means of visual analogue scale (VAS) and patient’s satisfaction score (PSS). The postoperative aesthetic appearance was better in the study group with more patients satisfied than that in control group and there were statistically significant differences (P=0.039). The mean total operative time was 678.81 minutes and 777.18 minutes in the study group and control group respectively (P<0.05) and the mean ischemia time was 133.18 minutes and 195.72 minutes for study group and control group respectively (P<0.05).The ischemia time and total operative time were shorter in the study group compared to those in the control group and there were no flap losses in both groups.Conclusion: The use of CAD/CAM prefabricated cutting guides facilitates scapular flap molding and placement, minimizes ischemic time and operating time as well as improves aesthetic outcomes.Trial registration: This trial was registered at ClinicalTrials.gov. Registration number: NCT03757286. Registration date: 28/11/ 2018.

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“…Midfacial reconstruction after maxillectomy is complex and requires addressing a number of functional and cosmetic demands. [1][2][3][4] The goals of midface reconstruction are tailored to the surgical defect, but generally include maintaining oronasal separation, buttressing orbital contents, approximating a natural facial structure, and ensuring a patent nasal airway. 3,4 Although some palatomaxillary defects may be adequately reconstructed with an obturator, more extensive midfacial deficits frequently require microvascular free flap reconstruction with a bony or soft tissue free flap.…”

Section: Introductionmentioning

confidence: 99%

“…Midfacial reconstruction after maxillectomy is complex and requires addressing a number of functional and cosmetic demands 1–4 . The goals of midface reconstruction are tailored to the surgical defect, but generally include maintaining oronasal separation, buttressing orbital contents, approximating a natural facial structure, and ensuring a patent nasal airway 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Sinonasal Issues After Maxillectomy With Free Flap Reconstruction: Incidence and Clinical Approach

et al. 2021

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Objective: To characterize the clinical features associated with sinonasal complaints after maxillectomy with free flap reconstruction as well as propose a screening and treatment algorithm.Methods: Retrospective review of patients who underwent maxillectomy and free flap reconstruction at a tertiary care center.Results: Fifty-eight patients were included, 25 (43.1%) of them had documented sinonasal complaints postoperatively. Eleven patients subsequently underwent revision surgery for sinonasal complaints. Among the 25 patients with sinonasal complaints, 22 patients (88.0%) had nasal crusting, 17 (68.0%) had nasal obstruction, 12 (48.0%) had rhinorrhea, 9 (36.0%) had facial pain or pressure, and 7 (28.0%) had foul odor. Twenty-two patients (88.0%) had multiple sinonasal complaints. There was a higher incidence of both sinonasal complaints and surgical intervention in patients who underwent adjuvant radiation, but this was not statistically significant (47.7% vs 28.6%, P = .235; 29.4% vs 7.1%, P = .265).Conclusions: Sinonasal complaints are common following free flap reconstruction for a maxillectomy defect and should be screened for at postoperative visits, with early referral to a rhinologist for consideration of endoscopic sinus surgery. Nonsurgical treatment strategies include large-volume nasal saline irrigations, xylitol irrigations for persistent inflammatory symptoms, and culture-directed antibiotic irrigations for persistent infectious symptoms.

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Midfacial Reconstruction â€“ A Systematic Review

Cited by 8 publications

References 36 publications

10 year experience with patient-specific midfacial reconstruction - A single-center study

10 year experience with patient-specific midfacial reconstruction - A single-center study

Aesthetic Reconstruction of Onco-surgical Maxillary Defects Using Free Scapular Flap with and without CAD/CAM Customized Osteotomy Guide

Sinonasal Issues After Maxillectomy With Free Flap Reconstruction: Incidence and Clinical Approach

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