Outcomes of Zygomatic Complex Reconstruction With Patient-Specific Titanium Mesh Using Computer-Assisted Techniques

Abstract

Zygomatic complex defects after extensive maxillectomy can cause severe esthetic and functional deformities. Patient-specific titanium mesh fabricated using a computer-assisted technique is a promising method for such midface reconstruction. The aim of this study was to evaluate the application and clinical outcomes of this technique. This was a retrospective study that included 9 patients with zygomatic complex defects after extensive maxillectomy from 2015 through 2017 at the authors' institution. A 3-dimensional stereo model was obtained based on mirror images of the unaffected side to fabricate a patient-specific titanium mesh using computer-assisted design and manufacturing. Titanium mesh was used to restore the contour of the zygomatic complex with free flap reconstruction after tumor resection. Anterolateral thigh flaps were used in 8 cases and a myocutaneous fibula flap was used in 1 case. Symmetry of the zygomatic complex was evaluated by measuring the zygomatic eminence on the postoperative computed tomogram, and complications were recorded during follow-up visits. Facial symmetry was self-evaluated and scored. Mean duration for follow-up was 27.3months (range, 15 to 39months). Mean deviation of the zygomatic eminence between the reconstructed and unaffected sides was 1.4±0.5mm. No significant difference was noted in the zygomatic eminence between the reconstructed and unaffected sides (P=.591). Titanium mesh exposure occurred in only 1 patient after radiotherapy. There were no other remarkable complications. All patients were satisfied with their postoperative facial symmetry. Patient-specific titanium mesh fabricated using a computer-assisted technique was an alternative option for extensive zygomatic complex reconstruction, resulting in acceptable clinical outcomes. A study with a larger sample and long-term follow-up is needed for the observation of long-term outcomes and risk of titanium mesh-related complications.