Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap

Abstract

This article describes our special considerations in virtual surgical planning for secondary maxillary reconstruction with vascularised fibular osteomyocutaneous flap and our revised surgical design for maxillary reconstruction. Eleven patients with different maxillary defects according to Brown's revised classification underwent virtual surgical planning for secondary accurate reconstruction. For different horizontal class defects, the fibular was osteomised to match the maxillary alveolar arch by using the mirror image of the contralateral alveolar ridge or the curve of the mandibular arch and dentition. Maxillary reconstruction was performed with the guidance of preoperative virtual planning and using fibular osteotomy and reposition guide templates to replicate the virtual planning intra-operatively. Virtual surgical planning was replicated intra-operatively in all patients. The fibulae were osteotomised into four segments in three patients with the horizontal class d2 defect and three segments in eight patients with the horizontal class b-d1 defects, respectively. The overall success rate for 11 flaps was 100%. Good bony unions and wound closure were observed and intelligible speech was achieved in 11 patients. Maximum incisal opening ranged from 3.0 to 4.0 cm. All patients tolerated a regular diet postoperatively. Postoperative midfacial appearance was good in all patients. We recommend that the horizontal class d defect in Brown's revised classification of maxilla and midface be divided into two sub-types according to whether it involves the contralateral canine or not. Special considerations in virtual surgical planning are helpful to perform accurate secondary maxillary reconstruction with a vascularised fibular osteomyocutaneous flap.