Abstract
ObjectiveMidface reconstruction is challenging for functional and esthetic reasons. The present study analyzed the effect of virtual surgical planning (VSP) of the deep circumflex iliac artery (DCIA) flap for midface reconstruction.Patients and MethodsThirty-four patients who underwent midface reconstruction with the DCIA flap were included in this retrospective study. Of the 34 patients, 16 underwent preoperative VSP, which used a three-dimensionally printed surgical guide, computer-assisted navigation system, and pre-bent titanium implants to transfer VSP into real-world surgery. The other 18 patients underwent traditional midface reconstruction. The following were compared between the two groups: bony contact rate in the buttress region (BCR), dental arch reconstruction rate (DAR), surgical approach, position of vascular anastomosis, and dental implantation rate. The independent-samples t-test and Fisher’s exact test were used for analysis. P < 0.05 was considered statistically significant.ResultsIn total, 12 males and 22 females were included in this study. All patients underwent midface reconstruction using the DCIA flap at the same institution. The median age of patients was 33 years (range: 16–68 years). The average BCR and DAR values in the VSP group were 59.4% ± 27.9% and 87.5% ± 18.9%, respectively, which were significantly higher compared with the non-VSP group (P = 0.049 and P = 0.004, respectively). The dental implantation rate in the VSP group (50.0%) was significantly higher compared with the non-VSP group (11.1%; P = 0.023). The intraoral approach for tumor ablation and vascular anastomosis was the most frequent choice in both groups. There was no significant difference between the two groups. All patients were satisfied with facial symmetry postoperatively.ConclusionsVSP could effectively augment the effect of midface reconstruction with the DCIA flap. Stronger bone contact in the buttress region and higher DAR provide more opportunity for dental implantation, which might be the best solution to improve masticatory function in patients with midface defects.
Highlights
Midface reconstruction is challenging for functional and esthetic reasons [1,2,3,4]
Patients who underwent midface reconstruction with the deep circumflex iliac artery (DCIA) flap at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China, between May 2017 and December 2020 were enrolled in this retrospective study
The dental implantation rate in the virtual surgical planning (VSP) group was 50.0%, which was significantly higher compared with the non-VSP group (11.1%; P = 0.023)
Summary
Midface reconstruction is challenging for functional and esthetic reasons [1,2,3,4]. Many subregions form the midface, including the orbital floor, the zygomaticomaxillary complex, and the alveolar ridge. The DCIA flap was first introduced by Urken in 1989 for oromandibular reconstruction [6] Brown used it for maxillary reconstruction in 1996 [7]. The most obvious advantage of the DCIA flap is that it provides a reasonable bone height, to support the midface buttress, and for dental implants. Our recent study showed that bone of the fibular flap for maxillary reconstruction is unlike mandibular reconstruction, since it is absorbed constantly over time [8]. This makes the DCIA flap popular at our institution
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
