Reconstruction Of Maxillofacial Defects Research Articles

Comparison of Aesthetic Outcomes of Different Methods of Reconstruction of Maxillofacial Defects: A Clinical Trial

Comparison of Aesthetic Outcomes of Different Methods of Reconstruction of Maxillofacial Defects: A Clinical Trial

Maxillofacial Reconstruction With Three Dimensional Resin Bone Substitutes as an Alternative to Transition Group of Metals: A Structured Review.

In recent years, novel technologies and techniques have allowed today the production of controlled architecture materials. Although autogenous bone graft substitutes remain the gold standard, enormous defects require supplementary alloplastic substitutes for reconstruction. Polymers have lately been explored for the same purpose and their biological performance has been under research since the last decade. The aim of this review is to analyse maxillofacial reconstruction with three-dimensional resin bone substitutes. A Problem InterventionComparison Outcomes (PICO) analysis was done and a search was carried out in the Cochrane Database, PubMed, Google Scholar etc databases and a hand search was done to collect the related literature. All articles for maxillofacial reconstruction with three-dimensional resin bone substitutes were scrutinised. The manuscripts published from 1990 till May 2021, were included in this review. A total of 106 articles were obtained from a PICO-based keyword search, and 91 manuscripts were retrieved after excluding the duplicates. Out of these 57 manuscripts were excluded on the basis of title and abstract. From the remaining 34 studies, 17 were excluded after reading the full text based on the inclusion and exclusion criteria.During data extraction, four studies were removed and finally, 13 studies were included in this research. From this scoping review, we could conclude that polymethylmethacrylate and polylactic acid formulations are very promising resin bone substitutes for 3-dimensional reconstruction of maxillofacial defects. However, rigorous long-term clinical trials are needed to validate this conclusion.

Versatility of use of nasolabial flap in reconstruction of maxillofacial defects: Our experience

Versatility of use of nasolabial flap in reconstruction of maxillofacial defects: Our experience

THEROLE OF VIRTUAL DESIGN AND 3D PRINTING FOR RECONSTRUCTION:WORKING ALGORITHM AND ITS APPLICATIONS

Reconstruction of Maxillofacial defects following complex resection is common challenge encountered by many maxillofacial surgeons.The important objectives are to restore the normal anatomy and function with proper adaptation in these complex defects. The introduction ofcomputer aided design (CAD) and 3D printing technology has significantly facilitated greater predictability with improved efficiencies in surgical procedures and prosthetic reconstruction. This paper reviews the concept of virtual surgical planningand 3D technology in surgical proceduresand its broad clinical application in oral & maxillofacial surgery.

Development, Evaluation, and Comparison of an Indigenous ‘APDS’ AI-based Digital Application for Effective Shade Selection of Silicone Maxillofacial Prosthesis: Protocol for A Cross-sectional Study

Introduction: Reconstruction of maxillofacial defects is challenging in achieving aesthetic results. Replicating natural skin colour in maxillofacial prosthesis has been traditionally done using trial-and-error methods. However, with their respective limitations, multiple methods have been developed recently, like colourimeter and spectrophotometer. Need for the study: The natural appearance of the prosthesis affects the patient’s emotional and psychological well-being. Therefore, aesthetics is a prime concern now. So, the problem with colour matching of the maxillofacial prosthesis is profound. So, there is a need to develop customised shade guides and more advanced digitised shade-matching applications with Artificial Intelligence (AI) help. Therefore, a concoction of a customised silicon shade guide was contemplated with Advanced Programme in Data Sciences (APDS) AI-based digital application, and its reproducibility in clinical practice will be analysed. Aim: Phase 1- To develop and validate a customised broad spectrum silicon shade guide and APDS AI-based digital application on a survey of the Indian population. Phase 2- Comparative evaluation of the efficacy of indigenous APDS AI-based digital application with available shade guide systems for shade selection for silicone maxillofacial prosthesis. Methodology: A cross-sectional study. The shade guide will be fabricated with medical grade room temperature vulcanising silicone based on an observational survey. The shade guide will consist of three main groups ABC, divided into different subgroups from lighter to darker skin shades, and its accuracy evaluation is done by spectrophotometer. APDS AI-based digital application will be developed using reference from broadspectrum customised maxillofacial shade guide, and efficacy will be evaluated with visual assessment of colour matching by fabricating facial veneers for participants through investigators to investigate the consent of perfect colour match. Data will be statistically analysed.

Surgical Site Adaptability and Outcomes of Patient Specific Implants used for the Reconstruction of Maxillofacial Defects: A Prospective Pilot Study

Surgical Site Adaptability and Outcomes of Patient Specific Implants used for the Reconstruction of Maxillofacial Defects: A Prospective Pilot Study

Utility of Temporalis Myofascial Flap in Reconstruction of Maxillary Palatal Defect

Abstract With advances in various maxillofacial surgeries and methods, maxillary defect reconstruction after tumor resection remains a challenge for a head-and-neck surgeon. The introduction of using regional flaps has been observed a beneficial management for the reconstruction of maxillofacial defects having poorer articulation, deglutition, and esthetic demands and which allowed a single-stage reconstruction method in such defects. Temporalis myofascial flap (TMFF) can readily adapt the palatal vault and induced fibrosis in the muscle can fully support the load of prosthetic devices. In this case report, we have done reconstruction of maxillary defect (Brown’s Class 2b maxillary defect) using TMFF in a 26-year-old patient diagnosed with mucoepidermoid carcinoma of hard palate.

Inclusion of calcium phosphate does not further improve in vitro and in vivo osteogenesis in a novel, highly biocompatible, mechanically stable and 3D printable polymer

At a time of unpredictable challenges for health, one trend is certain: there is an exceedingly high demand for functional implants, particularly bone grafts. This has encouraged the emergence of bone tissue engineering substitutes as an alternative method to conventional bone grafts. However, the current approaches in the field face several limitations that have prevented the ultimate translation into clinical settings. As a result, many attempts have been made to fabricate synthetic bone implants that can offer suitable biological and mechanical properties.Light curable methacrylate-based polymers have ideal properties for bone repair. These materials are also suitable for 3D printing which can be applicable for restoration of both function and aesthetics. The main objective of this research was to investigate the role of calcium phosphate (CaP) incorporation in a mechanically stable, biologically functional and 3D printable polymer for the reconstruction of complex craniofacial defects. The experimental work initially involved the synthesis of (((((((((((3R,3aR,6S,6aR)- hexahydrofuro[3,2-b]furan-3,6-diyl)bis(oxy))bis(ethane-2,1- 48 diyl))bis(oxy))bis(carbonyl))bis(azanediyl))bis(3,3,5-trimethylcyclohexane-5,1- 49 diyl))bis(azanediyl))bis(carbonyl))bis(oxy))bis(ethane-2,1-diyl) bis(2-methylacrylate) referred to as CSMA and fabrication of composite discs via a Digital Light Printing (DLP) method. The flow behaviour of the polymer as a function of CaP addition, surface remineralisation potential, in vitro cell culture, using MC3T3 and Adipose-Derived Mesenchymal Stem Cells (ADSCs) and ex ovo angiogenic response was assessed. Finally, in vivo studies were carried out to investigate neo-bone formation at 4- and 8-weeks post-implantation. Quantitative micro-CT and histological evaluation did not show a higher rate of bone formation in CaP filled CSMA composites compared to CSMA itself. Therefore, such polymeric systems hold promising features by allowing more flexibility in designing a 3D printed scaffold targeted at the reconstruction of maxillofacial defects.

What Factors Influence the Bony Fusion of Vascularized Fibula Free Flaps for Mandibular Reconstruction?

The vascularized fibula free flap was implemented over 20 years ago for reconstruction of maxillofacial defects,1 however, little is known about healing and osseous fusion postoperatively. We sought to determine the factors influencing bony fusion of the vascularized fibula free flap. We performed a retrospective cohort analysis of patients treated at University of Illinois Chicago with free fibula flaps for mandibular reconstruction from August 2016 to August 2021 in order to analyze fusion at osteotomy sites (UIC IRB #2022-0351).

Biocompatibility of fiber-reinforced composite (FRC) and woven-coated FRC: an in vivo study.

To investigate biocompatibility and bone contact area of FRC and woven-coated FRC (FRC-C) in rats. Sixty rats were allocated to three groups: FRC (n=20), FRC-C (n=20), and control group (n=20). Subgroups were determined as 4th (n=10) and 12th weeks (n=10). The specimens were placed in the femur of rats. In the control group, the bone defects were left empty and sutured. Four and 12 weeks after implantation, the rats were sacrificed. Histopathological examinations were performed in a semi-quantitative manner. Twenty rats (n=20) were used for scanning electron microscopy (SEM) examination. Bone contact surfaces were calculated in SEM analysis. A chi-square test was performed to analyze the data. No statistical difference was detected between the 4th and 12th weeks in the quality of bone union. Quality of bone union was lower in FRC compared to the control group in the 4th week (p=0.012) and the 12th week (p=0.017). The periosteal reaction at the 12th week was lower in FRC than in the control group (p=0.021). Bone contact of FRC and FRC-C was 85.5% and 86.3%, respectively. FRC and FRC-C were biocompatible and showed no inflammation. The woven coating did not increase the quality of bone union and bone contact area, while not reducing biocompatibility. The biocompatibility and good bone response of the woven glass fiber net were demonstrated to have the potential as a scaffold for the augmentation of alveolar bone deficiencies and the reconstruction of maxillofacial defects.

Vascular iliac myofascial flap to repair compound defect of the jaw

The vascular iliac myofascial flap is a compound flap with the deep circumflex iliac artery (DCIA) as the vascular pedicle, carrying the iliac bone and parts of the internal oblique, external oblique and muscle-fascial tissue that cover the surface of the iliac crest and inside the iliac bone. The aim of this study was to advocate a feasible surgical strategy for maxillofacial surgeons through our review of clinical applications and to improve the quality of life of patients after the operation. In recent years, Stomatology Hospital of Wuhan University has performed dozens of vascularized iliac myofascial flaps, not only to repair jaw defects but also to complete the repair of intraoral soft tissue defects. 20 patients were followed up. These patients with jaw tumors who received a vascular iliac myofascial flap to repair compound defects of the jaw from 2018 to 2020. The Quality of Life Questionnaire-Head and Neck Cancer-37 (QLQ-H&N37) was used to evaluate their speech function (Z=-0.061, P>0.05) and postoperative aesthetics (Z=-2.824, P<0.05). All patients obtained good surgical results and satisfaction in terms of aesthetics and function. The successful reconstruction of these cases prove that the vascularized iliac composite flap with myofascial tissue is a reliable flap for the reconstruction of maxillofacial defects.

Vessel anastomosis in free flap reconstruction for oral and maxillofacial defects: techniques and key points.

The quality of vessel anastomosis is a key element for the success of free flap reconstruction. When adopting free flaps for oral and maxillofacial defect reconstruction, skills in selecting vessels, determining the clinical manifestations of the recipient vessel, and anastomosis technique are needed. Key points on postoperative flap observation were also required. We are experienced on this subject given that we have accomplished more than 1 000 free flaps for patients with oral and maxillofacial defects in the last 5 years. In this article, we summarize the skills and key points in free flap reconstruction of oral and maxillofacial defects, including vessel anastomosis skills, vessel selection, and vessel crisis diagnosis.

Evaluation of the outcomes of using iliac bone graft for reconstruction of traumatic orbital floor fractures.

Orbital floor fracture is common in facial trauma patients. Although treated through surgical repair, the orbital floor fractures are associated with risk of persisting sensibility disorders, enophthalmos, and permanent diplopia due to complex anatomy of the orbit, time of surgery, and the reconstructive material used for such repairing.Failure of early recognition and treatment of these traumatic injuries may result in functional and cosmetic problems. Autogenous bone grafts are the gold standard for reconstruction of maxillofacial defects. The iliac crest is also considered the most ideal donor site for bone grafting when a large amount of bone is needed. To assess the outcome of early repair of orbital floor fractures regarding enophthalmos, double vision, extrusion, and gait disturbance. A total of 15 patients, all with orbital floor fracture, were enrolled, of which 12 of them were having pure blow-out fractures and 3 patients had impure blow-out fractures. All had undergone primary surgical reconstruction of the orbital floor by autogenous anterior iliac crest within 5-14 days of the injury. The results were as follows: Postoperative complications at recipient site included diplopia (13.3%), enophthalmos (6.7%), and extrusion (6.7%). At the donor site, one patient had pain and the other had gait disturbances, both relieved within 1 month after treatment. Less complications were reported postoperatively with the use of nonvascularized autogenous iliac bone graft.

Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction.

The scapula free flap is a versatile option in head and neck reconstruction but is less amenable to simultaneous harvest and ablation. Retrospective series (2015-2021) of consecutive scapula flaps. Cases categorized as simultaneous versus sequential, compared for operative time, oncological and patient-reported outcomes. Seventy consecutive scapula free flaps were performed (n= 21 simultaneous, n= 49 sequential). Mandible reconstruction was performed in 51.0% and 61.9% of sequential and simultaneous cases, respectively; 49.0% and 38.1% addressed bony maxillary defects. Simultaneous surgery reduced operative time by 37.9% (151 min, p < 0.00001) and there were fewer tracheostomies performed (p < 0.005). Rates of positive margins and free flap compromise were equivalent (n=1, 4.8% vs. n=2, 4.1%). There was no difference in patient-reported outcomes. This series demonstrates feasibility, efficacy, and outcomes of bony scapula reconstruction of maxillofacial defects comparing simultaneous and sequential approaches. Benefits of the two-team approach are highlighted including decreased operative time.

Femoral artery-nourished anteromedial thigh flap: A new perspective in oral and maxillofacial defect reconstruction

ObjectivesThe aim of this study was to evaluate the feasibility and efficacy of the femoral artery (FA)-nourished anteromedial thigh (AMT) flap for reconstructing oral and maxillofacial defects. Patients and methodsThe authors analyzed a retrospective case series of 13 patients who underwent the reconstruction of oral and maxillofacial defects with the FA-nourished AMT flap. The flap design and the methods for defect reconstruction are described, and the reconstructive efficacy is reported. ResultsOf the 13 patients, 12 were men, and 1 was woman, with an average age of 52.2 years. Of these FA-supplied AMT flaps, 7 were singly used, 5 were combined with the anterolateral thigh (ALT) flap or its chimeric flaps, and 1 was separately used with the ALT flap. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. ConclusionsThe FA-nourished AMT flap can also be used to reconstruct some common oral and maxillofacial defects, especially as a new alternative to the ALT flap. In addition, this flap can be combined with the ALT flap or its chimeric flaps or separately used with the ALT flap for the reconstruction of complex defects.

Use of the supraclavicular artery island flap for reconstruction of maxillofacial defects: a case report and literature review

BackgroundFree flaps are widely used in maxillofacial reconstruction; however, this approach was not feasible in the current case. It was not possible because the free flap method requires microvascular anastomosis expertise, which is difficult, time-consuming and costly.Case presentationAn 86-year-old woman suffered squamous cell carcinoma on the right side of her face, which resulted in a large soft-tissue defect. Here, we present a case of facial reconstruction from the inferior margin of the jaw to the top of the head. The size of the defect was 18.5 cm × 7.5 cm, which is rare for a patient of this age in the maxillofacial area. We used the supraclavicular artery island flap (SCAIFP) which measured 19.3 cm × 8.3 cm to repair the defect. After the operation, the flap survived without complications. Then, the patient was followed for 10 months and was satisfied with the aesthetic and functional results at the donor and recipient sites following the tumour resection. The tumour did not recur, and facial nerve function was preserved.ConclusionOur results provide a new choice for the reconstruction of large defects of the head and face, and expand the potential applications of the SCAIFP.

Application of the posteromedial thigh flap for oral and maxillofacial defect reconstruction

To explore the feasibility of using the posteromedial thigh flap as an alternative source for oral and maxillofacial reconstruction. During January 2019 to January 2020, twenty-three patients underwent oral and maxillofacial tumor ablation and defect reconstruction with 23 posteromedial thigh flaps were enrolled in the Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University. Thirteen of the patients were male and ten were female, with age of (54.5±9.7) years (33-72 years). The numbers and types of perforators, the dimension of flap and the vascular pedicle length were measured. The outcomes of flaps and donor-site complication were recorded. The patients' satisfaction with donor-site cosmesis were evaluated by the visual analogue scale (VAS). More than one sizable perforators was found in each case and the median number of perforators was 2 (range, 1 to 4), and all of the perforators were musculocutaneous. The pedicle length was (9.8±1.5) cm (range, 7.3 to 13.4 cm). The diameters of artery and the larger vein were 2.0 mm (range, 1.5 to 2.5 mm) and 2.0 mm (range, 1.5 to 3.0 mm), respectively. The dimension of the flaps ranged from 8 cm×6 cm to 12 cm×8 cm, and the donor sites were all closed primarily. All of the flaps were clinically survived, only one patient experienced partial wound dehiscence of donor site 14 days postoperatively and no donor site infection or permanent muscular weakness was reported. The VAS scores of the patients' satisfaction with donor-site cosmesis were all more than 8. The perforators of the posteromedial thigh flap is consistent and the donor-site scar is well concealed, which make the posteromedial thigh flap an excellent option for oral and maxillofacial reconstruction.

Application of superficial inferior epigastric artery flaps to repair oral and maxillofacial defects with the aid of digital three-dimensional reconstruction technique

Objective: To explore the application value of digital three-dimensional(3D) reconstruction technology in the repair of oral and maxillofacial defects with superficial inferior epigastric artery (SIEA) flap. Methods: Twelve cases of oral cancer patients, including 8 males and 4 females; aged (57.4±12.6) years, were selected from the Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Bengbu Medical College from January 2018 to October 2019 and were proposed to repair with SIEA flap. There were 10 cases of squamous cell carcinoma, one case of adenoid cystic carcinoma and 1 case of mucinous epidermal carcinoma. The data were imported into AW4.7 software for post-processing. The left or right dominant donor area was selected to clarify the origin, diameter, alignment, and location of penetration point of the flap blood supply, and digital 3D reconstruction technology was used to guide the flap preoperative design. Results: Eleven cases were repaired by SIEA flap in 12 patients, one case was repaired by superficial iliac artery flap because the source artery was undiscovered, one case had venous vascular crisis after surgery, and the rest of the flap survived. In 11 patients repaired with SIEA flap, there was no significant difference between the preoperative SIEA diameter measured by CTA [(1.0±0.3) mm] and the actual measured value [(1.1±0.3) mm] (P>0.05). The follow-up was 6 to 12 months, with an average of 10 months, and the donor-receiver areas were all healed in phase Ⅰ. No obvious complications occurred, and the abdominal scar was hidden. Conclusions: In the SIEA flap repair oral and maxillofacial defect reconstruction surgery, the use of digital 3D reconstruction technology can objectively reflect the diameter and the location of the superficial artery of the abdominal wall before surgery, effectively reduce the difficulty and risk of flap surgery.

The deep circumflex iliac artery free flap in maxillofacial reconstruction: a comparative institutional analysis.

The aim of the present study was to perform a comparative analysis of the utility, outcomes, and complications of DCIA (deep circumflex iliac artery) flap for the reconstruction of maxillofacial defects between two institutions that continue to use the DCIA flap as a reconstructive resource. This retrospective analysis included a total of 68 patients (mean age 51.1 years) at the University Hospital of Parma, Parma, Italy, and the University of Maryland, Baltimore, USA, between January 2010 and April 2019. No statistical differences were found in relation to the site of reconstruction (p = 0.09), bone graft quantity (p = 0.93), rehabilitation with dental implants (p = 0.464), length of hospitalization (p = 0.086), BMI (0.677), swallow function (p = 0.419), medical comorbidities (p = 0.933), pre-existing radiation (p = 0.691), adjuvant treatment (p = 0.298), ECOG-PS pre-and post-surgery (p = 0.329; p = 0.545), and flap failure: one partial failure observed (p = 0.412) and donor site morbidities (p = 0.742). A noted trend to increased risk of hernia without the use of a primary mesh repair was observed (p = 0.059). The DCIA free flap represents a useful and reliable reconstructive flap for maxillofacial reconstruction. Reconstructive microvascular surgeons should be proficiently trained in this flap technique for its consideration as a first-line option in maxillofacial reconstruction.

Biofunctional Glycol-Modified Polyethylene Terephthalate and Thermoplastic Polyurethane Implants by Extrusion-Based Additive Manufacturing for Medical 3D Maxillofacial Defect Reconstruction.

This work addresses the topic of extrusion-based additive manufacturing (filament-based material extrusion) of patient-specific biofunctional maxillofacial implants. The technical approach was chosen to overcome the shortcomings of medically established fabrication processes such as a limited availability of materials or long manufacturing times. The goal of the work was a successful fabrication of basic implants for defect reconstruction. The underlying vision is the implants’ clinic-internal and operation-accompanying application. Following a literature search, a material selection was conducted. Digitally prepared three-dimensional (3D) models dealing with two representative mandible bone defects were printed based on the material selection. An ex-vivo model of the implant environment evaluated dimensional and fitting traits of the implants. Glycol-modified PET (PETG) and thermoplastic polyurethane (TPU) were finally selected. These plastics had high cell acceptance, good mechanical properties, and optimal printability. The subsequent fabrication process yielded two different implant strategies: the standard implant made of PETG with a build-up rate of approximately 10 g/h, and the biofunctional performance implant with a TPU shell and a PETG core with a build-up rate of approximately 4 g/h. The standard implant is meant to be intraoperatively applied, as the print time is below three hours even for larger skull defects. Standard implants proved to be well fitting, mechanically stable and cleanly printed. In addition, the hybrid implant showed particularly cell-friendly behavior due to the chemical constitution of the TPU shell and great impact stability because of the crack-absorbing TPU/PETG combination. This biofunctional constellation could be used in specific reconstructive patient cases and is suitable for pre-operative manufacturing based on radiological image scans of the defect. In summary, filament-based material extrusion has been identified as a suitable manufacturing method for personalized implants in the maxillofacial area. A further clinical and mechanical study is recommended.