Dentoalveolar outcomes in maxillary reconstruction: A retrospective review of 85 maxillectomy reconstructions

Abstract

Background Although microvascular free flaps are often used to reconstruct maxillary defects, dentoalveolar rehabilitation is arguably less common despite its importance to midface function and aesthetics. The aim of this study is to review the contemporary management of maxillary defects in a single quaternary referral institution to identify factors that assist or impede dentoalveolar rehabilitation. Methods A retrospective review of maxillary reconstructions performed between February 2017 and December 2020 was performed. Patient characteristics, defect classification, operative techniques, complications and dentoalveolar outcomes were recorded. Results A total of 85 maxillary reconstructions were performed in 73 patients. Of the 64 patients where dental rehabilitation was required, 31 received a functional denture (48%) with 24 (38%) being implant‐retained. Significant predictors of successful rehabilitation included the use of virtual surgical planning (VSP; 86% vs. 25%, p < 0.001), preoperative prosthodontic assessment (82% vs. 21%, p < 0.001), prefabrication (100% vs. 40%, p = 0.002) and use of the zygomatic implant perforator flap technique (100% vs. 39%, p = 0.001). Preoperative prosthodontic consultation was associated with 21‐fold increase in the odds of rehabilitation (odds ratio 20.9, 95% confidence interval 6.54–66.66, p < 0.005). Conclusion Preoperative prosthodontic evaluation, VSP and reconstructive techniques developed to facilitate implant placement are associated with increased dental rehabilitation rates. Despite using an institutional algorithm, functional dentures are frequently prevented by factors including soft tissue constraints, disease recurrence and patient motivation.

Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers

“…First used for complex and re‐operative jaw reconstruction, 18,19 VSP is now routine and has led to several paradigm shifts, especially occlusal‐based planning 20 where the bone is positioned around the preferred endosseous implant locations 20 . VSP has facilitated more rapid dental rehabilitation, improved health‐related quality of life outcomes, 21–23 and bespoke options including the prefabricated fibula, 21 the ‘Alberta’ and ‘Sydney Modified Alberta Reconstruction Technique’, 20,24 and ‘Jaw in a Day’ approaches 25 . More recently, in‐house (point‐of‐care) digital planning and manufacturing has made these dental rehabilitative options even more accessible 26–29 …”

“…They have also used reconstructive approaches that are not routinely employed by all institutions including dynamic facial reanimation using the chimeric VALT, 11,12,33 scapular flaps for osseous reconstruction, 31,32 the SCIP flap for oral reconstruction, 17,34 fascial flaps such as the TPF flap for laryngotracheal reconstruction and osteoradionecrosis, [35][36][37] and point-of-care VSP with primary dental implants for maxillomandibular reconstruction. [18][19][20][21][22][23][24][26][27][28][29][30][31][32]38…”

Changing trends in the microvascular reconstruction and oral rehabilitation following maxillary cancer

“…There is still a place for composite free tissue alone, especially in the extensive resections, to provide adequate function and HROQOL, accepting that formal oral rehabilitation will not be achieved [19]. However, the emergence of zygomatic implants informs the previous algorithms for maxillary reconstruction [3][4][5][10][11][12][13][14][15].…”

“…In this group the risk of osteoradionecrosis and prosthetic failure versus improvement in appearance, chewing, speech and swallowing must be carefully considered [ 18 ]. Many patients do not complete full oral rehabilitation and cope and adapt to their outcome [ 19 ].…”

How age affects health‐related‐quality‐of‐life outcomes in maxillomandibular reconstructive surgery

“…These pathologies and their treatment can affect swallowing, mastication, speech, breathing, sleeping, and facial symmetry. [1][2][3] Additionally, psychosocial problems may present secondary to these aesthetic and functional deficits. These effects are likely to significantly impact patients' health-related quality of life (HRQOL).…”