Intraoral Microvascular Anastomosis of an Iliac Free Flap for Maxillary Fibrous Dysplasia

Sosin, Michael; Sinada, Ghassan G.; Rodriguez, Eduardo D.; Dorafshar, Amir H.

doi:10.1016/j.joms.2015.05.032

Cited by 15 publications

(10 citation statements)

References 9 publications

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“…There have also been no reported instances of facial nerve injury in these cases, likely relating to the more superficial anatomic location of the nerve when approached intraorally. 5,6,8,12,14,15,29 Our group did not use nerve monitoring to identify the facial nerve branch. Thus far, in our experience, we have found that the facial artery is commonly easier to identify because it is more anterior as compared to the facial vein, which is more posterior requiring deeper dissection.…”

Section: Discussionmentioning

confidence: 99%

Avoiding Facial Incisions with Midface Free Tissue Transfer

Stalder

Sosin

Urbinelli

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:We have adopted an intraoral microsurgical anastomosis to the facial vessels to eliminate the need for any visible facial incisions.Methods:Cadaveric dissection was used to demonstrate accessibility of the facial artery and vein through an intraoral approach. Additionally, 5 patients underwent free tissue transfer for reconstruction of major defects of the midface through an intraoral, transmucosal approach, obviating the need for visible skin incisions.Results:The pathology included palatal defects due to mucoepidermoid carcinoma and ischemic necrosis from cocaine abuse, maxillary defects secondary to fibrous dysplasia and avascular necrosis from traumatic blast injury, and a residual posttraumatic bony deformity of the zygoma. Reconstructions were performed with a free ulnar forearm flap, a free vastus lateralis muscle flap, a deep circumflex iliac artery myoosseous flap, a free fibula flap, and a deep circumflex iliac artery osseous flap, respectively. The facial artery and vein were used as recipient vessels for microvascular anastomosis for all cases. Mean follow-up was 12.2 months. All free tissue transfers were successful, and each patient had a satisfactory aesthetic outcome with no associated facial scars.Conclusion:This technique can be employed during reconstruction of an array of bony or soft-tissue midface deficits with minimal morbidity. This small series effectively demonstrates the varied pathologies and tissue deficiencies that can be successfully reconstructed with free tissue transfer using an entirely intraoral approach to the recipient facial vessels, resulting in no visible scars on the face and an improvement in the overall aesthetic outcome.

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Section: Discussionmentioning

confidence: 99%

Avoiding Facial Incisions with Midface Free Tissue Transfer

Stalder

Sosin

Urbinelli

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…This technique also facilitates identification of the facial nerve branches, preventing injury and paralysis. 23 Several reports of intraoral free flap anastomosis for a wide range of surgical indications and with a large variety of flaps followed and demonstrated favorable outcomes. 1,2,23–26 …”

Section: Discussionmentioning

confidence: 99%

Zygomatico-maxillary Reconstruction with Computer-aided Manufacturing of a Free DCIA Osseous Flap and Intraoral Anastomoses

Roy

Efanov

Mercier-Couture

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Summary:Craniomaxillofacial reconstruction using virtual surgical planning, computer-aided manufacturing, and new microsurgical techniques optimizes patient-specific and defect-directed reconstruction. A 3D customized free deep circumflex iliac artery (DCIA) flap with intraoral anastomoses was performed on a 23-year-old man with a posttraumatic right zygomatico-maxillary defect with failure of alloplastic implant reconstruction. An osseous iliac crest flap was sculpted based on a customized 3D model of the mirror image of the patient’s unaffected side to allow for perfect fit to the zygomatico-maxillary defect. An intraoral dissection of the facial artery and vein was performed within the right cheek mucosa and allowed for end-to-end microvascular anastomoses. 3D preoperative planning and customized free DCIA osseous flap combined with an intraoral microsurgical technique provided restoration of facial esthetics and function without visible scars. In cases where zygomatico-malar reconstruction by alloplastic material fails, a customized free DCIA osseous flap can be designed by virtual surgical planning to restore facial appearance and function.

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“…[9,11,16,18] In one article, the follow-up time is unknown. [13] 3.2.3 Florid cemento-osseous dysplasia (FCOD)…”

Section: Cleido-cranial Dysplasia (Ccd)mentioning

confidence: 99%

“…[34] Our review found a 100% success rate for dental implants in 5 patients with up to 7 years of follow-up. [9,11,13,16,18] However, it was observed that the contact between diseased bone and the implants is less stable than in healthy bone. [35][36][37] Hence, several authors suggested inserting longer implants (up to 16 mm) for compensation.…”

Section: Fibrous Dysplasiamentioning

confidence: 99%

“…[18] The latter time point is questionable since all loading strategies (2-12 months) were successful. [9,11,13,16,18] 4.3 Florid cemento-osseous dysplasia Florid cemento-osseous dysplasia is a rare fibro-osseous lesion [38] described first in 1976 by Melrose. [39] Many names were given to this pathology, but it was renamed FCOD in the second edition of the WHO classification of odontogenic tumors in 2013.…”

Section: Fibrous Dysplasiamentioning

confidence: 99%

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Survival of dental implants in patients with bone dysplasia: A systematic review

Perez

Dib

Terzic

et al. 2021

DCC

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Objective: This study used published studies to assess the survival rate of dental implants placed in patients with bone dysplasia of the maxillofacial region.Material and methods: An electronic search without a specified date range was performed using the MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane databases. No gender or age restrictions were applied.Results: Eighteen publications were found that met the study’s criteria, reporting data on 18 patients with bone dysplasia including cleidocranial dysplasia (CDD), fibrous dysplasia (FD), florid cemento-osseous dysplasia (FCOD), and odonto-maxillary segmental dysplasia (SOMD), who received a total of 130 implants, an average of 7.2 implants/patient (range 1 to 16). The mean age of the patients was 36.7 years (range 15 to 70 years). For implants placed in bone dysplasia, the survival rates were 100% for patients with CDD (n = 8), FD (n = 5), SOMD (n = 2), FCOD with implants inserted far from the lesions (n = 2) and 0% for dental implants inserted within FCOD (n = 1). The mean follow-up was 38.2 months (min 6, max 60).Conclusions: Dental implants placed in patients with dysplastic bone lesions show high survival rates, similar to those in the general population for CDD, FD, and SOMD. For FCOD, the failure rate was 100%.

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Intraoral Microvascular Anastomosis of an Iliac Free Flap for Maxillary Fibrous Dysplasia

Cited by 15 publications

References 9 publications

Avoiding Facial Incisions with Midface Free Tissue Transfer

Avoiding Facial Incisions with Midface Free Tissue Transfer

Zygomatico-maxillary Reconstruction with Computer-aided Manufacturing of a Free DCIA Osseous Flap and Intraoral Anastomoses

Survival of dental implants in patients with bone dysplasia: A systematic review

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