Microsurgical Three-Dimensional Reconstruction of Complex Nasal and Midfacial Defect: Multistep Procedure Respecting Aesthetic Unit Criteria

Iacoviello, Paolo; Bacigaluppi, Susanna; Gramegna, M; Callegari, Simone; Signorini, Giuseppe; Verrina, Giuseppe

doi:10.1097/scs.0000000000007056

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…Aesthetic roles of the maxilla include projection of the midface and attachment for the muscles involved into facial expression, therefore laying the foundation for social interaction and subsequently mental health of the patient. To allow sufficient functional and aesthetic rehabilitation of lost maxillary structures, it is self-evident that all resected tissue qualities such as bone, fat, and soft tissue, as well as mucosa and teeth must be incorporated into surgical planning of the reconstruction (10,11). To achieve favourable patient's prognosis however, it is sufficiently investigated and common consent that wide resection margins without OS infiltration are the paramount factor (12,13).…”

Section: Discussionmentioning

confidence: 99%

Maxillofacial osteosarcoma -- report of two cases with presentation of a two-staged reconstructive strategy and dental rehabilitation

Glajzer,

Lutz,

Nobis

et al. 2023

Preprint

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Background: Maxillofacial osteosarcoma (MOS) is a rare disease, mostly located to the mandible or maxilla. Surgical resection with wide free margins represents the key intervention to achieve favorable prognosis. MOS are particularly demanding to resect and surgically reconstruct because of the numerous tissue types and functions included in this location. Case reports: We introduce two patients with a highly malignant maxillary OS treated by primary tumor resection and immediate reconstruction with a microvascular soft tissue flap. After confirmation of relapse-free tissue healing and sufficiently free resection margins, osseous reconstruction was performed in a second operation by use of a virtually planned microvascular Fibula Flap. Both patients received implant-supported dental rehabilitation and show relapse-free for seven and three years, respectively. Conclusions: Combination of radical tumor resection, primary soft tissue reconstruction and secondary bone reconstruction allows high oncologic safety and optimal conditions for a thoroughly planned osseous as well as dental rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Maxillofacial osteosarcoma -- report of two cases with presentation of a two-staged reconstructive strategy and dental rehabilitation

Glajzer,

Lutz,

Nobis

et al. 2023

Preprint

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“…Neck dissection often requires facial artery transection to remove the first cervical lymph node station, and using this artery avoids wastage of the facial artery already transected and maintains the superior thyroid artery as a future possibility or as a second choice if flow in the former (FA) is not satisfactory. Even in surgery where neck dissection is not required (basal cell carcioma recurrence), the recipient vessels are harvested from the premandibular tract of the facial vessels ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Optimization of Vascular Supply in Free Flaps for Head and Neck Reconstruction: Analysis of a Young Team’s Experience

Iacoviello

Bacigaluppi²,

Callegari³

et al. 2022

Front. Surg.

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BackgroundFor head and neck reconstructive procedures, free flap survival depends on microsurgical and anatomical choices besides multimodal clinical management. The aim of the present study is to identify relevant variables for flap survival in our initial consecutive series.MethodsA single-center, novel reconstructive team consecutive surgical series was revised. The outcome was analyzed in terms of flap survival observing variables considered more relevant: flap type, recipient artery, vein(s), and graft interposition were discussed for facial thirds to be reconstructed. Statistical analysis was performed with Chi-square, Mann–Whitney, and Odds ratio.ResultsA total of 118 free flaps were performed in 115 microsurgical procedures (93.9% for malignancies) on 109 patients, with a flap survival rate of 91.5%. For reconstruction of the middle and lower third of the face, the facial artery was privileged, because it was already transected during lymph node dissection in order to save the superior thyroid artery for further microsurgical needs. Flap failure was 50% venous. Double vein anastomosis was not related to flap survival. Deep venous drainage (as the internal jugular vein system) required fewer revisions. Half of the re-explorations saved the flap. Grafts were a risk for flap survival. Bony flaps were more critical.ConclusionAt comparable reconstructive quality, flap choice should avoid a vascular graft. The facial artery is a preferable recipient vessel, since it saves other arteries both in the case of an arterial revision and in the case of recurrence, for further free flap reconstruction. For venous anastomosis, a deep venous recipient is safer, since it offers the possibility to choose the level of anastomosis optimizing the vascular pedicle geometry. A close postsurgical flap monitoring is advisable up to 7 days postoperatively to allow for timely flap salvage.

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“…Therefore, it is necessary to consider the subunit principle for the practical and aesthetic reconstruction of the nasal subunit. 11,12) Considering these reasons, we decided to use a separate free flap for the columella nasal subunit during maxillary reconstruction. The preauricular free flap was selected to reconstruct the nasal subunit.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Reconstruction of a Subtotal Maxillectomy and Columella Deficit using Radial Forearm and Preauricular Free Flaps

Yoon¹,

Eun²,

Cho³

et al. 2022

Korean J Head Neck Oncol

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Reconstruction of subtotal maxillectomy defects with columella deficit is challenging. We report a unique case of facial reconstruction using a free radial forearm flap and a free preauricular flap for the maxillectomy and columella deficit. A 73-year-old woman was diagnosed with recurrent sebaceous carcinoma of the nose. We performed wide excision, including areas of the right cheek, nose, upper lip, maxilla, and columella. The resultant subtotal maxillectomy defect was reconstructed using a three-dimensional flap. First, a free radial forearm flap was transfered to resurface the nasal, oral, and external facial side. Second, a preauricular flap was positioned into the columella defect and anastomosed with the distal portion of the radial forearm flap pedicle. The two flaps survived, and the patient recovered uneventfully. We believe the radial forearm and preauricular double free flaps with the pedicle connection method were effective in reconstructing the present case of subtotal maxillectomy defect.

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Microsurgical Three-Dimensional Reconstruction of Complex Nasal and Midfacial Defect: Multistep Procedure Respecting Aesthetic Unit Criteria

Cited by 4 publications

References 13 publications

Maxillofacial osteosarcoma -- report of two cases with presentation of a two-staged reconstructive strategy and dental rehabilitation

Maxillofacial osteosarcoma -- report of two cases with presentation of a two-staged reconstructive strategy and dental rehabilitation

Optimization of Vascular Supply in Free Flaps for Head and Neck Reconstruction: Analysis of a Young Team’s Experience

Simultaneous Reconstruction of a Subtotal Maxillectomy and Columella Deficit using Radial Forearm and Preauricular Free Flaps

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