Palatomaxillary Reconstruction: Fibula or Scapula

Badhey, Arvind; Khan, Muhammad Zia

doi:10.1055/s-0040-1709431

Cited by 5 publications

(3 citation statements)

References 79 publications

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“…The reconstruction involves separating the oral and nasal cavities, suspending the orbit and separating it from paranasal tissues, as well as decreasing dead spaces from the resected maxillary sinus. Restoring vertical and horizontal facial buttresses are important for facial height, width, and proportions, and to maintain the structural integrity of the midface [13]. When there is a severe bone defect of the maxillary arch, including significant defects in the nasomaxillary and zygomaticomaxillary bony buttresses with facial tissue loss in the midface, a vascularized bone flap is required.…”

Section: Reconstructionmentioning

confidence: 99%

Bone grafting in maxillofacial trauma

Gökdoğan¹

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review The purpose of this article is to review the recent grafting strategies in maxillofacial trauma. Recent findings Recent technological advancements have applications in the management of maxillofacial trauma; advancements in imaging modalities such as 3D imaging can help surgeons in both the preoperative and intraoperative periods. These may be coupled with navigational systems to further facilitate complex reconstructions. 3D printing has been used in reconstruction and 3D, 4D, and 5D bioprinting technologies continue to improve and to find new uses, and stem cells and growth factors in maxillofacial trauma are also among the most studied topics. Maxillofacial traumas have decreased in number during the COVID-19 pandemic, as more conservative approaches have been preferred in COVID pandemic conditions. Summary Preoperative planning is the most important step in the reconstruction of maxillofacial trauma defects, and early bone and soft tissue reconstructions are recommended in severe maxillofacial traumas. Autogenous grafts are the gold standard in bone grafting. Nonvascularized grafts are planned according to the size, shape, and location of the defect, with vascularized bone flaps preferred in large defects, wide soft tissue defects, and contaminated defects. Alloplastic grafts or xenografts may be used if autogenous grafts are not available.

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Section: Reconstructionmentioning

confidence: 99%

Bone grafting in maxillofacial trauma

Gökdoğan¹

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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“…It is essential for the head and neck surgeon when choosing a certain treatment option to assess the main aspects of midface rehabilitation. These goals include (1,3,6,8,(11)(12)(13)(14)(15)(16)(17):…”

Section: Goals Of Reconstructionmentioning

confidence: 99%

Reconstruction of midfacial defects

Lago-Beack¹,

Acero²

2021

Front Oral Maxillofac Med

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Defects of the maxilla and midfacial structures following trauma, benignant or malignant tumor ablation are a challenge for the reconstructive surgeon because of the importance of physical appearance and speech, swallowing and visual functions in which this anatomical area is involved. The bony and soft tissues constituting the midface provide much of the facial contour and profile giving each person its personal appearance. The aim of this paper is to review the methods of reconstruction after oncological resection of the middle third of the face and to present our reconstructive protocol. Reconstructive methods available to restore the defect after oncologic resection in this area can include: (I) obturators; (II) local or regional pedicled flaps; (III) microvascular flaps (forearm, rectus abdominis, fibula, iliac crest, scapula flap, etc.).Repair of a midfacial defect should be based on the size, location and type of tissues involved. It is important to understand the complex three-dimensional anatomy of the maxilla so as the interrelation to adjacent structures of the midface prior to approach the decision-making plan. Indications and disadvantages of the different techniques are reviewed. New technological developments including virtual planning, 3D printing and navigation can contribute to increase safety and accuracy in oncologic resection and reconstruction of the midface.

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“…These techniques include the use of autologous bone grafts, vascularized free flaps, and alloplastic materials [ 3 , 4 ]. Autologous bone grafts, such as rib and tibia grafts or iliac crest and tibia grafts, can be combined with reconstruction plates for mandibular reconstruction [ 5 ]. Vascularized free flaps, particularly the free fibula flap (FFF), have gained popularity in recent years due to their potential for successful osseointegration and their ability to provide a robust and reliable source of bone for reconstruction [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes and influential factors in functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region: a systematic review and meta-analysis

Tahmasebi

Keykha

Hajisadeghi

et al. 2023

Maxillofac Plast Reconstr Surg

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Background This systematic review and meta-analysis aimed to evaluate the factors influencing and success rates of dental implants for functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region. Main text We conducted a comprehensive search of electronic databases, including MEDLINE, Web of Science, Embase, Scopus, and Cochrane’s CENTRAL, as well as gray literature sources and manual searches of notable journals. The search was performed from inception until February 2023. Studies were included if they examined functional and dental rehabilitation outcomes in patients receiving maxillofacial reconstruction using microvascular fibula flaps and were retrospective or prospective cohort studies involving human subjects. Case–control studies, research involving other reconstruction methods, and animal-based studies were excluded. Data was extracted and confirmed by two independent researchers, and risk of bias was assessed using the Newcastle–Ottawa Scale. Meta-analyses were conducted for dental implant and graft success rate, with separate analyses for different factors affecting the outcome. Heterogeneity was evaluated using Cochran’s Q test and the I2 test. The pooled success rate for implants was 92% and for grafts, 95%, with significant heterogeneity. Implants in fibular grafts had a 2.91 times higher failure rate than those in natural bones. Radiated bone and smoking were identified as factors influencing implant failure, with radiated bone having a 2.29 times higher risk and smokers having a 3.16 times higher risk compared to their respective counterparts. Patient-reported outcomes showed improvements in key areas such as dietary intake, mastication, speech, and esthetics. The success rates declined over time, emphasizing the importance of long-term follow-up. Conclusions Dental implants in free fibula grafts generally have favorable success rates, with minimal bone resorption, manageable probing depths, and limited bleeding on probing. Implant success is influenced by factors such as smoking and radiated bone.

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Palatomaxillary Reconstruction: Fibula or Scapula

Cited by 5 publications

References 79 publications

Bone grafting in maxillofacial trauma

Bone grafting in maxillofacial trauma

Reconstruction of midfacial defects

Outcomes and influential factors in functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region: a systematic review and meta-analysis

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