Evan Matros, Leslie N Kim, Luke Poveromo, Thais Polanco, Evan Rosen, Ian Ganly, Jay Boyle, Marc Cohen, Joseph D Randazzo, Farooq Shahzad, Snehal G Patel, Jonas A Nelson, Peter G Cordeiro, Robert J Allen
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引用次数: 0
Abstract
Background: Maxillary reconstruction is a complex undertaking characterized by a 3-dimensional surgical site with deficiencies in multiple tissue types. Before virtual surgical planning (VSP), bony reconstruction was inaccurate and inefficient; thus, reconstructions defaulted to soft-tissue flaps or obturators. The current study describes an efficient and accurate approach to bony maxillary reconstruction with immediate dental implant placement (IDIP).
Methods: A reconstructive workflow was developed for osseous reconstruction to improve functional and aesthetic outcomes. Critical aspects include VSP, 3-dimensionally printed plates, and IDIP. Review of a prospectively maintained database identified patients who underwent osseous maxillary reconstruction with a fibula flap and immediate dental implants from 2017 to 2022, with a focus on oncologic characteristics and reconstructive outcomes.
Results: During the study, 20 patients underwent maxillary reconstruction with VSP and IDIP. One dental implant of 55 failed to osseointegrate, and no flaps were lost. Three patients experienced partial loss of the fibula skin island; 1 required palatal closure with a radial forearm flap, and 2 were managed with outpatient débridement. Fifteen patients achieved either an interim or final retained dental prosthesis. All prostheses achieved acceptable aesthetic results without the instability associated with non-bone-borne devices (eg, dentures/obturators). No patients experienced delays in oncologic treatment.
Conclusions: VSP technology has enabled surgeons to replace like with like to achieve better outcomes with acceptable morbidity for maxillary defects. IDIP provides all patients an opportunity for a fixed prosthesis even though not all complete the process. This maxillary reconstruction workflow can be safely accomplished in oncologic patients with promising and effective early results.
Clinical question/level of evidence: Therapeutic, IV.
期刊介绍：
For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis.
Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.
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