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Ferri A, Varazzani A, Tognin L, Bellanti L, Pedrazzi G, Bianchi B, Arcuri F, Ferrari S, Poli T. Perioperative pain management after scapular tip free flap harvesting for head and neck reconstruction using mini-catheters to inject the local anesthetic. Oral Maxillofac Surg 2024; 28:819-826. [PMID: 38270706 DOI: 10.1007/s10006-024-01212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Although functional and esthetic results after the use of a scapular tip free flap (STFF) in head and neck reconstruction, and the related donor-site morbidity, have been extensively described, data regarding acute postoperative donor-site pain management are lacking. Purpose of this study is to explore the use of mini-catheters to administer local anesthetics for donor-site pain management after reconstruction using STFF. METHODS Patients who underwent head and neck reconstruction using a STFF were prospectively enrolled and, through a perineural catheter placed in the donor site during the surgical procedure, a bolus of chirochaine was injected before the patient regained consciousness and at 8, 16, and 24 h postoperatively. Before and 40 min after each dose administration, donor-site pain on a numerical rating scale (NRS; 0-10) was evaluated. RESULTS Study population consisted of 20 patients (40-88 years). At 8 h, the pain scores before and after the injection were 0-10 (mean 3.35) and 0-5 (mean 1.25), respectively. At 16 h, the pain scores before and after the injection were 0-8 (mean 2.55) and 0-4 (mean 0.55), respectively. At 24 h, the pain scores before and after the injection were 0-8 (mean 1.30) and 0-4 (mean 0.30), respectively. CONCLUSION Statistical analysis confirmed a significant difference between the pain scores before and after administration at 8, 16, and 24 h (p < 0.001, p < 0.001, and p = 0.003, respectively). Mini-catheters for local anesthetic administration represent an effective strategy for pain control after STFF harvesting for head and neck reconstruction.
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Affiliation(s)
- A Ferri
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital of Parma, Parma, Italy
| | - A Varazzani
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital of Parma, Parma, Italy
| | - L Tognin
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital of Parma, Parma, Italy.
| | - L Bellanti
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital of Parma, Parma, Italy
| | | | - B Bianchi
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital San Martino of Genova, Genoa, Italy
| | - F Arcuri
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital San Martino of Genova, Genoa, Italy
| | | | - T Poli
- University of Parma, Parma, Italy
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Alwadeai M, Al-Aroomy L, Amin A, Shindy M, Zedan M, Baz S. Virtual Surgical Guidance Improves Quality of Life Following Scapular Free-Flap Reconstruction of Maxillary Defects. J Oral Maxillofac Surg 2024; 82:600-609. [PMID: 38432642 DOI: 10.1016/j.joms.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The best approach to maxillary reconstruction with negative impact on the patient's quality of life (QOL) remains the subject of debate. PURPOSE This study was designed to evaluate the QOL outcomes following maxillary reconstruction using a scapular-free flap, with and without the computer-aided design and computer-aided manufacturing (CAD/CAM) technique. STUDY DESIGN, SETTING, SAMPLE A prospective randomized controlled clinical trial was performed following the CONSORT checklist. To be included, patients suffering from maxillary defects without previous surgery or lymph node involvement were selected. Patients with poor oncological prognosis, deficient performance status, preoperative chemotherapy, or radiotherapy, besides vascular contraindications, were excluded. PREDICTOR VARIABLE The predictor variable was the reconstruction technique, grouped into two equal categories. Patients were randomly assigned to reconstruction with a scapular-free flap, with the control group not utilizing a guide and the study group utilizing a CAD/CAM-customized guide. MAIN OUTCOME VARIABLE The primary outcome variable was the various domains of QOL, measured using the University of Washington Quality of Life score, 12 months after reconstruction. COVARIATES Age; sex; scapular flap side; and maxillary defect tumour type, histopathology, side, length, class, sagittal, and axial differential areas were considered. ANALYSES Shapiro-Wilk and Kolmogorov-Smirnov tests were performed for normality. For comparisons between the two groups, Student's t-test and Mann-Whitney test were used. The category variables were compared using the χ2 test. P ≤ .05 was considered statistically significant. RESULTS The sample was composed of twenty-two eligible patients, eleven in each group. The mean age of the control group was (50.09 ± 17.14) years, and 45.45% were male, while in the study group, the mean age was (48.36 ± 14.14) years, with 36.36% male. All the patients were evaluated, showing statistically significant differences between control and study groups in terms of pain, appearance, chewing, swallowing, speech, and shoulder (P ≤ .05), indicating that the scapular-free flap with a CAD/CAM osteotomy guide had improved the patient's QOL. CONCLUSION AND RELEVANCE The findings of this study indicate that virtual surgical planning with a CAD/CAM customized osteotomy guide using a scapular-free flap can improve QOL in maxillary reconstruction in terms of pain, appearance, chewing and swallowing food, pronouncing words, and shoulder QOL outcomes.
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Affiliation(s)
- Mohamed Alwadeai
- Assistant Professor of Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ibb University, Yemen
| | - Leena Al-Aroomy
- Assistant Professor of Oral and Maxillofacial Pathology, Faculty of Dentistry, Ibb University, Yemen
| | - Ayman Amin
- Professor of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mostafa Shindy
- Associate Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mohamed Zedan
- Associate Professor of Surgical Oncology, National Cancer Institute, Cairo University
| | - Safaa Baz
- Lecturer of Oral Pathology Department, Faculty of Dentistry, The British University in Egypt, El Sherouk City, Cairo, Egypt.
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Chan TG, Nickel C, Solares C, Irizarry R, Pipkorn P, Baddour HM, Gross JH. Stacked fibula flap for unilateral total maxillectomy reconstruction with orbital preservation. Head Neck 2024; 46:218-227. [PMID: 37933883 DOI: 10.1002/hed.27567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
Unilateral total maxillectomy is indicated for locally advanced maxillary tumors that require complete removal of the midface bony structure and inferior orbital rim. Reconstruction of this defect is challenging due to aesthetic and functional concerns. A retrospective review of patients at two tertiary-care institutions undergoing unilateral total maxillectomy reconstruction with a stacked fibula flap from 2018 to 2022 was performed. Each patient's clinical course was reviewed, and attention was focused on the demonstration of surgical steps with photos. Twenty patients underwent stacked fibula flap reconstruction for unilateral total maxillectomy orbital preservation defects. Surgical extirpation was performed for malignancy (80%, 16/20) and for osteoradionecrosis or benign tumor in 20% (4/20). The complication rate was 30% (6/20). Most flaps survived (95%, 19/20). We present a modified, reproducible method of fibula flap reconstruction for unilateral total maxillectomy with orbital preservation that only requires two segments and maintains positive aesthetic and functional results.
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Affiliation(s)
- Tyler G Chan
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chris Nickel
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Clementino Solares
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Rachel Irizarry
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Siteman Cancer Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Harry Michael Baddour
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jennifer H Gross
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Shuck JW, Largo RD, Hanasono MM, Chang EI. Evolution of Medical Modeling and 3D Printing in Microvascular Midface Reconstruction: Literature Review and Experience at MD Anderson Cancer Center. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1762. [PMID: 37893480 PMCID: PMC10608668 DOI: 10.3390/medicina59101762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
Reconstruction of the midface represents a challenge for reconstructive microsurgeons given the formidable task of restoring both aesthetics and functionality. In particular, preservation of proper globe positioning and maintaining normal vision are as important as restoring the proper projection of the midface and enabling a patient to speak and eat as normally as possible. The introduction of virtual surgical planning (VSP) and medical modeling has revolutionized bony reconstruction of the craniofacial skeleton; however, the overwhelming majority of studies have focused on mandibular reconstruction. Here, we introduce some novel advances in utilizing VSP for bony reconstruction of the midface. The present review aims (1) to provide a review of the literature on the use of VSP in midface reconstruction and (2) to provide some insights from the authors' early experience.
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Affiliation(s)
| | | | | | - Edward I. Chang
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Jelovac D, Micic M, Hajdarevic S, Kuzmanovic C, Cukic B, Stefanovic B, Zelic K, Bonfante E, Ewers R, Petrovic M. Immediate placement of extra-short implants in refined scapula tip microvascular free flaps: In house virtual planning and surgical technique - Proof of concept. Heliyon 2023; 9:e18021. [PMID: 37496908 PMCID: PMC10366439 DOI: 10.1016/j.heliyon.2023.e18021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/24/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023] Open
Abstract
Scapula tip flaps have been introduced in the literature as an ideal surgical treatment option for large defects in the horizontal plane of the maxilla. This article aims to present a unique step by step protocol for a near total maxillectomy with a pterygoid bone resection and consecutive microvascular reconstruction with a harvested scapula tip flap. The protocol includes immediate placement of extra-short implants in donor bone with the aid of Virtual Surgical Planning (VSP), and an in-house 3D printing of medical 3D models and surgical guides. So far, there has been no presented surgical technique combining immediate implant placement in the scapula region with simultaneous microvascular repair. This technique allows: tumour resection; flap harvesting; extra-short implant placements and reconstruction to be performed in one simultaneous procedure. The technique is presented with illustrations, VSP (presented on videos), radiographs, and surgical findings. We discovered that this refinement of the scapula tip surgery has enabled reconstructive procedures to be performed at the same time as implant placements, providing expedited functional and aesthetic outcomes in selected cases. Moreover, modification of the surgical technique could enhance the competence of the oropharyngeal edge. In conclusion, this new surgical protocol utilizing VSP, 3D models and simultaneous extra-short implant placement provides indispensable advantages for such a complicated surgical procedures, while significantly shortening the duration of surgery.
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Affiliation(s)
- Drago Jelovac
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Milutin Micic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Sanela Hajdarevic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Cedomir Kuzmanovic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | | | | | - Ksenija Zelic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
- School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - E.A. Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo – Bauru School of Dentistry, Bauru, SP, Brazil
| | - Rolf Ewers
- University Hospital for Cranio Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18 - 20, 1090, Vienna, Austria
| | - Milan Petrovic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
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Kim H, Choi N, Kim D, Jeong HS, Son YI, Chung MK, Baek CH. Vascularized osseous flaps for head and neck reconstruction: Comparative analysis focused on complications and salvage options. Auris Nasus Larynx 2023:S0385-8146(23)00022-6. [PMID: 36710169 DOI: 10.1016/j.anl.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study aimed to compare the clinical outcomes of fibular (FFF group) and scapular (SFF group) osseous free flaps for reconstructing head and neck defects for primary surgery and salvage options. METHODS We analyzed 156 cases of osseous free flaps in 138 patients from a retrospective review of a single institutional database between January 1996 and January 2020 (FFF, 114 cases in 99 patients; SFF, 42 cases in 39 patients). Clinical profiles such as age, sex, primary tumor site, and defect type were investigated in the two groups. In addition, the incidences and types of perioperative complications, flap compromise, and salvage management were compared between the two groups. RESULTS FFF was used mostly for oromandibular defects, whereas SFF was preferred for maxillary defect reconstruction. The length of hospital stay was longer in the FFF group than in the SFF group. The flap compromise rate was not significantly different between the two groups; however, donor-site complications were not observed in the SFF group as compared to 7.9% in the FFF group. A regional or free (musculo) cutaneous flap was used as a salvage procedure in partial flap compromise. Contralateral SFF was available to replace a completely compromised SFF, whereas it was not feasible in a completely compromised FFF. Cox proportional hazards analysis showed no significant prognostic factors for flap-related complications. CONCLUSION The two osseous free flaps showed differences in defect type, flap donor complications, and options for compromised flap salvage. These findings must be considered carefully in the preoperative planning stage to guarantee early recovery and timely administration of postoperative adjuvant treatment if necessary.
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Affiliation(s)
- HeeJung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Donghyeok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Tran KL, Kwon JY, Gui XY, Wang E, Yang D, Durham JS, Prisman E. Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design. Head Neck 2023; 45:115-125. [PMID: 36255135 DOI: 10.1002/hed.27214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/23/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The study's objective is to assess the feasibility and utility of VSP for maxillary reconstruction with the scapular free flap. METHODS An open-source VSP platform was used to create the reconstruction models and simple guides. Clinical, operative, and postoperative data were collected. RESULTS Ten patients in the VSP cohort and 18 in the non-VSP control cohort were included in the study. There was a significant reduction in operative time (256.0 ± 69.4 vs. 448.1 ± 108.2 min, p < 0.01), tracheotomy rate (20% vs. 72%, p < 0.01), increased two-team utilization rate (80% vs. 0%, p < 0.01) and better reconstructive accuracy (7.5 ± 3.4 vs. 11.7 ± 7.6 mm, p = 0.048) for the VSP cohort. CONCLUSIONS Maxillary reconstruction planned with an in-house open-source VSP platform and accompanied simple guides can facilitate a two-team approach, reduce operative time, and improve structural accuracy. This open-source technology has great potential to be readily applied in other institutions to improve efficiency and outcomes.
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Affiliation(s)
- Khanh Linh Tran
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jae Young Kwon
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xi Yao Gui
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Wang
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Yang
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Scott Durham
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Alwadeai MS, Al-Aroomy LA, Shindy MI, Amin AAW, Zedan MH. Aesthetic reconstruction of onco-surgical maxillary defects using free scapular flap with and without CAD/CAM customized osteotomy guide. BMC Surg 2022; 22:362. [PMID: 36261822 PMCID: PMC9583586 DOI: 10.1186/s12893-022-01811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reconstruction of the maxillary defects following tumor ablation remains to be a challenge for surgeons. Virtual surgical planning (VSP), intraoperative cutting guides and stereolithographic models provides the head and neck reconstructive surgeon with powerful tools for complex reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular free flap has not been as widely reported. The aim of this study was to compare aesthetic results and operation time of free scapular flap, with and without computer-aided design and computer-aided manufacturing (CAD/CAM) customized osteotomy guide, for reconstruction of maxillary defects. METHODS In this prospective randomized controlled clinical trial study, we randomly assigned 22 patients with maxillary defects who were scheduled to undergo maxillary reconstruction with either free scapular flap with CAD/CAM customized osteotomy guide; study group (n = 11) or free scapular flap without CAD/CAM customized osteotomy guide; control group (n = 11). All patients were followed up for 3 months. The aesthetic outcome, operation and ischemic times were evaluated and compared. RESULTS Aesthetic outcomes were evaluated objectively by means of differential surface area (sagittal and axial) measurement, which showed improved aesthetic outcome (contour symmetry) in the study group with a mean of (241.39 ± 113.74 mm2), compared to patients in control group with a mean of (358.70 ± 143.99 mm2). There were significant differences between the two groups (P < 0.05). Aesthetic outcomes were also evaluated subjectively by means of visual analogue scale (VAS) and patient's satisfaction score (PSS). The postoperative aesthetic appearance was better in the study group with more patients satisfied than that in control group and there were statistically significant differences (P = 0.039). The mean total operative time was 678.81 min and 777.18 min in the study group and control group respectively (P < 0.05) and the mean ischemia time was 133.18 min and 195.72 min for study group and control group respectively (P < 0.05). The ischemia time and total operative time were shorter in the study group compared to those in the control group and there were no flap losses in both groups. CONCLUSION The use of CAD/CAM prefabricated cutting guides facilitates scapular flap molding and placement, minimizes ischemic time and operating time as well as improves aesthetic outcomes. Trial registration This trial was registered at ClinicalTrials.gov. REGISTRATION NUMBER NCT03757286. Registration date: 28/11/2018.
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Affiliation(s)
- Mohamed Salah Alwadeai
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Elmanial Street, Cairo, Egypt. .,Faculty of Dentistry, Ibb University, Ibb, Yemen.
| | - Leena Ali Al-Aroomy
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mostafa Ibrahim Shindy
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Elmanial Street, Cairo, Egypt
| | - Ayman Abdel-Wahab Amin
- Department of Surgical Oncology-National Cancer Institute, Cairo University, Cairo, Egypt
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The state of virtual surgical planning in maxillary Reconstruction: A systematic review. Oral Oncol 2022; 133:106058. [PMID: 35952582 DOI: 10.1016/j.oraloncology.2022.106058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/12/2022] [Accepted: 08/01/2022] [Indexed: 11/20/2022]
Abstract
Virtual surgical planning (VSP) and computer aided design utilization in head and neck reconstruction has become increasingly popular within the discipline. Advocates of the technology over traditional free hand surgery cite benefits including improved intraoperative efficiencies and postoperative outcomes that have been demonstrated during mandibular reconstruction. More recently, VSP for maxillary and mid facial reconstruction, generally considered more complex than their mandibular counterparts, have been applied with the hopes of similar benefits. However, our literature search revealed no large-scale randomized control trial substantiating these benefits. As such, the aim of this review was to synthesize the existing research on utilization of VSP in the context of maxillary reconstruction. Three databases were systematically searched for articles pertaining to maxillary reconstruction for oncologic, traumatic, or osteoradionecrosis indications. Four hundred and fourteen unique articles were reviewed by two independent reviewers ultimately revealing sixteen studies appropriate for qualitative synthesis including 142 patients. Results of our studies reveal the extreme heterogenicity of application of this technology under the label of virtual surgical planning. Outcome reporting methods were grossly inconsistent amongst all the articles resulting in inability to appropriately synthesize data quantitatively for a meta-analysis. Overall, there was no standard of reporting outcomes of maxillary reconstruction, and no randomized trials comparing virtual surgical planning versus freehand surgery and therefore there is insufficient data to objectively prove purported benefits. To facilitate future comparative studies, a minimal standard of reporting for maxillary VSP is presented and the need for a randomized control trial is highlighted.
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Nyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, Agrawal A, Old MO, Seim NB, Carrau RL, Rocco JW, VanKoevering KK. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol 2022; 132:105976. [PMID: 35809506 DOI: 10.1016/j.oraloncology.2022.105976] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 01/12/2023]
Abstract
Microvascular free flap reconstruction has remained the standard of care in reconstruction of large tissue defects following ablative head and neck oncologic surgery, especially for bony structures. Computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensionally (3D) printed models and devices offer novel solutions for reconstruction of bony defects. Conventional free hand techniques have been enhanced using 3D printed anatomic models for reference and pre-bending of titanium reconstructive plates, which has dramatically improved intraoperative and microvascular ischemia times. Improvements led to current state of the art uses which include full virtual planning (VP), 3D printed osteotomy guides, and patient specific reconstructive plates, with advanced options incorporating dental rehabilitation and titanium bone replacements into the primary surgical plan through use of these tools. Limitations such as high costs and delays in device manufacturing may be mitigated with in house software and workflows. Future innovations still in development include printing custom prosthetics, 'bioprinting' of tissue engineered scaffolds, integration of therapeutic implants, and other possibilities as this technology continues to rapidly advance. This review summarizes the literature and serves as a summary guide to the historic, current, advanced, and future possibilities of 3D printing within head and neck oncologic surgery and bony reconstruction. This review serves as a summary guide to the historic, current, advanced, and future roles of CAD/CAM and 3D printing within the field of head and neck oncologic surgery and bony reconstruction.
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Affiliation(s)
- Sarah C Nyirjesy
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Margaret Heller
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Natalia von Windheim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amelia Gingras
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Stephen Y Kang
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Enver Ozer
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amit Agrawal
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Matthew O Old
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Nolan B Seim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Ricardo L Carrau
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - James W Rocco
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Kyle K VanKoevering
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States.
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Deane EC, Liu AQ, Nguyen S, Anderson DW, Durham JS, Prisman E. Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction. Head Neck 2021; 44:760-769. [PMID: 34936161 DOI: 10.1002/hed.26963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The scapula free flap is a versatile option in head and neck reconstruction but is less amenable to simultaneous harvest and ablation. METHODS Retrospective series (2015-2021) of consecutive scapula flaps. Cases categorized as simultaneous versus sequential, compared for operative time, oncological and patient-reported outcomes. RESULTS Seventy consecutive scapula free flaps were performed (n = 21 simultaneous, n = 49 sequential). Mandible reconstruction was performed in 51.0% and 61.9% of sequential and simultaneous cases, respectively; 49.0% and 38.1% addressed bony maxillary defects. Simultaneous surgery reduced operative time by 37.9% (151 min, p < 0.00001) and there were fewer tracheostomies performed (p < 0.005). Rates of positive margins and free flap compromise were equivalent (n = 1, 4.8% vs. n = 2, 4.1%). There was no difference in patient-reported outcomes. CONCLUSIONS This series demonstrates feasibility, efficacy, and outcomes of bony scapula reconstruction of maxillofacial defects comparing simultaneous and sequential approaches. Benefits of the two-team approach are highlighted including decreased operative time.
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Affiliation(s)
- Emily C Deane
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Q Liu
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sally Nguyen
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald W Anderson
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Scott Durham
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Butterworth CJ, Lowe D, Rogers SN. The Zygomatic Implant Perforated (ZIP) flap reconstructive technique for the management of low-level maxillary malignancy - clinical & patient related outcomes on 35 consecutively treated patients. Head Neck 2021; 44:345-358. [PMID: 34825746 DOI: 10.1002/hed.26933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/13/2021] [Accepted: 11/01/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The zygomatic implant perforated (ZIP) flap technique provides immediate reconstruction and rapid dental rehabilitation for low-level malignant tumors. METHODS Patients who underwent ZIP flap reconstruction between December 2015 and February 2021 were followed prospectively. RESULTS Thirty-five consecutively treated patients were studied with 16 undergoing surgery alone and 19 undergoing surgery followed by radiotherapy. The median time to fit the prosthesis was 29 days with all patients requiring adjuvant radiotherapy receiving their fixed dental prosthesis prior to its commencement. Vascularized flap (100%), zygomatic implant (98.4%), and prosthesis (97%) survival were excellent and the ZIP flap protocol was highly rated by patient-related outcome measures especially for the chewing domain. CONCLUSIONS The ZIP flap technique provides an excellent means of providing an autogenous oronasal seal and a foundation for immediate cortically anchored fixed dental rehabilitation. CLINICAL SIGNIFICANCE This technique provides rapid and robust rehabilitation for patients presenting with low-level maxillary malignancy despite the use of radiotherapy.
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Affiliation(s)
- Chris J Butterworth
- Department of Oral and Maxillofacial Surgery, Liverpool University Hospital Foundation Trust, Liverpool, UK.,Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Simon N Rogers
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.,Liverpool University Hospital Foundation Trust, Liverpool, UK
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Moore EJ, Price DL, Van Abel KM, Janus JR, Moore ET, Martin E, Morris JM, Alexander AE. Association of Virtual Surgical Planning With External Incisions in Complex Maxillectomy Reconstruction. JAMA Otolaryngol Head Neck Surg 2021; 147:526-531. [PMID: 33792635 DOI: 10.1001/jamaoto.2021.0251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Maxillectomy can commonly be performed through a transoral approach, but maxillectomy defect reconstruction can be difficult to precisely design, contour, and inset through this approach. Objective To evaluate whether the use of virtual surgical planning (VSP) and 3-dimensional (3-D) modeling is associated with a decrease in the requirement of lateral rhinotomy (LR) for patients undergoing total and partial maxillectomy reconstruction. Design, Setting, and Participants This retrospective cohort study was conducted among patients undergoing subtotal or total maxillectomy with microvascular free flap reconstruction with or without VSP and 3-D modeling at a single tertiary care academic medical center between January 1, 2008, and October 3, 2019. Interventions Maxillectomy and free flap reconstruction with or without VSP. Main Outcomes and Measures Necessity of LR or other external incision for contouring, placement, and fixation of reconstruction as well as surgical complications. Results Fifteen patients (12 men [80%]; mean age, 64 years) underwent maxillectomy with free flap reconstruction without VSP. Eight patients (53%) in this group underwent total maxillectomy, and 4 patients in this group (27%) underwent partial maxillectomy. Twenty-three patients (18 men [78%]; mean age, 58 years) underwent maxillectomy with free flap reconstruction and VSP and 3-D modeling. Twelve of these patients (52%) underwent total maxillectomy, and 11 (48%) underwent partial maxillectomy. Lateral rhinotomy was necessary for 1 patient (4%) in the VSP group vs 12 patients (80%; 95% CI, 54%-98%) in the pre-VSP group. There were no LR complications in the VSP group vs 6 in the pre-VSP group. Among both groups, 14 patients underwent fibula free flap, 22 patients underwent subscapular system free flap, and 2 patients underwent cutaneous or osteocutaneous radial forearm free flap. There were no flap failures in the LR group and 1 flap failure in the group without LR. Conclusions and Relevance This cohort study suggests that the use of VSP and 3-D modeling for maxillectomy reconstruction is associated the a decrease in the need for external incisions without compromising reconstructive flap utility.
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Affiliation(s)
- Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffery R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ethan T Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Eli Martin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Amy E Alexander
- Department of Anatomic Modeling, Mayo Clinic, Rochester, Minnesota
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Swendseid B, Stewart M, Mastrolonardo E, McCreary E, Heffelfinger R, Luginbuhl A, Sweeny L, Wax MK, Curry J. Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction. Laryngoscope 2021; 131:2465-2470. [PMID: 34378801 DOI: 10.1002/lary.29708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Mid and upper face free flaps frequently are associated with challenges due to pedicle length. We sought to evaluate the frequency at which alternative pedicle maneuvers were required for these reconstructions and determine if there was any association with flap survival or postoperative complications. STUDY DESIGN Retrospective review at three tertiary care institutions. METHODS Database review. RESULTS Free flap reconstruction of the upper and midface was performed in 295 patients (108 bony, 187 soft tissue). In 82% of cases, the vessels reached the ipsilateral neck for anastomosis to traditional target vessels. Arterial grafts were required in 2% of reconstructions (4% bony and 1% soft tissue). Venous grafting was required in 7% of reconstructions (21% fibula, 16% scapula, and 3% soft tissue) and was associated with an increase in flap failure rate (19% vs 3%, P = .003). The most common recipient artery for revascularization was the cervical facial artery (78%). Alternate recipient vessels were selected in 13% of cases, including the superficial temporal vessels (7%), distal facial branches through a separate facial incision (4%), and angular vessels (2%). Vein grafting was associated with a higher flap failure rate. Alternative maneuvers did not affect need for intraoperative pedicle revision or complications. CONCLUSIONS In upper and midface reconstruction, vascular grafting, targeting more distal branches of the facial system, or additional maneuvers to optimize pedicle orientation is often required to secure revascularization. Vein grafting is associated with a higher free flap failure rate. Scapular border flaps often require vascular grafting or atypical anastomotic locations. LEVEL OF EVIDENCE 3-Non randomized cohort study 4 Laryngoscope, 2021.
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Affiliation(s)
- Brian Swendseid
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
| | - Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
| | - Eric Mastrolonardo
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
| | - Eleanor McCreary
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Ryan Heffelfinger
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
| | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
| | - Larissa Sweeny
- Otolaryngology-HNS, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A
| | - Mark K Wax
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Joseph Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
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Nguyen S, Tran KL, Wang E, Britton H, Durham JS, Prisman E. Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions. Head Neck 2021; 43:2623-2633. [PMID: 33961717 DOI: 10.1002/hed.26731] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/17/2021] [Accepted: 04/22/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND This study virtually compares patient-specific fibular and scapular reconstructions for maxillectomies. METHODS Nine maxillectomy defects were created on 10 maxillas and virtually reconstructed with patient-specific fibulas and scapulas. Reconstructions were compared for restoring midface cephalometrics, dental implantability, and pedicle length. RESULTS Of 90 maxillectomy defects, the vertically oriented scapula provided improved orbital floor and maxillary height reconstructions (p < 0.001), albeit at the cost of dental implantability compared to the fibula (p < 0.001). In two defects crossing the midline, the fibula, allowing for more osteotomies, provided improved maxillary projection. In the remaining three defects crossing the midline, the horizontally oriented scapula was comparable to the fibula. Fibular and scapular reconstructions were amenable for dental implantation and had similar pedicle lengths, although favoring scapula in extensive defects. CONCLUSION Fibular and scapular reconstructions of maxillectomy defects provide unique strengths. This virtual analysis can guide a goal-oriented reconstruction based on defect type and patient-specific goals.
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Affiliation(s)
- Sally Nguyen
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Khanh Linh Tran
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Wang
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heidi Britton
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Scott Durham
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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16
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May MM, Howe BM, O'Byrne TJ, Alexander AE, Morris JM, Moore EJ, Kasperbauer JL, Janus JR, Van Abel KM, Dickens HJ, Price DL. Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: Decreased nonunion and complication rates. Head Neck 2021; 43:2342-2352. [PMID: 33786910 DOI: 10.1002/hed.26688] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To determine whether virtual surgical planning and three-dimensional printed cutting guides (3D/VSP) improved radiographic bone union compared to conventional methods (CM) in fibula free flap (FFF) reconstruction of the mandibles. METHODS Retrospective study from the years 2000-2018 at a tertiary hospital. Osseous union was evaluated by a radiologist blinded to each patient's treatment. RESULTS Two hundred sixty patients who underwent FFF tissue transfer, 28 with VSP and 3D cutting guides. Bony union was not achieved in 46 (20%) patients who underwent CM compared to 1 (4%) of patients with VSP and guides (p = 0.036). FFF complication was significantly higher in CM with 87 patients (38%) compared to three patients (11%) in 3D/VSP (p = 0.005). Median time to bony union for patients who underwent CM was 1.4 years compared to 0.8 years in 3D/VSP. CONCLUSIONS 3D/VSP reduced the rate of radiographic nonunion and flap-related complications in FFF reconstruction for mandibular defects.
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Affiliation(s)
- Matthew M May
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Alexander
- Anatomical Modeling Lab, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathon M Morris
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Anatomical Modeling Lab, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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17
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Tang MY, Luo DW, Sun LB, Zhou HY, Wu SJ, Fu GX, Xiao JG. [Application of a modified paramedian lower lip-submandibular approach in maxillary (subtotal) total resection]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:380-384. [PMID: 32865355 DOI: 10.7518/hxkq.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the clinical efficacy of a modified paramedian lower lip-submandibular approach for maxillary (subtotal) total resection. METHODS Eleven patients of maxillary tumors underwent maxillary (subtotal) total resection through the modified paramedian lower lip-submandibular approach. Clinical follow-up visits were conducted to evaluate appearance restoration, facial nerve functional status, parotid gland functional status, and orbital region complication. RESULTS During the follow-up period of 6-36 months, the appearance of all 11 patients recovered well. All cases presented hidden scars. No facial nerve and parotid duct injury, lower eyelid edema, lower eyelid ectropion, or epiphora in all cases was observed. CONCLUSIONS Applying modified paramedian lower lip-submandibular approach to maxillary (subtotal) total resection effectively reduces incidence of orbital region complications including lower eyelid edema, lower eyelid ectropion, and epiphora, which often occur to traditional approach. The modified approach produces more subtle scars than other methods and should be applied to treatment of maxillary (subtotal) total resection.
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Affiliation(s)
- Meng-Ying Tang
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China;Dept. of Oral Implantology, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Dao-Wen Luo
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Li-Bo Sun
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Hang-Yu Zhou
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Shuang-Jiang Wu
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Guang-Xin Fu
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Jin-Gang Xiao
- Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China;Dept. of Oral Implantology, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China;Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
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18
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Three-dimensional modeling of the scapular tip for anterolateral and lateral mandibular defects. Oral Oncol 2020; 107:104718. [DOI: 10.1016/j.oraloncology.2020.104718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/12/2020] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
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19
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Solis RN, Mahaney J, Mohhebali R, Laks S, Wax MK, Petrisor D, Brockhoff HC. Digital imaging evaluation of the scapula for prediction of endosteal implant placement in reconstruction of oromandibular defects with scapular free flaps. Microsurgery 2019; 39:730-736. [DOI: 10.1002/micr.30466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 04/17/2019] [Accepted: 04/26/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Roberto N. Solis
- Department of Surgery, Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El Paso Texas
| | - Justin Mahaney
- Department of Surgery, Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El Paso Texas
| | - Roxana Mohhebali
- Department of Surgery, Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El Paso Texas
| | - Shaked Laks
- Department of Surgery, Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El Paso Texas
- Department of Radiology, Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El Paso Texas
| | - Mark K. Wax
- Department of Otolaryngology—Head and Neck SurgeryOregon Health Sciences and University Portland Oregon
| | - Daniel Petrisor
- Department of Oral and Maxillofacial SurgeryOregon Health Sciences and University Portland Oregon
| | - Hans C. Brockhoff
- Department of Surgery, Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El Paso Texas
- Division Chief, Oral/Head and Neck Oncology and Microvascular Reconstructive SurgeryDepartment of Oral and Maxillofacial Surgery, El Paso Children's Hospital/University Medical Center El Paso Texas Partner High Desert Oral and Facial Surgery
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Tracy LF, Patel SN, Buckmire RA, Shah RN. Laryngeal reconstruction for recurrent desmoid tumor using three-dimensional modeling: A unique approach for a rare tumor. Laryngoscope 2018; 129:1989-1992. [PMID: 30585331 DOI: 10.1002/lary.27756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 12/11/2022]
Abstract
Desmoid tumors are exceedingly rare within the larynx and cause significant morbidity due to their locally aggressive and infiltrative nature. Surgery is the mainstay of treatment with previous reports describing total and near-total laryngectomy for cure. We present a case of recurrent glottic desmoid tumor managed with hemilaryngectomy and reconstructed with temporoparietal free tissue, rib, and buccal grafts. Three-dimensional modeling was utilized to optimize aerodigestive function after laryngeal reconstruction. Laryngoscope, 129:1989-1992, 2019.
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Affiliation(s)
- Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospital, Chapel Hill, North Carolina, U.S.A
| | - Samip N Patel
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospital, Chapel Hill, North Carolina, U.S.A
| | - Robert A Buckmire
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospital, Chapel Hill, North Carolina, U.S.A
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospital, Chapel Hill, North Carolina, U.S.A
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Miyamoto S, Arikawa M, Fujiki M. Deep inferior epigastric artery perforator flap for maxillary reconstruction. Laryngoscope 2018; 129:1325-1329. [DOI: 10.1002/lary.27646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/22/2018] [Accepted: 09/04/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Shimpei Miyamoto
- Division of Plastic and Reconstructive SurgeryNational Cancer Center Hospital Tokyo Japan
| | - Masaki Arikawa
- Division of Plastic and Reconstructive SurgeryNational Cancer Center Hospital Tokyo Japan
| | - Masahide Fujiki
- Division of Plastic and Reconstructive SurgeryNational Cancer Center Hospital Tokyo Japan
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Obturators versus flaps after maxillary oncological ablation: A systematic review and best evidence synthesis. Oral Oncol 2018; 82:152-161. [PMID: 29909890 DOI: 10.1016/j.oraloncology.2018.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/02/2018] [Accepted: 05/25/2018] [Indexed: 02/05/2023]
Abstract
Maxillary defects can be resolved by prosthetic obturation, autologous tissue reconstruction, or a combination of both. However, there is still controversy in the selection of the optimal approach. Therefore, the aim of this study was to systematically review evidences comparing the performance of obturators and flaps in patients after maxillary oncological ablation. Both electronic and manual searching approaches were conducted to identify eligible evidence. Two reviewers independently assessed the risk of bias. In addition, the same reviewers independently extracted the data. Meta-analyses were performed using Revman 5.3, and best evidence synthesis was performed. Sixteen studies were included and a total of 528 participants were analyzed. All studies were assessed at low quality. Results of this meta-analysis showed weak evidence in the difference between obturators and flaps on the outcome regarding word intelligibility (P = 0.004) and masticatory efficiency (P = 0.002). However, no differences were detected regarding speech intelligibility and nasalance. All studies were compiled into the best evidence synthesis. The sum of 31 evidences was considered. Twelve evidences were evaluated at a moderate level, such as speech, mastication, pain, salivation, taste sensations, and mouth opening. Except the outcomes of word intelligibility, masticatory efficiency, and mouth pain, other moderate evidences showed no difference between obturators and flaps. In conclusion, both obturators and flaps might be effective in patients' rehabilitation functions after maxillary ablation. However, some advantages were observed when using surgical reconstruction over prosthetic rehabilitation. Additional high-quality studies are needed to provide more solid evidence before applying these results into clinical practice.
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Secondary Maxillary and Orbital Floor Reconstruction With a Free Scapular Flap Using Cutting and Fixation Guides Created by Computer-Aided Design/Computer-Aided Manufacturing. J Craniofac Surg 2017; 28:2060-2062. [DOI: 10.1097/scs.0000000000004012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Microvascular Tissue Transfers for Midfacial and Anterior Cranial Base Reconstruction. J Craniofac Surg 2017; 28:659-663. [DOI: 10.1097/scs.0000000000003448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Yu Y, Zhang WB, Liu XJ, Guo CB, Yu GY, Peng X. Three-Dimensional Image Fusion of 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography and Contrast-Enhanced Computed Tomography for Computer-Assisted Planning of Maxillectomy of Recurrent Maxillary Squamous Cell Carcinoma and Defect Reconstruction. J Oral Maxillofac Surg 2017; 75:1301.e1-1301.e15. [PMID: 28320612 DOI: 10.1016/j.joms.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to describe new technology assisted by 3-dimensional (3D) image fusion of 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) for computer planning of a maxillectomy of recurrent maxillary squamous cell carcinoma and defect reconstruction. MATERIALS AND METHODS Treatment of recurrent maxillary squamous cell carcinoma usually includes tumor resection and free flap reconstruction. FDG-PET/CT provided images of regions of abnormal glucose uptake and thus showed metabolic tumor volume to guide tumor resection. CECT data were used to create 3D reconstructed images of vessels to show the vascular diameters and locations, so that the most suitable vein and artery could be selected during anastomosis of the free flap. The data from preoperative maxillofacial CECT scans and FDG-PET/CT imaging were imported into the navigation system (iPlan 3.0; Brainlab, Feldkirchen, Germany). Three-dimensional image fusion between FDG-PET/CT and CECT was accomplished using Brainlab software according to the position of the 2 skulls simulated in the CECT image and PET/CT image, respectively. After verification of the image fusion accuracy, the 3D reconstruction images of the metabolic tumor, vessels, and other critical structures could be visualized within the same coordinate system. These sagittal, coronal, axial, and 3D reconstruction images were used to determine the virtual osteotomy sites and reconstruction plan, which was provided to the surgeon and used for surgical navigation. RESULTS The average shift of the 3D image fusion between FDG-PET/CT and CECT was less than 1 mm. This technique, by clearly showing the metabolic tumor volume and the most suitable vessels for anastomosis, facilitated resection and reconstruction of recurrent maxillary squamous cell carcinoma. CONCLUSIONS We used 3D image fusion of FDG-PET/CT and CECT to successfully accomplish resection and reconstruction of recurrent maxillary squamous cell carcinoma. This method has the potential to improve the clinical outcomes of these challenging procedures.
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MESH Headings
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Contrast Media
- Female
- Fluorodeoxyglucose F18
- Humans
- Imaging, Three-Dimensional/methods
- Maxillary Neoplasms/diagnostic imaging
- Maxillary Neoplasms/pathology
- Maxillary Neoplasms/surgery
- Middle Aged
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Otorhinolaryngologic Surgical Procedures/methods
- Positron Emission Tomography Computed Tomography/methods
- Radiographic Image Interpretation, Computer-Assisted
- Radiopharmaceuticals
- Surgery, Computer-Assisted/methods
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Yao Yu
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wen-Bo Zhang
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao-Jing Liu
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chuan-Bin Guo
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Guang-Yan Yu
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xin Peng
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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