Long-term Effect of Individualized Titanium Mesh in Orbital Floor Reconstruction After Maxillectomy

Spheno-Orbital Meningiomas: Advances in Reconstruction Workflow and Cosmetic/Functional Outcomes in the Digital Era

Spheno-orbital (SOM) meningioma is a rare subtype of skull base tumor characterized by the proliferation of arachnoid cap cells with intradural expansion, hyperostosis of calvarial and spheno-orbital bone, and consecutive infiltration of critical surrounding neurovascular structures of the frontotemporal base of the skull. Surgical resection is often challenging due to the infiltrative growth and the anatomically complex localization. In most cases, a microsurgical transcranial approach is performed, resulting in the need to reconstruct the orbit with or without a cranioplasty. This review highlights the evolution and current state-of-the-art reconstructive strategies used in SOM surgery.

Complications in Deep Circumflex Iliac Artery-Related Vascularized Free Iliac Flap

BACKGROUND

Since its first application in 1978, the vascularized free iliac flap (VFIF) has gradually become a mainstay for tissue defect reconstruction. However, the complications associated with harvesting the bone flap and its corresponding reconstruction surgery cannot be overlooked.

METHODS

We conducted a narrative review through literature search to identify the types, incidence, influencing factors, measurement methods, and treatment approaches of complications related to DCIA-related VFIF.

RESULTS

We propose the "LIP" rule (Loss, Injury, Postoperative) for classifying donor site complications. For the four most common recipient sites, mandible, maxilla, extremities, and hip joint, we list the common and rare complications that may occur. Additionally, we provide a summary of the methods and advances in preventing these complications.

CONCLUSIONS

We comprehensively describe the complications observed in the application of DCIA-related VFIF and introduce the "LIP" principle and other strategies to minimize or avoid adverse outcomes.

Evolution of Medical Modeling and 3D Printing in Microvascular Midface Reconstruction: Literature Review and Experience at MD Anderson Cancer Center

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.

Necessity of infraorbital wall reconstruction in patients with residual periosteum after total maxillectomy

BACKGROUND

To date, there have been no reports regarding the necessity or methods of reconstruction for cases where the orbital periosteum remains even though the orbital floor bone has been resected in primary reconstruction after total maxillectomy. This study investigated the reconstruction methods for infraorbital wall reconstruction in patients with residual orbital periosteum.

METHODS

This was a retrospective cohort study at a single center from June 2010 to June 2019. The following two main cohorts were evaluated: non-reconstruction and reconstruction groups (reconstructed with fascia or costal cartilage) according to whether the orbital floor was reconstructed after total maxillectomy with residual orbital periosteum. The main outcomes were the deviation of the globe evaluated using computed tomography images and subjective signs of diplopia obtained from medical records.

RESULTS

Enophthalmos occurred in all five cases in the non-reconstruction group, and diplopia appeared in four cases. In five out of six cases in the reconstruction group, deviation of the globe was not observed. Exophthalmos occurred in one case reconstructed with costal cartilage. Diplopia was not observed in the reconstruction group. In the statistical assessment, a significant difference was observed in the globe deviation between the two groups (P = 0.004).

CONCLUSIONS

In cases where the orbital periosteum remains, it is necessary to actively reconstruct the infraorbital wall. Moreover, we believe that the reconstruction with fascia is convenient and useful because it is less invasive, the surgical procedure is simple, and the fascia can be collected from the same surgical field when the flap is elevated.

LEVEL OF EVIDENCE

4 (retrospective cohort study).

Modified individualized titanium mesh in orbital floor reconstruction for preventing exposure

Objective

To describe a novel method of medial fixation of titanium mesh with a right-angled screwdriver for orbital floor and maxillary reconstruction and to compare the reconstruction outcome of orbital floor reconstruction with modified and traditional methods.

Methods

The data of 23 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2018 and 2021 were retrospectively reviewed. While eight patients received modified orbital floor reconstruction with titanium mesh and angled screwdriver (group A), 15 patients received traditional orbital floor reconstruction (group B). The contact area with buccal flap for titanium mesh in groups A and B was calculated. Titanium mesh deformation, fracture or exposure was recorded. Postoperative ophthalmic function and success of esthetic restoration were assessed.

Results

Mean follow-up was for 15.7 months (range, 9-22 months). The contact area with buccal flap for the modified titanium mesh in group A (13.11 ± 1.41 cm2) was significantly less than that of the traditional titanium mesh in group B (21.83 ± 1.23 cm2; p < .05). The exposure of titanium mesh occurred in two patients in group B. The self-evaluation of facial symmetry for 23 patients showed no significant difference between group A (7.75 ± 0.71) and group B (6.68 ± 1.30; p > .05). No specific complications were reported.

Conclusion

We propose a novel method of zygomatic medial fixation of titanium mesh with a right-angled screwdriver for orbital floor and maxillary reconstruction, which has the potential to prevent the postoperative exposure of titanium mesh.

Level of Evidence

Level III (Retrospective comparative study).

The Use of Patient-Specific Orbital Reconstruction Implants During Maxillectomy Reconstruction

Background: Reconstruction of the orbital floor after maxillectomy can result in significant functional and aesthetic morbidity. Study Objective: To measure eyelid position, self-reported visual outcomes, and complications in patients undergoing concurrent maxillectomy and reconstruction with a patient-specific orbital reconstruction implant (PSORI). Design Type: Case series. Materials and Methods: Case series including 12 patients who received PSORI for orbital floor reconstruction after tumor extirpation. Primary outcomes gathered were diplopia, ectropion, and wound healing complications. Results: The majority of patients were men (75%) and the mean age was 53.3 years. Ten patients underwent free flap reconstruction with the majority receiving fibula free flaps (n = 6). Median follow-up was 415.5 days. Three patients (25%) experienced long-term complications, including diplopia (n = 1) and hardware extrusion (n = 3). Each of these occurred in the context of total maxillectomy and radiation. This prompted subsequent use of a modified implant design for the final six patients and the preferential use of a midface-degloving approach. These interventions eliminated extrusions in subsequent patients. Conclusion: PSORIs can be used for orbital floor reconstruction following maxillectomy in combination with free tissue transfer. Implant design is critical to reduce complications. The use of a midface degloving approach and a modified low-profile design was associated with a low rate of complications.