Three-dimensional model simulation and reconstruction of composite total maxillectomy defects with fibula osteomyocutaneous flap flow-through from radial forearm flap
Received 13 April 2009; received in revised form 10 July 2009; accepted 17 July 2009.
Objective
A total maxillectomy always causes composite defects of maxilla, zygomatic bone, orbital floor or rim, and palatal and nasal mucosa lining. This leads to significant functional and cosmetic consequences after ablative surgery. The purpose of this clinical study was to preliminarily 3-dimensionally reconstruct the defect of total maxillectomy with sufficient bone support and soft tissue lining.
Study design
Three-dimensional model simulation technique and free fibula osteomyocutaneous flap flow-through from radial forearm flap were used to reconstruct a total maxillectomy defect for a 21-year-old female patient. Preoperatively, the 3-dimensional (3D) simulated resin models of skeleton and fibula were used to design the osteotomies and bone segment replacement. At surgery, a 22-cm-length free fibula was divided into 4 segments to make 1 maxilla skeletal framework in the schedule of the preoperative model surgical planning with a radial forearm flap flow-through for the free fibula flap with skin paddle to repair the palatal and nasal region.
Results
Free fibula and radial forearm flap were alive, and the patient was satisfied with the results both esthetically and functionally after dental rehabilitation which was carried out 6 months after surgery.
Conclusion
This preliminarily clinical study and case demonstrated that: the fibula osteomyocutaneous flap is an ideal donor site in 3D total maxillectomy defect reconstruction, because of its thickness, length, and bone uniformity which makes ideal support for dental rehabilitation; the flow-through forearm radial flap not only serves as the vascular bridge to midface reconstruction, but also provides sufficient soft tissue cover for the intraoral defect; and the 3D model simulation and preoperative surgical planning are effective methods to refine reconstruction surgery, shorten the surgical time, and predict the outcome after operation.
aDepartment of Oral and Maxillofacial Surgery, Medical School, Shanghai Jiao-tong University, Shanghai Ninth People's Hospital, Shanghai, China
bDepartments of oromaxillofacial plastic surgery, Johann Wolfgan Goethe-University Medical school, Frankfurt am Main, Germany
Reprint requests: Han-guang Zhu, Department of Oral and Maxillofacial Surgery, Medical School, Shanghai Jiao-tong University, Shanghai Ninth People's Hospital, Zhi-zao-ju road, No 639, Shanghai, China
Supported by grants of the National Natural Science Foundation of China (NSFC: 30600714) and Shanghai Scientific and Technological Star Foundation (07QA14039).
ABSTRACT