Search

Purpose: The aim of the present prospective cohort study was to report on an approach for maxillary reconstruction with autogenous bone grafts allowing implant placement for immediate function with fixed bridges after 6 months. Materials and methods: A total of 35 bilateral bone grafting procedures were performed on 35 consecutive patients (mean age 54.5 years). The iliac crest was used as donor site for all patients. The method for retaining the immediate prosthesis after bone graft ranged from mucosa retention (6 patients), implant retention (10 patients with immediate-function implants placed in non-grafted bone at the same surgical step as the bone graft procedure), teeth retention (6 patients) or palatal implant retention (13 patients). The graft was considered to be successful when it allowed the placement of the planned implants for immediate function rehabilitation with a fixed bridge. Results: All bone-grafting procedures were successful, allowing all patients to be rehabilitated after 6 months with a fixed bridge supported by immediate-function implants. The cumulative survival rate of the palatal implants was 94% after 2 months. A total of 219 immediate-function implants were placed in grafted bone and loaded occlusally. Two patients dropped out of the study 2 and 4 months after the bone graft procedure, while one patient with four implants dropped out of the study 13 months after the rehabilitation with implants. The cumulative survival rate of the implants was 97.3% at 1-year and 96.7% at 5-years (up to 129 months; minimum of 29 months; median of 52.5 months). Seven implants failed to integrate in the grafted bone. The marginal bone resorption for the implants placed in grafted areas at 1-year and 5-year follow-up was 2.0 mm (SD = 1.2mm) and 2.0mm (SD = 1.1mm), respectively. Conclusions: Maxilla reconstruction with autogenous grafted bone is a viable process, allowing, in some cases, the use of a removable or fixed prosthetic rehabilitation immediately after grafting. Maxillary rehabilitation with immediate-function implants in grafted bone is possible, with the implant success rate achieved at 5 years comparable to other rehabilitations with implants placed in grafted bone, but lower than the results obtained with implants placed in residual bone. [ABSTRACT FROM AUTHOR]

Introduction: The defect complexity and reconstructive options make the maxillary reconstruction a controversial theme and in a constant debate. The maxilla is a fundamental aesthetic and functional structure of the face. Microsurgical vascularized flaps replaced the usage of prosthetic material and pedicled flaps as a 'gold standard' for the reconstruction of complex defects following maxillectomy. Methods: The authors report their experience of 24 maxillectomies with immediate microsurgical reconstruction, performed by the senior author (H.C.) between 1998 and 2011. They evaluate and classify the defects and the reconstructive options according to the classification system as proposed by Cordeiro and Santamaria in 2000, by a patient questionnaire and post-operative surgeon follow-up for the functional (diet, speech, and vision) and aesthetic end results. Results: There were no flap failures. The main etiology was squamous cell carcinoma and the most used flap was rectus abdominis free flap. Classes I and II were responsible for the cases in which the reconstructive algorithm was not followed. Most patients responded as having a normal diet, a nearly normal speech and unaffected vision. In a score of 1 to 5, the mean score in esthetic given by the patient was 3.62, while the mean score given by the surgeons was 4.13. Conclusions: Microsurgical reconstruction of maxillectomy defects with free flaps is the best reconstructive option, being the osteomyocutaneous flaps as the gold standard. Although with limited rehabilitation, good functional and aesthetic results are to be expected with myocutaneous flaps. The existence of an algorithm facilitates the classification and systematization of maxillary reconstruction. However, due to defect complexity and large number of reconstructive options, a perfect solution does not exist. The individual assessment of the patient and the defect always provides the best method for the reconstructive planning, mainly when choosing free flaps. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Maxillary defects caused by tumor ablative surgery might lead to deformity of the face and malfunction of mastication, swallowing, phonation and respiration. Microsurgical reconstruction of maxilla is technical challenging and time consuming. The study aims at reporting our experience of maxilla reconstruction using free flaps. Methods: We evaluated bony reconstruction after maxillectomy with deep circumflex iliac artery free flap (DCIA) and fibular flap. For fibular flap, preoperative surgical simulation was performed based on CT scans of maxillofacial region and low extremity. Resection template, segmentation template and transfer template were designed and fabricated via rapid prototyping technique. Tumor resection, fibula segmentation and bone graft transfer were performed according to the templates. Results: The surgical procedures were all performed successfully. No major post-operative complications were observed. Dental implants were done in selected cases, with satisfactory functional outcome. Conclusion: With preoperative surgical simulation, microsurgical reconstruction of maxilla defects with free flap can be accurately performed. [Copyright &y& Elsevier]