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Objectives: This study analyzed the human maxilla to support the development of mean-value-based cutting guide systems for maxillary reconstruction, bridging the gap between freehand techniques and virtual surgical planning (VSP). Materials and methods: This retrospective cohort study used routine CT scans. DICOM data enabled 3D modelling and the maxilla was divided into four regions: paranasal (R1), facial maxillary sinus wall (R2), zygomatic bone (R3) and alveolar process (R4). Surface comparisons were made with a reference skull. Statistical analyses assessed anatomical variations, focusing on mean distance (Dmean), area of valid distance (AVD), integrated distance (ID) and integrated absolute distance (IAD). The study addressed hemimaxillectomy defects for two-segmental reconstructions using seven defined bilateral points to determine segmental distances and angles. Results: Data from 50 patients showed R2 as the most homogeneous and R4 as the most heterogeneous region. Significant age and gender differences were found in R3 and R4, with younger patients and females having more outliers. Cluster analysis indicated that males had R1 and R3 positioned anterior to the reference skull. The mean angle for segmental reconstruction was 131.24° ± 1.29°, with anterior segment length of 30.71 ± 0.57 mm and posterior length of 28.15 ± 0.86 mm. Conclusions: Anatomical analysis supported the development of semistandardized segmental resection approaches. Although gender and anatomical differences were noted, they did not significantly impact the feasibility of mean-value-based cutting-guide systems. Clinical relevance: This study provides essential anatomical data for creating cost-effective and efficient reconstruction options for maxillary defects, potentially improving surgical outcomes and expanding reconstructive possibilities beyond current techniques. [ABSTRACT FROM AUTHOR]

Introduction: The scapular osseous free flap (SOFF) is being increasingly used for complex head and neck reconstructions. This study examined the surgical outcomes, focusing on post-operative complications and sequelae in patients who underwent SOFF for maxillary and mandibular reconstructions. Material and Methods: This retrospective, observational, population-based study included patients who underwent SOFF reconstruction at a tertiary referral centre, the Department of Otorhinolaryngology-Head and Neck Surgery, Skåne University Hospital, Sweden, from November 2016 to March 2023. All patients were followed-up for at least six months after surgery. Results: Forty-two of the 44 consecutive patients (60 % men) consented to the study and were evaluated with a median follow-up time of 49 months (range 8–85 months). The study divided the patients into two groups; maxillary (n = 29) and mandibular (n = 13) reconstructions. The World Health Organisation performance status and the Charlson comorbidity index were lower in the maxillary group (p = 0.025 and p = 0.011, respectively). The maxillary group experienced high complication rates including six total flap failures and nine oronasal fistulas. Conversely, the mandibular group had no flap failures but a similar rate of general post-operative complications were observed. Dental rehabilitation was more common in the maxillary group. Conclusion: The SOFF is an option for complex reconstructions of the maxilla but is associated with a relatively high rate of complications. Methods that can prevent or minimise sequelae, e.g., oronasal fistulas, in future patients are warranted. The SOFF is an excellent alternative for mandibular reconstructions.

Current indications of maxillary reconstruction with scapular tip free flap (STFF) are palatoalveolar defects associated with zygomaticomaxillary buttress and/or orbital floor defects. STFF can be placed either horizontally or vertically. Horizontal placement usually allows ideal palatal conformation, preventing oronasal communication, but has been argued to compromise orbital support and projection of the midface, whereas vertical placement is advocated for midface support but may be insufficient for the complete closure of the palate. The present study focuses on the horizontal placing of STFF to allow complete palate reconstruction and fistulae prevention while still obtaining optimal midface projection and orbital support. This study included 21 case complex maxillary reconstructions with this flap, in which the horizontally placed scapular tip component replaced the palate, a muscular flap component was included for midface volume restoration, and an alloplastic implant was utilized for supporting the orbital content when needed. None of the patients presented palatal fistulas or alterations in the orbital support. A multilevel approach was proposed according to the maxillectomy defect. This experience supported the horizontal insetting of STFF to allow palatal fistulae prevention while still obtaining an optimal midface projection and orbital support. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Maxillary reconstruction is often a challenging task for the surgeons because of the complex anatomy. However, with the advances in virtual surgical planning (VSP) and 3D printing technology there is a new avenue for the surgeons which offers a suitable alternative to conventional flap-based reconstructions. Patients and Methods: In this article, we have described 4 case scenarios which were managed with the help of VSP and additive manufacturing technology for complex maxillary reconstruction procedures. Use of the technologies aided the clinician in achieving optimal outcomes with regards to form, function and esthetics. Discussion: Virtual surgical planning (VSP) has gained a lot of impetus in past 1 decade. These aides the surgeon in determining the extent of disease and also carry out the treatment planning. In addition to VSP, the concept of additive manufacturing provides a viable alternative to the conventional reconstruction modalities for maxillary defect rehabilitation. Increased accuracy, rehabilitation of normal anatomical configuration, appropriate dental rehabilitation, decreased intra-operative time and post-operative complications are some of the advantages. In addition, patient-specific implants eliminate the need for a separate donor site. Apart from the treatment of pathologies, they also can be used for reconstruction of post-traumatic defect, where endosteal implant placement is not possible. Conclusion: These modalities show promising results for reconstruction of complex maxillary defects. [ABSTRACT FROM AUTHOR]

Background: The zygomatic implant perforated (ZIP) flap is a novel approach to the challenge of reconstructing the maxilla. We report on our experience using the ZIP flap technique for patients undergoing infrastructure maxillectomy at Chris O'Brien Lifehouse, Sydney, Australia. Methods: Thirteen patients who underwent a ZIP flap reconstruction between August 2019 and August 2021 were identified. Demographic, surgical, and histopathological information was collected. Health Related Quality of Life (HRQOL) was assessed using the FACE‐Q Head and Neck Cancer module, the M.D. Anderson Dysphagia Inventory, and the Speech Handicap Index. Results: A total of 44 zygomatic implants were placed, of which 42 (95%) survived. The median time from surgery to dental rehabilitation was 35 days. HRQOL data was available for nine patients over 24 months, demonstrating improved speech and swallowing outcomes over the follow up period. Conclusions: The ZIP flap is a reproducible surgical technique that facilitates rapid dental rehabilitation post infrastructure maxillectomy. [ABSTRACT FROM AUTHOR]

The radicular inflammatory cyst develops at the apex of odontogenic roots where the inflammation persists for a long time. Some therapies can help complement treatment, such as the use of fibrin-rich plasma (L-PRF). Sticky bone is a mixture of autologous fibrin glue and bone graft, allowing the material to be modeled. The association of these materials accelerates tissue regeneration. Photodynamic therapy (PDT) presents excellent results for the treatment of bacterial infections and promotes greater postoperative comfort. This work reports a clinical case of a 31-year-old patient, referred for treatment of a cystic lesion. The procedure was performed under local anesthesia. After gaining access, enucleation and curettage of the lesion were performed. The collected material was sent for anatomopathological examination, apicoectomy of teeth 21, 22 and 23 and retrograde filling were performed. PDT was performed and the sticky bone graft associated with L-PRF was placed. After 1 year of follow-up, satisfactory results were observed in the clinical and imaging examination. The use of complementary therapies in the reconstructive treatment of oral lesions can benefit bone healing and photodynamic therapy contributes to the prevention of local infections and a better postoperative period. [ABSTRACT FROM AUTHOR]

Abstract 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). 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).

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). [ABSTRACT FROM AUTHOR]

Introduction: The residual post-COVID maxillary mucormycosis defect (PCMMD) were extensive, due to unilateral or bilateral maxillectomies. The Goal of rehabilitation of PCMMD is to deliver a prosthetically driven reconstruction. FEA was to evaluate the biomechanical response of PSI struts (PSI 1), PSI Screw retained (PSI 2) and QZI to masticatory load on virtual simulation to improve accuracy and enhance the design. Aim: To validate and compare the Biomechanical benefit of the PSI struts, PSI Screw retained, QZI in a case of rehabilitation of post-COVID maxillary mucormycosis defect (PCMMD) by FEA study. Methodology: The result of stress to masticatory load on virtual simulation for (1) Maximum and minimum stress (Von Mises stress); (2) the Displacement (in three positions) and (3) the Deformation (Plastic strain) was compared on virtual simulation for PSI 1 and PSI 2 and QZI. Conclusion: The FEA and comparative evaluation of PSI 1, PSI 2 and QZI showed a good resistance to displacement. The stress and strain values are low and acceptable. In comparison QZI shows more stress in the anterior region. [ABSTRACT FROM AUTHOR]

Introduction: Patients affected with mucormycosis of maxilla have been increasing following Covid-19 infections. We followed the reconstruction of the maxilla using 3D manufactured patient-specific implants. The additive manufacturing technology is capable of fabricating custom-made titanium implants precisely for oral and maxillofacial reconstructions. Aim: To analyse the effectiveness of 3D manufactured patient-specific implants in the reconstruction of maxilla affected by mucormycosis secondary to Covid-19. Methodology: This study was conducted among 20 patients receiving patient-specific implants for surgical and prosthetic reconstruction of the maxilla. The parameters analysed at baseline, 3 months, 6 months, and 12 months were pain, implant exposure, infection, wound dehiscence, fit of implant, postoperative surgical rating scale, and patient experience evaluation rating scale. Results: Inferential Statistics revealed a positive correlation. Conclusion: From the present data, it can be concluded that within the limitations of the study, patient-specific implant systems are an effective treatment strategy for the reconstruction of the maxilla affected by mucormycosis secondary to Covid-19. More studies with larger sample size and longer follow-up periods are required to substantiate the results from the present study. [ABSTRACT FROM AUTHOR]

Featured Application: subperiosteal custom-made implants can be a safe and effective solution in primary maxillary reconstructions in patients who cannot undergo free bone flap reconstructions. In these difficult cases, this type of custom-made implant can guarantee support to the soft tissues of the middle-third of the face and a solid anchorage for dental prostheses or palatal obturators, thus improving the quality of life of patients. Recent reports on secondary restorations with subperiosteal implants have demonstrated promising results in terms of esthetic and functional restoration. We report the case of a reconstruction of a total maxillectomy with a custom-made subperiosteal implant associated with a temporal muscle flap in a patient who could not undergo bone reconstruction with a free flap. This technique made it possible to restore the division between the oral cavity and the mouth, providing a solid anchorage to the dental prosthesis and correcting an oroantral communication with a small palatal obturator. The subperiosteal implant also granted proper soft tissue support in the middle-third of the face. Subperiosteal implants can be safe and effective even in primary maxillary reconstructions for patients who cannot undergo free bone flap reconstructions. In these difficult cases, this type of implant can provide support to the soft tissues of the middle-third of the face and a solid anchorage for dental prostheses or palatal obturators, thus improving the quality of life for patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Autogenous non-vascularized bone graft (NVBG) is the gold standard for treating defects smaller than 6 cm. In the maxillofacial region, NVBG is useful to treat periodontal defects, congenital defects, ridge atrophy, sinus augmentation, etc. The addition of autogenous platelet-rich fibrin (PRF) was reported to improve clinical outcomes. However, no high-quality evidence was ever made regarding this treatment combination. OBJECTIVES: To assess the evidence of adding PRF to autogenous NVBG in the mandibular and maxillary regions. MATERIAL AND METHODS: Literature searches were conducted in PubMed, EMBASE, ProQuest, Scopus, EBSCOhost, and Science Direct to identify randomized controlled trials comparing PRF combined with autogenous NVBG and autogenous NVBG alone. The main outcomes were quantitative bone regeneration measured as height, length, volume, percentage, or other possible quantitative outcomes. RESULTS: Five studies were included in this systematic review comparing PRF and autogenous NVBG to ANVBG alone, with a total of 130 patients with ridge resorption, periodontitis with furcation involvement, or alveolar cleft. Measurements of outcomes were displayed as gained width, vertical bone changes, and volumetric changes. Two studies presented significant differences in the tested group. CONCLUSIONS: PRF may improve bone regeneration in combination with autogenous NVBG. Future studies need to investigate with a larger population, size of defects, and better outcome measurements. [ABSTRACT FROM AUTHOR]

Reconstruction of defects of the jaws is mainly performed via free fibula flap. An incidence of 2–21% of overall flap failure is still described. We investigated the roles of volume, length and number of fibula flap segments on flap survival using novel three-dimensional segmentation tools. We also analyzed the role of other possible risk factors. Seventy-one consecutive patients with a follow up of at least three months and who underwent free fibula flap reconstruction in a single center between 2002 and 2022 have been evaluated. A total of 166 fibula segments were analyzed. Malignancies were the main reason of resection (45.1%). In 69% of the cases a reconstruction of the mandible was performed. The flaps were mainly divided in two segments (39%) (range 1–4), with a mean length of 2.52 cm and a mean volume was 3.37 cm3. Total flap failure (TFF) occurred in 12 cases, (16.9%), while partial flap failure (PFF) appeared in 3 patients (4.2%). Volume, length and number of fibula flap segments did not seem to influence flap failure incidence in uni- and multivariate analysis. Reconstruction of the maxilla and use of a recipient vessel different from the facial artery seemed to significantly impact on flap failure. Smoking and previous surgeries showed a higher trend to flap failure, but they did not reach statistical significance. Prospective and multicentric analysis on a wider population should be assessed. [ABSTRACT FROM AUTHOR]

Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To review potential complications that may occur using the zygoma implant published in the literature as well as complications encountered by the primary author. Solutions for prevention as well as the management of such complications are also discussed in detail. Materials and Methods: The authors have reviewed and outlined reports discussing the etiology as well as the management of potential complications associated with the use of the zygoma implant and have offered recommendations for the management of these complications. Results: Predictable clinical solutions are offered for the identification of the cause as well as the management of complications, including orbital involvement, intracranial involvement, paresthesia of V2, subperiosteal infections, overextended apical extension, vestibular dehiscence, failed zygoma implant, fractured implant, and management of sinus infections. Conclusion: A comprehensive knowledge of the specific steps for the proper execution of this complex procedure will allow for a predictable outcome as presented by the systematic reviews of the zygoma implant, which have reported a cumulative survival rate of 96.7% to 97.8%. Understanding the cause, the prevention, as well as the management of potential complications is imperative for the contemporary surgeon using the zygoma implant. [ABSTRACT FROM AUTHOR]

Competing Interests: Disclosure Dr S. Betz, Dr R.Y. Kim, and Dr J. Jelmini has nothing to disclose. Dr F.C. Williams is a consultant for Stryker, Kalamazoo, Michigan. Dr D.A. Hammer is a consultant for Stryker, Kalamazoo, Michigan. R.Y. Kim: The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. I am a military Service member or employee of the US Government. This work was prepared as part of my official duties. Title 17, U.S.C., §105 provides that copyright protection under this title is not available for any work of the US Government. Title 17, U.S.C., §101 defines a US Government work as a work prepared by a military Service member or employee of the US Government as part of that person’s official duties.

Competing Interests: Disclosure The authors have no disclosures.

Competing Interests: Disclosure The authors have nothing to disclose.

Competing Interests: Disclosure The authors have nothing to disclose.

The objective of this work – to evaluate the results of reconstructive interventions using free revascularized tissue complexes of the scapular region in patients after maxillary resection for malignant tumors. Materials and methods. Between 2014–2020 the post-resection maxillary defects were replaced with free blood-sup plied flaps of the scapular region in 19 patients. In Group 1 (n = 10), the defect was eliminated after total maxillectomy with preservation of the eyeball using a “chimeric” tissue complex, parts of which were positioned in several planes. In Group 2 (n = 9), total and subtotal defects of the hard palate and alveolar process were replaced using a free flap with the inclusion of the scapula angle, which was placed horizontally. The functional and aesthetic results of the reconstructions, the degree of morphological correspondence of the reconstructed structures, as well as the incidence of postoperative complications were assessed. Results. In Group 1 total necrosis of the flap was noted in 2 cases (20 %), in 1 (10 %) case – necrosis of the skin fragment). In Group 2 graft necrosis was observed in 1 (11 %) patient. Satisfactory and excellent aesthetic and functional results were achieved in 6 (60 %) patients in Group 1 and 8 (89 %) patients in Group 2. Conclusion. The scapular flap has a number of advantages for microsurgical reconstruction, including the presence of a long vascular pedicle with large vessels, inclusion of different tissues, possibility of harvesting a “chimeric” version (with significant mobility of parts), low rate of vascular lesions in the area, and most importantly, morphologically close location of bone tissue of the scapula to the maxilla, which ensures successful application of this flap for maxillary repair in patients with advanced cancer of the upper jaw.

Introduction: The fibula free flap (FFF) is considered a gold standard for maxillary reconstructions, and in the last few decades, this flap has been widely used for mandibular defects, with a range of modifications, which have allowed the improvement and greater success. The reconstructions of the maxilla and midface are less reported than mandibular reconstructions, despite the remarkable evolution over the years. In the reconstruction of type IIIa maxillary defects using FFF, some authors report that it may not provide enough height to support the orbit in class 3 and 4 defects. Others also encountered several difficulties, mainly in modeling fibular bone (FB) for the zygomatic–maxilla complex reconstruction and orbital floor, due to the difficulty in rotating the soft tissues, pedicle, orientation of the (FB) segments. Objective: To show this new technique presents another option for maxillary reconstruction with a FFF in type IIIa defects. Methods: After harvesting FFF in the standard fashion, differentiated osteotomies, modeling, and arrangement of the fibular bone segments are performed. Results and Conclusion: This new technique presented has the advantage of requiring only one flap, promoting the resolution of the technical difficulties previously reported. [ABSTRACT FROM AUTHOR]

Recent reports on secondary restorations with subperiosteal implants have demonstrated promising results in terms of esthetic and functional restoration. We report the case of a reconstruction of a total maxillectomy with a custom-made subperiosteal implant associated with a temporal muscle flap in a patient who could not undergo bone reconstruction with a free flap. This technique made it possible to restore the division between the oral cavity and the mouth, providing a solid anchorage to the dental prosthesis and correcting an oroantral communication with a small palatal obturator. The subperiosteal implant also granted proper soft tissue support in the middle-third of the face. Subperiosteal implants can be safe and effective even in primary maxillary reconstructions for patients who cannot undergo free bone flap reconstructions. In these difficult cases, this type of implant can provide support to the soft tissues of the middle-third of the face and a solid anchorage for dental prostheses or palatal obturators, thus improving the quality of life for patients.

Zygomatic implants are used in patients with maxillary defects to improve the retention and stability of obturator prostheses, thereby securing good oral function. Prosthetic-driven placement of zygomatic implants is even difficult for experienced surgeons, and with a free-hand approach, deviation from the preplanned implant positions is inevitable, thereby impeding immediate implant-retained obturation. A novel, digitalized workflow of surgical planning was used in 10 patients. Maxillectomy was performed with 3D-printed cutting, and drill guides were used for subsequent placement of zygomatic implants with immediate placement of implant-retained obturator prosthesis. The outcome parameters were the accuracy of implant positioning and the prosthetic fit of the obturator prosthesis in this one-stage procedure. Zygomatic implants (n = 28) were placed with good accuracy (mean deviation 1.73 ± 0.57 mm and 2.97 ± 1.38° 3D angle deviation), and in all cases, the obturator prosthesis fitted as pre-operatively planned. The 3D accuracy of the abutment positions was 1.58 ± 1.66 mm. The accuracy of the abutment position in the occlusal plane was 2.21 ± 1.33 mm, with a height accuracy of 1.32 ± 1.57 mm. This feasibility study shows that the application of these novel designed 3D-printed surgical guides results in predictable zygomatic implant placement and provides the possibility of immediate prosthetic rehabilitation in head and neck oncology patients after maxillectomy. [ABSTRACT FROM AUTHOR]

Reconstruction of Brown’s Class III maxillary defect can be challenging due to the complex geometry of maxilla. We aimed to introduce an improved method for maxillary reconstruction with a composite deep circumflex iliac artery (DCIA) flap aided by virtual surgical planning and intraoperative navigation. A 27-year-old woman diagnosed with left maxillary fibromyxoma was admitted to our institution in December 2018. Pre-operative facial and iliac computed tomography data were obtained for virtual surgical planning. Personalized cutting template, tooth-supported surgical guide, and rapid prototype model with reconstructed orbital floor were printed for pre-operative preparation. Surgery was completely guided by the intraoperative navigation system. The root mean square estimate of the reconstructed area was 3.68 mm. The average errors measured on the lateral and medial DCIA segments were 0.61 and 0.85 mm, respectively. Application of virtual surgical planning and intraoperative navigation could potentially enhance the reconstruction outcomes.

After total or subtotal maxillectomy, reconstruction using a free rectus abdominis myocutaneous (RAMC) flap is a fundamental and useful option. The purpose of the present study was to clarify the degree of flap volume change and volume distribution change with time after total or subtotal maxillectomy and free RAMC flap reconstruction and to examine the factors affecting the results. A total of 20 patients who underwent total or subtotal maxillectomy with free RAMC flap reconstruction were examined, and the flap volume change rate (volume at final evaluation [POD 181–360] / volume at initial evaluation [POD 5–30]) was investigated using the results of imaging tests. Moreover, the flap was divided into four blocks (A–D) in the cranio-caudal direction, and the volume change of each block was individually analyzed. The overall volume change rate of fat/muscle/total was 0.84 ± 0.21/0.36 ± 0.08/0.67 ± 0.15, at the mean follow-up period of 309±35 days after the operation. The multiple regression analysis revealed that weight loss (for fat), postoperative RT (for fat and muscle), and young age (for muscle) were independently associated with flap volume loss. The results also indicated that the fat volume was stable, whereas the muscle volume decreased to <40% over time, assuming there were no influencing factors. Regarding flap volume distribution change, the fat volume tended to gather toward the central-cranial direction, while the muscle volume gathered toward the cranial direction, and total flap volume gathered toward the central direction. [ABSTRACT FROM AUTHOR]

Reconstruction of Brown's Class III maxillary defect can be challenging due to the complex geometry of maxilla. We aimed to introduce an improved method for maxillary reconstruction with a composite deep circumflex iliac artery (DCIA) flap aided by virtual surgical planning and intraoperative navigation. A 27-year-old woman diagnosed with left maxillary fibromyxoma was admitted to our institution in December 2018. Pre-operative facial and iliac computed tomography data were obtained for virtual surgical planning. Personalized cutting template, tooth-supported surgical guide, and rapid prototype model with reconstructed orbital floor were printed for pre-operative preparation. Surgery was completely guided by the intraoperative navigation system. The root mean square estimate of the reconstructed area was 3.68 mm. The average errors measured on the lateral and medial DCIA segments were 0.61 and 0.85 mm, respectively. Application of virtual surgical planning and intraoperative navigation could potentially enhance the reconstruction outcomes. [ABSTRACT FROM AUTHOR]

Reconstruction of defects of the jaws is mainly performed via free fibula flap. An incidence of 2–21% of overall flap failure is still described. We investigated the roles of volume, length and number of fibula flap segments on flap survival using novel three-dimensional segmentation tools. We also analyzed the role of other possible risk factors. Seventy-one consecutive patients with a follow up of at least three months and who underwent free fibula flap reconstruction in a single center between 2002 and 2022 have been evaluated. A total of 166 fibula segments were analyzed. Malignancies were the main reason of resection (45.1%). In 69% of the cases a reconstruction of the mandible was performed. The flaps were mainly divided in two segments (39%) (range 1–4), with a mean length of 2.52 cm and a mean volume was 3.37 cm3. Total flap failure (TFF) occurred in 12 cases, (16.9%), while partial flap failure (PFF) appeared in 3 patients (4.2%). Volume, length and number of fibula flap segments did not seem to influence flap failure incidence in uni- and multivariate analysis. Reconstruction of the maxilla and use of a recipient vessel different from the facial artery seemed to significantly impact on flap failure. Smoking and previous surgeries showed a higher trend to flap failure, but they did not reach statistical significance. Prospective and multicentric analysis on a wider population should be assessed.

After initial resorption, the bone volume showed long‐term stability following loading of the implant. Furthermore, 3D matching was a suitable quantification method to analyze the volume development of bone augmentation. [ABSTRACT FROM AUTHOR]

Abstract After initial resorption, the bone volume showed long‐term stability following loading of the implant. Furthermore, 3D matching was a suitable quantification method to analyze the volume development of bone augmentation.

Minor salivary gland malignancies of the oral cavity most commonly affect the palate. En bloc surgical resection of the disease, via maxillectomy, remains the primary treatment. The functional and esthetic difficulties associated with a maxillectomy defect can be improved with prosthetic and/or surgical techniques. However, replicating the structure, esthetics, and function of the maxilla and palate can be challenging. This clinical report describes the surgical and prosthetic rehabilitation of an adolescent female patient with a grade 2 intermediate mucoepidermoid carcinoma of the left maxillary sinus and hard palate. A staged reconstructive approach with close collaboration of the interprofessional team between the surgical and prosthodontic services optimized the functional and esthetic outcomes. [ABSTRACT FROM AUTHOR]

Background: Melanotic neuroectodermal tumour of infancy (MNTI) is a rare benign neoplasm. MNTI appears most often during the first year of life, arises predominantly in the maxilla and tends to recur. We discuss possible therapeutic options given in the literature and within our experience in three cases. Patients: In our recent case, we used an intraoral approach to perform resection of the right-sided maxilla. Despite tumour-positive margins, there was no recurrence over the course of one year. In a previous case of MNTI, two recurrences occurred and 6 months after last resection patient received a rib graft for maxillary reconstruction. However, at the age of 7 years, the infant displayed severe maxillary hypoplasia. In a third case of MNTI, the patient was followed up after initial therapy for two decades and underwent multiple reconstruction procedures to achieve successful rehabilitation. Conclusion: Surgical treatment of MNTI should respect vital anatomic structures to avoid gross mutilation. The need for extended and repetitive tumour resection in early childhood can lead to growth disturbances and to further multiple reconstruction procedures in adulthood. Because of the rarity of MNTI, an international database is warranted to evaluate therapies and clinical courses over decades. [ABSTRACT FROM AUTHOR]