ISSN : 0376-4672
Maxilla is a complex three-dimensional structure at midface. When wide defect occurred by oral cancer re section, it leaves a great challenge to oral and maxillofacial surgeons for the reconstruction of surgical defects. The wide maxilla defects usually include oral mucosa, skin, fascia and muscle as well as hard tissue such as dentition, bone structure. Consequently, great care should be given with the approach of composite 3D recon struction. A Microvascular free flap has been mainstay for maxilla reconstruction of multiple tissue defect. Fibula free flap, deep circumflex iliac artery free flap come as first choice. The composite 3D reconstruction is assisted by three dimensional image processing, 3D printing technology, polymer based fixation materials and concomitant soft tissue harvesting. The advanced treatment strategy for wide maxilla defect would be presented with three case reports in this article.
1. Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification, Lancet Oncol 2010;11:1001-1008.
2. Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect, Head Neck 2000;22:17-26.
3. Baliarsing AS, Kumar VV, Malik NA, B DK. Reconstruction of maxillectomy defects using deep circumflex iliac artery-based composite free flap, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e8-13.
4. Jang WH, Lee JM, Jang S et al. Mirror Image Based Three-Dimensional Virtual Surgical Planning and Three-Dimensional Printing Guide System for the Reconstruction of Wide Maxilla Defect Using the Deep Circumflex Iliac Artery Free Flap, J Craniofac Surg 2019;30:1829-1832.
5. Thomas CV, McMillan KG, Jeynes P et al. Use of a titanium cutting guide to assist with raising and inset of a DCIA free flap, Br J Oral Maxillofac Surg 2013;51:958-961.
6. Wang LM, Tian YY, Liu XM et al. Quality of life in patients with cancer-related Brown IIb maxillary defect: A comparison between conventional obturation rehabilitation and submental flap reconstruction, Oral Oncol 2022;132:105980.
7. De Virgilio A, Iocca O, Di Maio P et al. Head and neck soft tissue reconstruction with anterolateral thigh flaps with various components:Development of an algorithm for flap selection in different clinical scenarios, Microsurgery 2019;39:590-597.
8. Nguyen S, Tran KL, Wang E et al. Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions, Head Neck 2021;43:2623-2633.
9. Williams FC, Hammer DA, Wentland TR, Kim RY. Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing, J Oral Maxillofac Surg 2020;78:1320-1327.
10. Kim SR, Jang S, Ahn KM, Lee JH. Evaluation of Effective Condyle Positioning Assisted by 3D Surgical Guide in Mandibular Reconstruction Using Osteocutaneous Free Flap, Materials (Basel)2020;13.
11. Jung BT, Kim WH, Park B et al. Biomechanical evaluation of unilateral subcondylar fracture of the mandible on the varying materials:A finite element analysis, PLoS One 2020;15:e0240352.