Download PDF
J Reconstr Microsurg 2018; 34(03): 193-199
DOI: 10.1055/s-0037-1607394
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Staged Reconstruction (Delayed-Immediate) of the Maxillectomy Defect Using CAD/CAM Technology

John Henry Pang   *
1   Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Sebastian Brooke   *
1   Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Mark W. Kubik
2   Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Robert L. Ferris
2   Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Matilda Dhima
3   Department of Prosthodontics, University of Pittsburgh, School of Dental Medicine, Pittsburgh, Pennsylvania
,
Matthew M. Hanasono
4   Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Eric W. Wang
2   Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Mario G. Solari
1   Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
2   Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
5   McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
› Author Affiliations
Further Information

Publication History

12 June 2017

14 September 2017

Publication Date:
27 November 2017 (online)

    Permissions and Reprints

Corrected by:

Erratum to: Staged Reconstruction (Delayed-Immediate) of the Maxillectomy Defect Using CAD/CAM TechnologyJ Reconstr Microsurg 2018; 34(03): e1-e1
DOI: 10.1055/s-0038-1635090

Abstract

Background Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has become increasingly popular for free fibula reconstruction of the mandible. The same technology, however, has not been widely utilized in immediate complex midface reconstruction utilizing free fibula flaps. Maxillary defects are difficult to precisely predict or produce matched cutting guides for after the ablative surgery. We present a protocol for “delayed-immediate” two-stage reconstruction for complex mid-facial defects, by delaying lymph node neck dissection and using CAD/CAM technology for delayed bony reconstruction.

Methods Stage 1 includes the extirpative surgery, placement of a temporary obturator, and an immediate post-excision fine cut computed tomography (CT) of the defect that is used for CAD/CAM planning. The time interval between stages is used for virtual surgical planning (VSP) and provides an opportunity for the final pathologic margins to be evaluated. At stage 2, definitive reconstruction is performed in conjunction with the delayed neck dissection. Briefly delaying the neck dissection until stage 2 allows for recipient vessel dissection and microsurgical anastomoses to safely occur in a surgically naïve neck.

Conclusion A two-stage delayed-immediate reconstruction of complex mid-face defects can be safely and effectively performed. This protocol takes advantage of advancing CAD/CAM technology, provides an opportunity to evaluate final margins, and avoids recipient vessel dissection and microsurgery in previously operated or irradiated necks.

Keywords

CAD/CAM - head and neck cancer - free fibula

Financial Disclosure

No authors have financial interest in any products, devices, or drugs mentioned in this article.


* Co-first authors contributed equally to this work.


 

  • References

  • 1 Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg 2000; 105 (07) 2331-2346 , discussion 2347–2348
    CrossrefPubMedGoogle Scholar
  • 2 Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification. Lancet Oncol 2010; 11 (10) 1001-1008
    CrossrefPubMedGoogle Scholar
  • 3 Eckardt A, Swennen GR. Virtual planning of composite mandibular reconstruction with free fibula bone graft. J Craniofac Surg 2005; 16 (06) 1137-1140
    CrossrefPubMedGoogle Scholar
  • 4 Hallermann W, Olsen S, Bardyn T, Taghizadeh F, Banic A, Iizuka T. A new method for computer-aided operation planning for extensive mandibular reconstruction. Plast Reconstr Surg 2006; 117 (07) 2431-2437
    CrossrefPubMedGoogle Scholar
  • 5 Hirsch DL, Garfein ES, Christensen AM, Weimer KA, Saddeh PB, Levine JP. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg 2009; 67 (10) 2115-2122
    CrossrefPubMedGoogle Scholar
  • 6 Seruya M, Fisher M, Rodriguez ED. Computer-assisted versus conventional free fibula flap technique for craniofacial reconstruction: an outcomes comparison. Plast Reconstr Surg 2013; 132 (05) 1219-1228
    CrossrefPubMedGoogle Scholar
  • 7 Hanasono MM, Skoracki RJ. Computer-assisted design and rapid prototype modeling in microvascular mandible reconstruction. Laryngoscope 2013; 123 (03) 597-604
    CrossrefPubMedGoogle Scholar
  • 8 Matros E, Albornoz CR, Rensberger M, Weimer K, Garfein ES. Computer-assisted design and computer-assisted modeling technique optimization and advantages over traditional methods of osseous flap reconstruction. J Reconstr Microsurg 2014; 30 (05) 289-296
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Kääriäinen M, Kuuskeri M, Gremoutis G, Kuokkanen H, Miettinen A, Laranne J. Utilization of three-dimensional computer-aided preoperative virtual planning and manufacturing in maxillary and mandibular reconstruction with a microvascular fibula flap. J Reconstr Microsurg 2016; 32 (02) 137-141
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Petruzzelli GJ, Myers EN. Malignant neoplasms of the hard palate and upper alveolar ridge. Oncology (Williston Park) 1994; 8 (04) 43-48 , discussion 50, 53
    PubMedGoogle Scholar
  • 11 Lin HW, Bhattacharyya N. Survival impact of nodal disease in hard palate and maxillary alveolus cancer. Laryngoscope 2009; 119 (02) 312-315
    CrossrefPubMedGoogle Scholar
  • 12 Carrau RL, Segas J, Nuss DW. , et al. Squamous cell carcinoma of the sinonasal tract invading the orbit. Laryngoscope 1999; 109 (2 Pt 1): 230-235
    CrossrefPubMedGoogle Scholar
  • 13 National Comprehensive Cancer Network. Head and Neck Cancers. (Version 2.2017). https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf . Accessed June 1, 2017
    PubMed
  • 14 Miles BA, Gilbert RW. Maxillary reconstruction with the scapular angle osteomyogenous free flap. Arch Otolaryngol Head Neck Surg 2011; 137 (11) 1130-1135
    CrossrefPubMedGoogle Scholar
  • 15 Eskander A, Givi B, Gullane PJ. , et al. Outcome predictors in squamous cell carcinoma of the maxillary alveolus and hard palate. Laryngoscope 2013; 123 (10) 2453-2458
    PubMedGoogle Scholar
  • 16 Kreeft AM, Smeele LE, Rasch CR. , et al. Preoperative imaging and surgical margins in maxillectomy patients. Head Neck 2012; 34 (11) 1652-1656
    CrossrefPubMedGoogle Scholar
  • 17 Lethaus B, Kessler P, Boeckman R, Poort LJ, Tolba R. Reconstruction of a maxillary defect with a fibula graft and titanium mesh using CAD/CAM techniques. Head Face Med 2010; 6: 16
    CrossrefPubMedGoogle Scholar
  • 18 Shen Y, Sun J, Li J, Li MM, Huang W, Ow A. Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap. J Plast Reconstr Aesthet Surg 2012; 65 (07) 893-902
    CrossrefPubMedGoogle Scholar
  • 19 Morris LG, Patel SG, Shah JP, Ganly I. High rates of regional failure in squamous cell carcinoma of the hard palate and maxillary alveolus. Head Neck 2011; 33 (06) 824-830
    CrossrefPubMedGoogle Scholar
  • 20 Amit M, Na'ara S, Sharma K. , et al. Elective neck dissection in patients with head and neck adenoid cystic carcinoma: an international collaborative study. Ann Surg Oncol 2015; 22 (04) 1353-1359
    CrossrefPubMedGoogle Scholar
  • 21 Yoo SH, Roh JL, Kim SO. , et al. Patterns and treatment of neck metastases in patients with salivary gland cancers. J Surg Oncol 2015; 111 (08) 1000-1006
    CrossrefPubMedGoogle Scholar
  • 22 Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 1999; 103 (02) 403-411
    CrossrefPubMedGoogle Scholar
  • 23 Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery 2009; 29 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 24 Ang KK, Trotti A, Brown BW. , et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001; 51 (03) 571-578
    CrossrefPubMedGoogle Scholar
  • 25 Loveland-Jones CE, Ruth K, Sigurdson ER, Egleston BL, Boraas M, Bleicher RJ. Patterns of nodal staging during breast conservation surgery in the medicare patient: will the ACOSOG Z0011 trial change the pattern of care?. Breast Cancer Res Treat 2014; 143 (03) 571-577
    CrossrefPubMedGoogle Scholar
  • 26 Pavri SN, Clune J, Ariyan S, Narayan D. Malignant melanoma: beyond the basics. Plast Reconstr Surg 2016; 138 (02) 330e-340e
    CrossrefPubMedGoogle Scholar