• Journal of International Society for Simulation Surgery
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• 제1권1호
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• pp.32-36
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• 2014

Reconstruction of the maxilla is quite a difficult challenge for reconstructive surgeons. The maxilla is the most important part of the midface, which contributes to facial esthetics, mastication, swallowing, speech, supporting orbital contents and sinus function. Free fibular flap is most versatile to reconstruct jaw bone because of its adequate length, containing both soft and bony tissues and acceptance of dental implants. In this case report, a reconstruction of the maxilla using free fibular flap and dental implants is described in which rapid prototype was used before surgery to simulate the final prosthetic results.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.448-454
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• 2007

Purpose: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects. Methods: 27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated. Results: Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result. Conclusion: LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권1호
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• pp.1-11
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• 1994

The functional deformity following removal of the maxilla is considerable, especially following maxilla cancer excision. Rehabilitation of oral and maxillofacial region used to be very difficult with prosthesis or traditional flaps. Temporal muscle and fascia flaps have been described for immediate reconstruction following hemi-maxillectomy, but not total maxillectomy. The muscle and superficial fascia of the temporal area differ in their physical characteristics, vascular supply and clinical applications. Both can be employed independently or simultaneously as regional flaps in the reconstruction of a variety of complex craniofacial defects. Four case is presented in which 3 case maxilla cancer, one case non-union after maxilla fracture, and all case showed successful use of this flap. Only one patient developed partial necrosis of the flap ; significant necrosis did not occur in any other patient. This present paper reviews the anatomy, surgical technique and utilisation of temporal muscle and fascia flaps.

• Journal of International Society for Simulation Surgery
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• 제2권1호
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• pp.1-6
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• 2015

Purpose Bisphophonate-related osteonecrosis of the jaw (BRONJ) is an emerging problem. Extensive osteonecrosis of the jaw needs free flap reconstruction. Free fibular flap is the most useful flap for maxilla-mandibular hard and soft tissue reconstruction. The advantages of fibular free flap are simultaneous soft and hard tissue reconstruction and placing implant in reconstructed mandible and maxilla. In this study, four consecutive BRONJ patients who underwent fibula free flap reconstruction using simulation surgery were reviewed. Materials and Methods Four BRONJ patients who underwent free fibula reconstruction between May 2006 and September 2014 were included in this study. Male to female ratio was 1:3 and average age was 67.3 years old (62-70). All patients need mandibular bone reconstruction. Three patients suffered from osteoporosis and one male patient had multiple myeloma. Postoperative flap survival, functional reconstruction, esthetic results, food taking were evaluated. Results Three osseous flaps and one osteocutaneous flap were used. All the fibular flaps were survived and patients were recovered without complications. Oro-cutaneous fistula was resolved after operation. All patients were satisfied with the esthetic results. Patients reported improved solid food intake after operation with partial denture. One fully edentulous patient had semi-fluid diet after operation. Conclusion Treatment of the BRONJ is difficult due to lack of standard protocol. Fibular free flap using simulation surgery is the workhorse flap for mandibular hard and soft tissue reconstruction, especially in stage III BRONJ patient. In this study, functional and esthetic results were successful in all patients. Normal diet was possible with partial dentures.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권1호
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• pp.85-92
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• 2005

Reconstruction of defect in the anterior part of the maxilla to enable implant placement or prothesis is a complicated treatment due to the anatomical position and lack of soft tissues. Two cases are presented in which autogenous iliac PMCB(particulate marrow and cancellous bone) with titanium mesh were used for premaxilla reconstruction and alveolar bone repair of the anterior maxillas prior to denture and implants fixation respectively. Cancellous bone from the anterior iliac crest was compressed and placed against a titanium mesh fixed to the bone of palate in a patient with severe defect of the anterior maxilla. There were no problem in the healing, and the anterior maxillas of two patients had increased height and width during the initial healing and remodeling. The clinical reports describe the use of titanium mesh for reconstruction of premaxilla. Autogenous bone grafts were harvested from the iliac crest and were loaded on a titanium mesh that were left in the patient's maxilla for 6 months before they were removed respectively. The radiographic analysis demonstrated that a 10mm vertical ridge augmentation had been achieved. In guided bone regeneration, the quantity of bone regenerated under the barrier has been demonstrated to be directly related to the amount of the space under the membrane. This space can diminish as a result of membrane collapse. To avoid this problem which involved the use of a titanium mesh barrier to protect the regenerating tissues and to achieve a rigid fixation of the bone segments, were used in association with autologous bone in 2 cases. The aim of this study was to evaluate the capability of a configured titanium mesh to serve as a mechanical and biologic device for restoring a vertically defected premaxilla.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.779-782
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• 2013

Chondroblastomas are rare entities accounting for approximately 1% of all primary bone tumors. We describe a case of a 7-year-old girl with a giant chondroblastoma of the maxilla, treated with bilateral class III maxillectomy and reconstruction with a double-barreled and double skin paddle fibular free flap. We show evidence of an excellent aesthetic outcome at 6 months' follow up with no evidence of tumor recurrence.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권2호
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• pp.143-151
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• 2007

One of the treatment methods for maxillary cancers or infections in maxilla is maxillectomy. Palatal defect can be resulted from this operation and it may cause functional problems with swallowing and speech, and psychological problems of patients. After maxillectomy, as rehabilitation, there can be two options. One is a prosthodontic treatment using obturator and the other is surgical reconstruction of defect with graft. As both methods have advantages and disadvantages, in determining treatment method after maxillectomy, various factors have to be considered. The purpose of this study is to compare the prosthodontic group to surgical group after maxillectomy with elapsed days prior to commencement of postoperative oral feeding, and to analyze the results of prosthodontic treatment and surgical treatment. During the period from March of 2000 to June of 2006, 74 patients were treatment by prosthodontic methods for maxillary defect. Among these patients, patients who had only velopharyngeal deficiency after surgery, whose data were incomplete, whose causes of palatal defect were not the treatment of diseases in maxilla, and who already had palatal defect due to previous surgery were excluded in this study. The patients who underwent maxillectomy for the treatment of diseases in the maxilla and were treated immediately after operation using surgical reconstruction or prosthodontic rehabilitation were included in this study. The records of 43 patients were reviewed to compare and to analyze the prosthodontic treatment and surgical reconstruction after maxillectomy. The median of days elapsed prior to commencement of postoperative oral feeding in the prosthodontic group was compared with data of surgical group. The data was analyzed using the Mann-Whitney test (${\alpha}$=.05). Days elapsed prior to postoperative oral feeding commencement in the prosthodontic group were less than those in the surgical group.

• Journal of International Society for Simulation Surgery
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• 제3권1호
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• pp.36-38
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• 2016

Fibrous dysplasia is a relatively rare disease but the management would be quite challenging. Because this is not a malignant tumor, the preservation of the facial contour and the various functions seems to be important in treatment planning. Until now the facial bone reconstruction with autogenous bone would be the standard. Although the autogenous bone would be the ideal one for facial bone reconstruction, donor site morbidity would be the inevitable problem in many cases. Meanwhile, various types of allogenic and alloplastic materials have been also used. However, facial bone reconstruction with many alloplastic material have produced no less complications including infection, exposure, and delayed wound healing. Because the 3D printing technique evolved so fast that 3D printed titanium implant were possible recently. The aim of this trial is to try to restore the original maxillary anatomy as possible using the 3D printing model, based on the mirrored three dimensional CT images based on the computer simulation. Preoperative computed tomography (CT) data were processed for the patient and a rapid prototyping (RP) model was produced. At the same time, the uninjured side was mirrored and superimposed onto the traumatized side, to create a mirror-image of the RP model. And we molded Titanium mesh to reconstruct three-dimensional maxillary structure during the operation. This prefabricated Titanium-mesh implant was then inserted onto the defected maxilla and fixed. Three dimensional printing technique of titanium material based on the computer simulation turned out to be successful in this patient. Individualized approach for each patient could be an ideal way to restore the facial bone.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권2호
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• pp.112-119
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• 2021

Objectives: Myxomatous odontogenic tumors (MOTs) are the third most common odontogenic tumors in the oral and maxillofacial region. Due to its slow-growing, but locally invasive nature, the tumor is usually detected by accident or only when it becomes a large mass, which causes facial deformity. Materials and Methods: Current study reports three unusual cases of MOT including huge myxoma involve the mandible in middle-aged man, MOT with ossifying fibroma pattern in mandible, and MOT in maxilla of young female patient. The diagnosis and treatment strategy of MOTs was also summarized and updated. Results: In reported three cases of patients with large MOTs, surgical treatment was indicated with fibular free flap reconstruction in the mandible and plate reconstruction in the maxilla. The tumors were successfully treated with radical resection and did not show signs of recurrence during the follow-up period. Conclusion: Surgical treatment indication depends on size, the position of the lesion, patient systemic condition and surgeon individual experience. In the case of a large tumor, radical resection and reconstruction is the standard surgical strategy. The conservative surgical treatment including enucleation with wide curettage is still under controversy. The recurrence rate for MOTs is significantly high, up to 30%, therefore long-term follow-up is essential.

• 대한두개안면성형외과학회지
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• 제21권3호
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• pp.193-197
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• 2020

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare, benign, fibro-osseous variant of ossifying fibroma. It exhibits short-term rapid growth and has a high recurrence rate. Herein we describe a case of JPOF of the maxilla that was treated via complete excision utilizing an intraoral approach with immediate reconstruction using an iliac bone graft, in conjunction with a comprehensive review of the literature. A 20-year-old man presented with a mass on his right cheek that he reported had been growing over the last 10 months. In that cheek he had noticed fullness and experienced pressure, tenderness, and fluffiness, with no other ophthalmic or dental symptoms. After clinical, radiological, and histological examinations, the diagnosis was confirmed as JPOF. Surgical excision was performed, followed by immediate reconstruction with an autologous iliac cortical and cancellous bone graft harvested from the right iliac crest under general anesthesia. Good cicatrization of the intraoral surgical wounds and right iliac crest were evident. He was monitored for 6 months after the surgery and exhibited appropriate midfacial contour. There were no signs of recurrence or complications.