Reconstruction of anterior maxilla defect with fibula musculocutaneous flap assisted by digital surgical technology
10.3760/cma.j.cn114453-20200707-00409
- VernacularTitle:数字化外科技术辅助腓骨肌皮瓣修复上颌骨前部缺损
- Author:
Guowen SUN
1
;
Xudong YANG
;
Jianmin WEN
;
Xin CHEN
;
Qingang HU
Author Information
1. 南京大学医学院附属口腔医院 南京市口腔医院口腔颌面外科 210008
- Keywords:
Computer-aided design;
Imaging, three-dimensional;
Printing, three-dimensional;
Surgery, oral;
Maxilla;
Mouth neoplasms;
Fibula;
Musculocutaneous flap
- From:
Chinese Journal of Plastic Surgery
2021;37(10):1122-1128
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the precise reconstruction method of anterior maxillary defect with fibula musculocutaneous flap assisted by digital surgical technology.Methods:The clinical data of the patients with anterior maxillary defect repaired by fibular free flap from January 2014 to January 2020 in Nanjing Stomatological Hospital were analyzed retrospectively. Mimics 23.0 software was used to perform computer virtual surgery using preoperative CT data of patients. Then the design of the focal osteotomy guide plate, fibular plastic guide plate and fibular reduction guide plate as well as the surgical plan was completed. The navigation registration point was designed by the Accunavi-A navigation system. The surgical guide plates were 3D printed. During the operation, the fibular musculocutaneous flap was harvested to cover the defect after resection of the anterior maxillary lesion with the assistance of the surgical guide plate and navigation technology. The facial appearance and function were followed up after operation.Results:A total of 12 cases, 9 males and 3 females, aged from 33 to 56 years, were included. There were 5 cases of gingival carcinoma, 4 cases of ameloblastoma, 1 case of chondrosarcoma, 1 case of mucoepidermoid carcinoma and 1 case of odontogenic myxoma. The size of the defect after resection was 5 cm×4 cm-6 cm×5 cm. In 12 patients, the focal osteotomy guide plate and fibula plastic guide plate were designed accurately, and the fibular reduction guide plate was successfully placed with accurate navigation and no displacement during the operation. The position of transplanted fibula was consistent with the normal maxillary position. The length of fibula was 8 -10 cm, and the size of the fibular free flap was 5 cm× 4 cm-6 cm×5 cm. All fibular musculocutaneous flaps survived. The patients were followed up for 1 to 72 months, with an average of 24.5 months. The patients had clear pronunciation, no oral and nasal reflux during diets, and presented in good facial appearance. No tumor recurrence occurred in 12 patients during follow-up.Conclusions:It is an accurate and feasible method to repair the anterior maxilla defect with fibula free flap assisted by digital surgical technology. The function of oral and nasal closure and speech was well maintained. A satisfactory facial appearance was obtained.
