Objective:To investigate the clinical value of navigation assisted zygomatic implant technique in the repair of bilateral maxillary defects.Methods:Clinical data: from January 2013 to December 2019, patients underwent bilateral subtotal maxillectomy in the Department of Oral and Maxillofacial Head and Neck Oncology, the Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiao Tong University. Inclusion criteria: James Brown’s class Ⅱ patients with bilateral maxillary defect, with oral nasal communication, without residual teeth. Exclusion criteria: patients with zygomatic pathologic involvement or requiring postoperative radiotherapy. The obturator was fitted with the defect by using digital technology and Simplant 3D software, and the implant direction and exposure position of the platform were determined. The bilateral zygomatic implants were implanted under the guidance of Brainlab platform navigation at the same time or in the second stage after tumor resection. Finally, the implant supported obturator was used to repair the maxillary defect. The patients were followed up for 1 year, and the clinical effect was evaluated by obturator functional scale(OFS).Results:A total of 20 patients, 13 males and 7 females, aged from 28 to 72 years, with an average of 53.6 years, were included in this study. A total of 68 zygomatic implants were implanted and 2 of them failed. The osseointegration rate was 97.06%. The repair rate of implant occluder was 90%. By the evaluation of OFS scale, the patients achieved satisfactory result in chewing, pronunciation and appearance.Conclusions:Zygomatic implant can provide decent repair effect for maxillary obturator, and navigation technology can make zygomatic implant accurately implanted into the ideal site.

Objective:To investigate the clinical value of navigation assisted zygomatic implant technique in the repair of bilateral maxillary defects.Methods:Clinical data: from January 2013 to December 2019, patients underwent bilateral subtotal maxillectomy in the Department of Oral and Maxillofacial Head and Neck Oncology, the Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiao Tong University. Inclusion criteria: James Brown’s class Ⅱ patients with bilateral maxillary defect, with oral nasal communication, without residual teeth. Exclusion criteria: patients with zygomatic pathologic involvement or requiring postoperative radiotherapy. The obturator was fitted with the defect by using digital technology and Simplant 3D software, and the implant direction and exposure position of the platform were determined. The bilateral zygomatic implants were implanted under the guidance of Brainlab platform navigation at the same time or in the second stage after tumor resection. Finally, the implant supported obturator was used to repair the maxillary defect. The patients were followed up for 1 year, and the clinical effect was evaluated by obturator functional scale(OFS).Results:A total of 20 patients, 13 males and 7 females, aged from 28 to 72 years, with an average of 53.6 years, were included in this study. A total of 68 zygomatic implants were implanted and 2 of them failed. The osseointegration rate was 97.06%. The repair rate of implant occluder was 90%. By the evaluation of OFS scale, the patients achieved satisfactory result in chewing, pronunciation and appearance.Conclusions:Zygomatic implant can provide decent repair effect for maxillary obturator, and navigation technology can make zygomatic implant accurately implanted into the ideal site.

Objective:To evaluate the use and effect of reconstruction with anterolateral thigh flap(ALTF)in orbitomaxillary defect resulting from oral maxillofacial oncology surgery.Methods:Patients with orbitomaxillary defects following enucleation of orbit were reconstructed with ALTF from January 2013 to September 2020 in Department of Oral & Maxillofacial Surgery-Head & Neck Oncology, Shanghai Ninth People’s Hospital and the data of the cases were collected. Based on the types of the defects, they were classified as orbit-nasal-oral defect, oronasal defect without defect of peri-orbit skin, nasal-orbit defect without defect of oral mucosa and peri-orbit skin defect. Based on the types of the defects and the number of the perforators of ALTF, the flaps were designed as tri-lobed, bi-lobed or mono-lobed flaps and oronasal fistula was determined to repair. Performance of maxillary prosthesis depended on the intraoral situation.Results:There were 19 male cases and 10 female cases and the age arranged from 23 to 82 years old. In terms of defect type, there were 8 cases of orbit-nasal-oral defect, 17 cases of oronasal defect without defect of peri-orbit skin, 1 case of nasal-orbit defect without defect of oral mucosa, 3 cases of peri-orbit skin defect. All the 29 cases of ALTF were successfully completed. Loculated flaps were designed in 16 cases, including 3 cases of tri-lobed flap and 13 cases of bi-lobed flaps. The oral-nasal fistula was repaired with ALTF in 11 cases and maxillary prosthesis was used in 7 cases after surgery. The oral-nasal fistula was not repaired in 14 cases and maxillary prosthesis was used in 6 cases in this group. Two cases were reconstructed with implant supported prosthesis with artificial eyes. The follow-up duration was 4 to 88 months. Eleven patients died of recurrence or metastasis and the other patients were alive without recurrence.Conclusions:In the reconstruction of the maxillary defects with intra-orbital loss following oromaxillofacial tumor resection, ALTF could be an ideal donor site because of flexible design, applicable in complicated defect repair and closure of oronasal fistula, improvement of facial appearance and sanitary maintenance of the oral and nasal cavities.

Objective:To evaluate the use and effect of reconstruction with anterolateral thigh flap(ALTF)in orbitomaxillary defect resulting from oral maxillofacial oncology surgery.Methods:Patients with orbitomaxillary defects following enucleation of orbit were reconstructed with ALTF from January 2013 to September 2020 in Department of Oral & Maxillofacial Surgery-Head & Neck Oncology, Shanghai Ninth People’s Hospital and the data of the cases were collected. Based on the types of the defects, they were classified as orbit-nasal-oral defect, oronasal defect without defect of peri-orbit skin, nasal-orbit defect without defect of oral mucosa and peri-orbit skin defect. Based on the types of the defects and the number of the perforators of ALTF, the flaps were designed as tri-lobed, bi-lobed or mono-lobed flaps and oronasal fistula was determined to repair. Performance of maxillary prosthesis depended on the intraoral situation.Results:There were 19 male cases and 10 female cases and the age arranged from 23 to 82 years old. In terms of defect type, there were 8 cases of orbit-nasal-oral defect, 17 cases of oronasal defect without defect of peri-orbit skin, 1 case of nasal-orbit defect without defect of oral mucosa, 3 cases of peri-orbit skin defect. All the 29 cases of ALTF were successfully completed. Loculated flaps were designed in 16 cases, including 3 cases of tri-lobed flap and 13 cases of bi-lobed flaps. The oral-nasal fistula was repaired with ALTF in 11 cases and maxillary prosthesis was used in 7 cases after surgery. The oral-nasal fistula was not repaired in 14 cases and maxillary prosthesis was used in 6 cases in this group. Two cases were reconstructed with implant supported prosthesis with artificial eyes. The follow-up duration was 4 to 88 months. Eleven patients died of recurrence or metastasis and the other patients were alive without recurrence.Conclusions:In the reconstruction of the maxillary defects with intra-orbital loss following oromaxillofacial tumor resection, ALTF could be an ideal donor site because of flexible design, applicable in complicated defect repair and closure of oronasal fistula, improvement of facial appearance and sanitary maintenance of the oral and nasal cavities.