Application of personalized polyetheretherketone implants in the functional and accurate reconstruction of maxillary defects
10.3760/cma.j.cn114453-20201209-00619
- VernacularTitle:个体化聚醚醚酮在上颌骨缺损精确重建中的应用
- Author:
Mingming LYU
1
;
Jinbing WANG
;
Xin YANG
;
Jun LI
;
Jian SUN
Author Information
1. 上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所 200011
- Keywords:
Maxilla;
Osteotomy;
Computer-aided design
- From:
Chinese Journal of Plastic Surgery
2021;37(2):144-151
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the applicable value of personalized polyetheretherketone (PEEK) in maxillary reconstruction.Methods:6 patients with benign lesions in the maxilla and 7 patients with maxillary defects after tumor resection were repaired with personalized PEEK implant in our department from September 2018 to November 2020. In 6 patients with benign maxillary lesions, the maxillary defect models were obtained after the extent of tumor resection was established by virtual surgical design. Then, the individual PEEK was designed and produced on the base of mirroring technique. Cutting guide plates were also designed and printed according to virtual surgical planning. Then ablative surgery was performed under the guide of cutting guide, and PEEK was implanted. For 7 patients with maxillary defects, 3D models of maxillary defects were directly reconstructed in the computer based on the preoperative maxillofacial CT, then the individual PEEK was designed and produced based on mirroring technique. Afterwards PEEK was implanted associated with anterolateral thigh flap to repair palatal defects if necessary. All patients were followed up at regular intervals after surgical implantation of PEEK to observe postoperative complications. And postoperative appearance and function of the patients were evaluated by clinical and CT examinations one month after surgery.Results:PEEK implant operation was carried out with all of the patients according to the preoperative design. During implantation, PEEK did not match exactly with the defects in 2 patients. Then PEEK could be put into position after trimming and grinding. Three patients were performed anterolateral thigh flaps at the same time to restore the palatal defects to separate the oral and nasal cavity. The wound healed well after operation in all of the patients. All of the flaps survived, and the survival rate was 100%. Facial symmetry and eyeball location were well restored and mouth opening was recovered to normal after surgery. Image fusion showed the location of PEEK implant was accurate with an error of (0.68±0.12) mm. In 6 patients with benign lesions, postoperative orbital volume [(26.37±0.94) ml], eye vertical position [(0.98±0.48) mm] and the ratio of exophthalmos [(1.10±0.28) mm ]were significantly improved compared to pre-operation [(24.06±0.85) ml, (3.83±0.81) mm, (2.53±0.67) mm]. The difference were statistically significant ( P<0.05). In 7 patients with maxillary defects after tumor resection, postoperative eye verticalposition [(0.77±0.42) mm] and the ratio of exophthalmos [(0.61±0.31) mm] were significantly improved compared to pre-operation [(2.03±1.07) mm, (2.01±0.34) mm]. The difference were statistically significant ( P<0.05). The range of postoperative follow-up was 1-27 months [(12.0±7.6 ) months]. During follow-up, a PEEK implant was removed in one case because of implant extrusion and the other due to tumor recurrence. Conclusions:With the aid of virtual surgical planning, the personalized PEEK implant combined or not with hard/soft tissue flap can accurately restore the maxillary appearance and support the orbital floor, thus effectively improving the accuracy and safety of maxillary reconstruction.
