Clinical study of free anterolateral thigh perforator flap in repairing maxillary complex tissue defects / 肿瘤研究与临床

Objective To explore the effect of free anterolateral thigh (ALT) perforator flap in the repairment of complex maxillary defects. Methods The clinical data of 51 patients undergoing the reconstruction of maxillary defects in ALT perforator flap between January 2013 and October 2016 in the Peking University Hospital of Stomatology were retrospectively analyzed. All the patients received ALT reconstruction during the maxillary tumor resection. Results Four patients had blood vessel crisis after surgery in 51 cases. Two cases were removed due to flap necrosis, and 49 cases survived with a satisfactory appearance and function, and the overall flap survival rate of 49 cases was 96.08 ％ (49/51). Conclusion ALT perforator flap provides an ideal reconstruction for complex maxillary defects with a well-restored function in the surgical ares which could avoid the facial asymmetry and contribute to the following treatment.

Research progress of three-dimensional finite element analysis in unilateral maxillary defect restorations / 口腔疾病防治

@#Unilateral maxillary defects are common clinical maxillofacial deformities. Because of their large area and the complexity of the maxillary structure, the distribution of pressure from dental prostheses and on the sustentacular tissue is usually uneven, which often results in pain or ulceration of the soft tissue and agomphiasis during the therapeutic process. Recently, the finite element method has been used to guide prosthesis design and implantation. This method is conducive to the restoration and stability of the dental prosthesis and the protection of the remaining tissue, which improves restoration quality and patient satisfaction. This paper summarizes the establishment of a three-dimensional finite element model of unilateral maxillary defects and its application in repairing unilateral maxillary defects with traditional prostheses, implant-supported prostheses and surgical flap transplantation combined with prostheses.

Surgical reconstruction of maxillary defects using computer-assisted techniques / 北京大学学报(医学版)

The maxilla is the most important bony support of the mid-face skeleton and is critical for both esthetics and function.Maxillary defects,resulting from tumor resection,can cause severe functional and cosmetic deformities.Furthermore,maxillary reconstruction presents a great challenge for oral and maxillofacial surgeons.Nowadays,vascularized composite bone flap transfer has been widely used for functional maxillary reconstruction.In the last decade,we have performed a comprehensive research on functional maxillary reconstruction with free fibula flap and reported excellent functional and acceptable esthetic results.However,this experience based clinical procedure still remainssome problems in accuracy and efficiency.In recent years,computer assisted techniques are now widely used in oral and maxillofacial surgery.We have performed a series of study on maxillary reconstruction with computer assisted techniques.The computer assisted techniques used for maxillary reconstruction mainly include:(1) Three dimensional (3 D) reconstruction and tumor mapping:providing a 3 D view of maxillary tumor and adjacent structures and helping to make the diagnosis of maxillary tumor accurate and objective;(2) Virtual planning:simulating tumor resection and maxillectomy as well as fibula reconstruction on the computer,so that to make an ideal surgical plan;(3) 3D printing:producing a 3D stereo model for prebending individualized titanium mesh and also providing template or cutting guide for the surgery;(4) Surgical navigation:the bridge between virtual plan and real surgery,confirming the virtual plan during the surgery and guarantee the accuracy;(5) Computer assisted analyzing and evaluating:making a quantitative and objective of the final result and evaluating the outcome.We also performed a series of studies to evaluate the application of computer assisted techniques used for maxillary reconstruction,including:(1)3D tumor mapping technique for accurate diagnosis and treatment of maxillary tumor;(2) Maxillary reconstruction with free fibula flap used computer assisted techniques;(3) Computer assisted orbital floor reconstruction after maxillectomy.The results suggested that computer assisted techniques could significantly improve the clinical outcome of maxillary reconstruction.

Comparison of obturator design for acquired maxillary defect in completely edentulous patients.

The most challenging and appreciated area in the field of Prosthodontics is the rehabilitation of maxillary defects. Tumors of the head and neck are the common cause for acquired maxillofacial defects. Surgical consequences predispose the patient to hypernasal speech, fluid leakage into nasal cavity, impaired masticatory function, and cosmetic deformity. The Prosthodontists play a significant role in the intervention and improve the quality of life of such patients. The current article describes two clinical case reports of completely edentulous patients with acquired maxillary defects.

Rectus Abdominis Free Flap Reconstruction for Orbital-Maxillary Defect in Advanced Maxillary Sinus Cancer / 대한이비인후과학회지

In the management of advanced maxillary sinus cancer, sometimes it requires an extensive ablation and orbital exenteration that results in large and full defects of the cheek and orbital regions. Reconstruction of large orbital-maxillary defects can be accomplished in one stage by microsurgical free transfer of rectus abdominis myocutaneous flap. The muscle component is suitable to fill the orbital and maxillary cavities, and the skin components are used for cheek, palate and lateral nasal cavity wall reconstruction as a three-dimentional folded free flap. Major problems with this flap are the bulkiness, the possibility of abdominal hernia and muscle weakness following the removal of the rectus abdominis muscle. Free deep inferior epigastric artery skin flap without rectus abdominis muscle is available in the reconstruction of large orbital-maxillary defect without the problems of the rectus abdominis myocutaneous free flap. We experienced one case of rectus abdominis myocutaneous free flap, and one other case of inferior rectus abdominis free flap for the reconstruction of huge surgical defects due to radical maxillectomy with orbital excenteration. Both of the patients were satisfied and there have been no severe complication associated with these technique.