The functional and aesthetic reconstruction of midfacial and orbital defects by combining free flap transfer and craniofacial prosthesis

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• 作者：S. Mueller ; B. Hohlweg-Majert ; R. Buergers ; T. Steiner…
• 关键词：Reconstructive surgery ; Free flap ; Extraoral implants ; Orbital defects ; Midfacial defects ; Episthesis ; Craniofacial prosthesis
• 刊名：Clinical Oral Investigations
• 出版年：2015
• 出版时间：March 2015
• 年：2015
• 卷：19
• 期：2
• 页码：413-419
• 全文大小：2,579 KB
• 参考文献：1. Hanasono, MM, Lee, JC, Yang, JS, Skoracki, RJ, Reece, GP, Esmaeli, B (2009) An algorithmic approach to reconstructive surgery and prosthetic rehabilitation after orbital exenteration. Plast Reconstr Surg 123: pp. 98-105 CrossRef
  2. Schmelzeisen, R, Schliephake, H (1998) Interdisciplinary microvascular reconstruction of maxillary, midfacial and skull base defects. J Craniomaxillofac Surg 26: pp. 1-10 CrossRef
  3. Funk, GF, Laurenzo, JF, Valentino, J, McCulloch, TM, Frodel, JL, Hoffman, HT (1995) Free-tissue transfer reconstruction of midfacial and cranio-orbito-facial defects. Arch Otolaryngol Head Neck Surg 121: pp. 293-303 CrossRef
  4. Mucke, T, Holzle, F, Loeffelbein, DJ, Ljubic, A, Kesting, M, Wolff, KD, Mitchell, DA (2011) Maxillary reconstruction using microvascular free flaps. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111: pp. 51-57 CrossRef
  5. Mucke, T, Loeffelbein, DJ, Hohlweg-Majert, B, Kesting, MR, Wolff, KD, Holzle, F (2009) Reconstruction of the maxilla and midface—surgical management, outcome, and prognostic factors. Oral Oncol 45: pp. 1073-1078 CrossRef
  6. Futran, ND, Mendez, E (2006) Developments in reconstruction of midface and maxilla. Lancet Oncol 7: pp. 249-258 CrossRef
  7. Cordeiro, PG, Chen, CM (2012) A 15-year review of midface reconstruction after total and subtotal maxillectomy: part I. Algorithm and outcomes. Plast Reconstr Surg 129: pp. 124-136 CrossRef
  8. Neligan, PC, Mulholland, S, Irish, J, Gullane, PJ, Boyd, JB, Gentili, F, Brown, D, Freeman, J (1996) Flap selection in cranial base reconstruction. Plast Reconstr Surg 98: pp. 1159-1166 CrossRef
  9. Gliklich, RE, Rounds, MF, Cheney, ML, Varvares, MA (1998) Combining free flap reconstruction and craniofacial prosthetic technique for orbit, scalp, and temporal defects. Laryngoscope 108: pp. 482-487 CrossRef
  10. Federspil, PA (2010) Craniofacial prostheses for facial defects. HNO 58: pp. 621-631 CrossRef
  11. Chu, Y, Liu, HG, Yu, ZK (2012) Patterns and incidence of sinonasal malignancy with orbital invasion. Chin Med J (Engl) 125: pp. 1638-1642
  12. Moyer, JS, Chepeha, DB, Prince, ME, Teknos, TN (2009) Microvascular reconstruction of the orbital complex. Facial Plast Surg Clin N Am 17: pp. 225-237 CrossRef
  13. Al Mardini, M (2009) Prosthetic rehabilitation of the head and neck: the state of the art. Curr Opin Otolaryngol Head Neck Surg 17: pp. 253-257 CrossRef
  14. Black, C, Marotti, J, Zarovnaya, E, Paydarfar, J (2006) Critical evaluation of frozen section margins in head and neck cancer resections. Cancer 107: pp. 2792-2800 CrossRef
  15. Priya, SR, D’Cruz, AK, Pai, PS (2012) Cut margins and disease control in oral cancers. J Cancer Res Ther 8: pp. 74-79 CrossRef
  16. Leonardi, A, Buonaccorsi, S, Pellacchia, V, Moricca, LM, Indrizzi, E, Fini, G (2008) Maxillofacial prosthetic rehabilitation using extraoral implants. J Craniofac Surg 19: pp. 398-405 CrossRef
  17. Chepeha, DB, Wang, SJ, Marentette, LJ, Bradford, CR, Boyd, CM, Prince, ME, Teknos, TN (2004) Restoration of the orbital aesthetic subunit in complex mi
• 刊物类别：Medicine
• 刊物主题：Dentistry
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1436-3771

文摘

Objectives The reconstruction of complex facial defects should satisfy both aesthetic and functional requirements. In the midfacial area, the nasal passage should be sufficiently separated from the orbit and the oral cavity to avoid both dysphagia and articulation disorders and to allow unimpaired nasal breathing. In the case of large defects, the use of craniofacial prostheses alone is ineffective in the restoration of functional units in the majority of patients. Therefore, we evaluated the combination of microvascular tissue transfer and episthetic constructions in a series of patients. Material and methods Our case series included ten patients requiring one or more free flaps in combination with extraoral implants and episthetic work. Results Four women and six men with a mean age of 68?years were included. All patients were treated because of tumours in the midface area. Eight patients were free of recurrence, one patient died during the follow-up. For the reconstructions, we used anterolateral thigh flaps, radial forearm flaps, fibular flaps and iliac crest bone flaps. On average, we inserted four extraoral implants in the periorbital region. Seven implants of four patients did not osseointegrate and had to be removed. Conclusions For complex reconstructions of extensive defects in the midfacial area, microvascular free tissue transfer in combination with extraoral implants and craniofacial prosthetic work yields reasonable functional and aesthetic outcomes and noticeably improves the quality of life. Clinical relevance This work investigates patient cases with extensive defects in which free flap or episthetic work alone proved ineffective for reconstruction.