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Staged Reconstruction (Immediate-Delayed) of the Maxillectomy Defect Using CAD/CAM Technology
John Henry Pang, MD, Sebastian Brooke, MD, Mark W. Kubic, MD, Robert L Ferris, MD, PhD, Matilda Dhima DMD, MS, Matthew M. Hanasono, MD, Eric W Wang, MD, Mario G Solari, MD
University of Pittsburgh Medical Center
2017-02-15
Presenter: John Henry Pang
Affidavit:
I certify that the work on this project represents the original work of the resident.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Computer aided design/computer aided manufacturing (CAD/CAM) technology has become increasingly popular for free fibula reconstruction of the mandible. The same technology however, has not been widely utilized in immediate complex midface reconstruction utilizing free fibula flaps. Maxillary defects are difficult to precisely predict or produce matched cutting guides for after the ablative surgery. Bony margins during a maxillectomy cannot be assessed with intraoperative frozen section. We present a protocol for "delayed-immediate" two-stage reconstruction for complex mid-facial defects, by delaying lymph node neck dissection and using CAD/CAM technology for delayed bony reconstruction.
Methods: Stage one includes the extirpative surgery, placement of a temporary obturator, and an immediate post-excision fine cut CT of the defect that is used for CAD/CAM planning. The time interval between stages is used for virtual surgical planning and provides an opportunity for final pathologic margins to be evaluated. At stage two, definitive reconstruction is performed in conjunction with the delayed neck dissection. Briefly delaying the neck dissection until stage two allows for recipient vessel dissection and microsurgical anastomoses to safely occur in a surgically naïve neck.
Results/Conclusion: A two-stage delayed-immediate reconstruction of complex mid-face defects can be safely and effectively performed. This protocol takes advantage of advancing CAD/CAM technology, provides an opportunity to evaluate final margins, and avoids recipient vessel dissection and microsurgery in previously operated or irradiated necks.
