Skip to main content

Post-oncological and Post-traumatic Maxillary Reconstruction

  • 444 Accesses

Abstract

Based on developments since the 1990s, the routine clinical application of comprehensive 3D planning and simulation combined with rapid prototyping for the fabrication of individualized implants has been gaining in significance. While the technical expenditure in the early stage required extensive engineering knowledge and skills, the “usability” of these techniques is clearly improved nowadays and even sophisticated workflows are not limited to specialized university hospitals any more.

This chapter illustrates the following maxillofacial casuistics:

  1. 1.

    Point-to-point navigation-assisted repositioning of the zygoma by means of pre-bent osteosynthesis plates.

  2. 2.

    Complex orbital reconstruction after a comminuted fracture using a combination of titanium mesh and synthetic material, accompanied by intraoperative navigation.

  3. 3.

    Correction of midfacial deformity (hypoplasia) by means of individualized polyether-ether-ketone (PEEK) implants.

  4. 4.

    Maxillary reconstruction with prefabricated vascularized free fibula flap with dental implants already inserted before harvesting the flap.

The presented concepts are illustrative and can be adapted to a variety of treatment workflows in maxillofacial surgery with reasonable expenditure and resources.

Keywords

Based on original research published with/by Arnulf Baumann, Rolf Ewers, Clemens Klug, Emeka Nkenke, Franz Watzinger.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Wagner F, Figl M, Cede J, Schicho K, Sinko K, Klug C. Soft tissue changes in patients undergoing intraoral quadrangular Le Fort II osteotomy versus conventional Le Fort I osteotomy. J Oral Maxillofac Surg. 2018;76(2):416–25. https://doi.org/10.1016/j.joms.2017.07.158. Epub 2017 Jul 25. PMID: 28822722.

    Article  PubMed  Google Scholar 

  2. Willinger K, Cede J, Guevara-Rojas G, Sinko K, Figl M, Schicho K, Nemec S, Klug C. Midfacial advancement line—a comparative evaluation of a new measurement method in orthognathic surgery. J Oral Maxillofac Surg. 2020;78(2):286.e1–9. https://doi.org/10.1016/j.joms.2019.10.013. Epub 2019 Oct 28. PMID: 31778641.

    Article  PubMed  Google Scholar 

  3. Willinger K, Guevara-Rojas G, Cede J, Schicho K, Stamm T, Klug C. Comparison of feasibility, time consumption and costs of three virtual planning systems for surgical correction of midfacial deficiency. Maxillofac Plast Reconstr Surg. 2021;43(1):2. https://doi.org/10.1186/s40902-020-00284-1. PMID: 33411020; PMCID: PMC7790928.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Willinger K, Guevara-Rojas G, Cede J, Schicho K, Stamm T, Klug C. Accuracy of soft tissue prediction of 2 virtual planning systems in patients undergoing intraoral quadrangular Le Fort II osteotomy. Plast Reconstr Surg Glob Open. 2021;9(2):e3326. https://doi.org/10.1097/GOX.0000000000003326. PMID: 33680633; PMCID: PMC7929711.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Klug C, Schicho K, Ploder O, Yerit K, Watzinger F, Ewers R, Baumann A, Wagner A. Point-to-point computer-assisted navigation for precise transfer of planned zygoma osteotomies from the stereolithographic model into reality. J Oral Maxillofac Surg. 2006;64(3):550–9. https://doi.org/10.1016/j.joms.2005.11.024. PMID: 16487823.

    Article  PubMed  Google Scholar 

  6. Schicho K, Figl M, Seemann R, Ewers R, Lambrecht JT, Wagner A, Watzinger F, Baumann A, Kainberger F, Fruehwald J, Klug C. Accuracy of treatment planning based on stereolithography in computer assisted surgery. Med Phys. 2006;33(9):3408–17. https://doi.org/10.1118/1.2242014. PMID: 17022237.

    Article  PubMed  Google Scholar 

  7. Baumann A, Sinko K, Dorner G. Late reconstruction of the orbit with patient-specific implants using computer-aided planning and navigation. J Oral Maxillofac Surg. 2015;73(12 Suppl):S101–6. https://doi.org/10.1016/j.joms.2015.06.149. PMID: 26608137.

    Article  PubMed  Google Scholar 

  8. Ploder O, Klug C, Voracek M, Backfrieder W, Tschabitscher M, Czerny C, Baumann A. A computer-based method for calculation of orbital floor fractures from coronal computed tomography scans. J Oral Maxillofac Surg. 2001;59(12):1437–42. https://doi.org/10.1053/joms.2001.28278. PMID: 11732031.

    Article  PubMed  Google Scholar 

  9. Guevara-Rojas G, Figl M, Schicho K, Seemann R, Traxler H, Vacariu A, Carbon CC, Ewers R, Watzinger F. Patient-specific polyetheretherketone facial implants in a computer-aided planning workflow. J Oral Maxillofac Surg. 2014;72(9):1801–12. https://doi.org/10.1016/j.joms.2014.02.013. Epub 2014 Feb 15. PMID: 24679957.

    Article  PubMed  Google Scholar 

  10. Jaquiéry C, Rohner D, Kunz C, Bucher P, Peters F, Schenk RK, Hammer B. Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants—a prospective study. Clin Oral Implants Res. 2004;15(5):598–606. https://doi.org/10.1111/j.1600-0501.2004.01065.x. PMID: 15355403.

    Article  PubMed  Google Scholar 

  11. Nkenke E, Agaimy A, Vairaktaris E, Lell M, von Wilmowsky C, Eitner S. Case history report: immediate rehabilitation with a prefabricated fibula flap following removal of a locally aggressive maxillary tumor. Int J Prosthodont. 2016;29(1):53–8. https://doi.org/10.11607/ijp.4010. PMID: 26757329.

    Article  PubMed  Google Scholar 

  12. Nkenke E, Eitner S. Complex hemimaxillary rehabilitation with a prefabricated fibula flap and cast-based vacuum-formed surgical template. J Prosthet Dent. 2014;111(6):521–4. https://doi.org/10.1016/j.prosdent.2013.07.028. Epub 2013 Dec 19. PMID: 24360016.

    Article  PubMed  Google Scholar 

  13. Nkenke E, Vairaktaris E, Hanke S, Hoffmann B, Schlittenbauer T. Skeletal stability and complications in transantral maxillary distraction in patients with cleft lip and palate. J Craniofac Surg. 2014;25(2):689–93. https://doi.org/10.1097/SCS.0000000000000607. PMID: 24621725.

    Article  PubMed  Google Scholar 

  14. Nkenke E, Vairaktaris E, Kramer M, Schlegel A, Holst A, Hirschfelder U, Wiltfang J, Neukam FW, Stamminger M. Three-dimensional analysis of changes of the malar-midfacial region after LeFort I osteotomy and maxillary advancement. Oral Maxillofac Surg. 2008;12(1):5–12. https://doi.org/10.1007/s10006-008-0094-8. PMID: 18600355.

    Article  PubMed  Google Scholar 

  15. Nkenke E, Vairaktaris E, Schlittenbauer T, Eitner S. Masticatory rehabilitation of a patient with cleft lip and palate malformation using a maxillary full-arch reconstruction with a prefabricated fibula flap. Cleft Palate Craniofac J. 2016;53(6):736–40. https://doi.org/10.1597/15-051. Epub 2015 Nov 17. PMID: 26575963.

    Article  PubMed  Google Scholar 

  16. Rohner D, Jaquiéry C, Kunz C, Bucher P, Maas H, Hammer B. Maxillofacial reconstruction with prefabricated osseous free flaps: a 3-year experience with 24 patients. Plast Reconstr Surg. 2003;112(3):748–57. https://doi.org/10.1097/01.PRS.0000069709.89719.79. PMID: 12960855.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kurt Schicho .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Schicho, K., Guevara Rojas, G. (2023). Post-oncological and Post-traumatic Maxillary Reconstruction. In: Rinaldi, M. (eds) Implants and Oral Rehabilitation of the Atrophic Maxilla. Springer, Cham. https://doi.org/10.1007/978-3-031-12755-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-12755-7_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-12754-0

  • Online ISBN: 978-3-031-12755-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics