10 - Reconstruction

Question 2

Free Flaps

Answer 2

Question 4

Defects - Maxilla Classification

Answer 4

• Classification can be broken down into defect based classification and rehabilitation based classification
• Defect based classification
  
  • Browns 2010
    
    • Vertical/Esthetic
      
      • I - Alveolus
      • II - Alveolus + Infrastructure maxilla
      • III - Alveolus + Orbital floor
      • IV - Alveolus + Orbital floor + Orbital contents
      • V - Orbitomaxillary defect
      • VI - Nasomaxillary defect
    • Horizontal/Functional
      
      • A - Palatal defect only
      • B - Less than 1/2 unilateral
      • C - Anterior defect, less than 1/2
      • D - Greater than 1/2
        ​
  • Cordeiro 2000
    Based on the maxilla having 6 walls
    
    • I - Limited maxillectomy - 1 or 2 walls resected
    • II - Subtotal maxillectomy - Resection of the lower 5 walls maxillary arch, palate, ant and lateral walls with preservation of orbital floor
    • III - Total maxillectomy - Resection of all 6 walls of the maxilla
      
      • a - Preservation of orbital contents
      • b - Exenteration of orbital contents
    • IV - Orbitomaxillecomy - Resection of the upper 5 walls with preservation of the palate
      ​
• Rehabilitation Classifications
  Based on whether obturator is able to be supported
  • Okay Classification
    
    • Ia - Defects that involve hard palatel but not the tooth-bearing alveolus
    • Ib - Defects that involve any part of the maxillary alveolus and dentition posterior to the canines or involving the pre-maxilla
    • II - Defects that involve any portion of the tooth-bearing alveolus but include only 1 canine
      Anterior palatectomy that involved less than one half of the palate
    • III - Defects that involved any portion of tooth-bearing maxillary alveolus and includes both canines, total palatectomy and anterior transverse palatectomy that involve >50% of the palate surface
    • Subclass
      
      • f - Defects including inferior orbital rim
      • z - Defects involving the zygoma
        ​
  • Ohngren’s Line
    
    • Line that connects from the ipsilateral medial canthus to the ipsilateral angle of the mandible
      
      • Suprastructure - Above Ohngren’s line
        ​Lesions arising from above this line carry a worse prognosis
      • Infrastructure - Below Ohngren’s line
        Lesions below this line can be obturated

Question 5

Defects - Mandible Classification

Answer 5

• Browns Classification
  
  • I - Lateral not including canine or condyle​
  • II - Hemimandibulectomy - Including ipsilateral canine
  • III - Anterior defect - Bilateral canines but not angles
  • IV - Extensive anterior defect - Bilateral canines and bilateral angles
  • c - Denotes the resection of a condyle
• Urken’s Classification
  Different permutations used to describe defect
  
  • Bone
    
    • C - Condyle
    • R - Ramus & Angle
    • B - Body
    • S - Symphysis
      
      • SH - Hemi-symphysis
  • Soft Tissue
    
    • Mucosa
      
      • L - Labial
      • B - Buccal
      • SP - Soft Palate
      • FOM - Floor of Mouth
    • T - Tongue
    • C - Cutaneous
  • Neurological
    
    • IA - Inferior Alveolar
    • L - Lingual
    • H - Hypoglossal
    • F - Facial
• Jewer’s Classification
  Different permutations of HCL is used to described the defect
  
  • H - Hemi - Lateral defect including the condyle but not including canines
  • L - Lateral - Lateral defect not including condyle or canine
  • C - Central - Central defect including bilateral canines

Question 6

Bone Graft - Non vascularized vs Vascularized

Answer 6

• Pogrel 1997
  
  • Vascularized vs Non-vascularized bone grafts
  • Non vascularized bone graft
    
    • <6cm : 17% failure rate
    • >12cm : 75% failure rate
      ​