Hirsch - Advances in Maxillofacial and Mandibular Reconstruction

Question 1

Web Meeting

Answer 1

Online planning meeting between attending and reps to plan for the type of guides and plates used. Resident should go to some of these to learn that part of the process.

Question 2

Reconstruction Success

Answer 2

Ability to return both form and function: Aesthetic results, ability to eat and speak

Question 3

Reconstructive options utilizing fibula

Answer 3

Resection with delayed implants
Resection with immediate implants and delayed prosthesis
Resection with immediate implants and prosthesis (“Jaw in a day”)

Question 4

Pros/Cons: Delayed implants at second procedure

Answer 4

P: Allows time for fibula to consolidate
P: Allows time for disease to resolve (Osteomyelitis)
P: Allows better implant position if fibula is “off”
C: Multiple procedures
C: Usually requires vestibuloplasty (2/2 implantitis)

Question 5

Pros/Cons: Immediate implants, delayed prosthesis

Answer 5

P: Faster time to prosthesis (3 months)
P: Requires one surgery
C: Implant position dependent on perfect position of fibula
C:

Question 6

Rohner Technique Article

Answer 6

Maxillofacial Reconstruction with Prefabricated Osseous Free Flaps: A 3 year Experience with 24 Patients
Plast & Reconstruct Surg. 2003; 112:748-757

Fibula shaped and left in the leg. Harvested months later and put in place simultaneously with H/N procedure

Question 7

Jaw in a Day Article

Answer 7

Jaw in a Day: Total Maxillofacial Reconstruction Using Digital Technology

Question 8

Algorithm: Mandible Recon w/o Radiation

Answer 8

Soft tissue intact: Jaw in a day

Large soft tissue loss: Immediate implants, delay prosthesis

Question 9

Algorithm: Mandbile Recon w/ Radiation

Answer 9

Poor prognosis: No implants

OK prognosis: Immediate implants, wait 6w for RT (after implants have healed in)

Question 10

When to cover implants

Answer 10

Before radiation injury takes effect (prior to 12w post radiation)

OR

1 year after radiation

Question 11

Pros/Cons: Obturator prosthesis

Answer 11

P: Less OR time
P: No donor site required
P: Able to monitor site for recurrence
C: Bulky
C: Poor hygiene
C: Retention issues
C: Allows oronasal leakage
C: Teeth wear out

Question 12

Maxilla Reconstruction Options

Answer 12

Obturator
Zygomatic-retained obturator
MVFF - Soft tissue only
Zygomatic-retained prosthesis with MVFF
Jaw in a day

Question 13

Zygomatic Implants

Answer 13

May be done in severe bone resorption cases
Presents a “graftless” solution
Immedaite function and short treatment time (no waiting for osteointegration)
1cm torpedoes that can end up in the wrong place unless you’re placing under direct visualization
Prosthesis snaps onto implants, but when you take it out (for sleep at night) the nose and mouth are continuous.

Question 14

Zygomatic-Retained Prosthesis & Soft Tissue MVFF

Answer 14

Soft tissue MVFF
Tunnel zygomatic implants through flap
Flap seals oral cavity from nasal cavity, even when prosthesis is out for sleep

Question 15

Immediate fibula reconstruction of maxilla w/ implant placement & delayed prosthesis

Answer 15

Tether fibula to zygoma

Question 16

Algorithm: Maxilla Recon w/o Radiation

Answer 16

Soft tissue intact: Jaw in a day

Large soft tissue loss: Immediate implants, delayed prosthesis

Question 17

Algorithm: Maxilla Recon w/ Radiation

Answer 17

Poor prognosis: No implants/obturate or MVFF

OK prognosis: Immediate implants