Simple maxillary reconstruction following total maxillectomy using artificial bone wrapped with vascularized tissue: five key points to ensure success

Abstract

Conclusion: Our new method for hard tissue maxillary reconstructions using artificial bone implants provides stable results during long-term follow-up. Objective: To date, vascularized bone/cartilage grafting has been the most popular method for hard tissue reconstruction after total maxillectomy; however, such three-dimensional reconstruction requires complex and lengthy invasive surgery. We have developed a simple maxillary reconstruction procedure using artificial bone. Methods: This study included six patients who had undergone hard tissue reconstructions using artificial bone (Ceratite^TM) implants after total maxillectomies between October 2002 and October 2010. We considered the following five key points to ensure success: (1) the procedure was conducted in two stages without communicating with the nasal cavity and sinuses; (2) when constructing the artificial bone, the curvature was reduced; (3) the space for the implant was kept to a minimum; (4) the artificial bone implant was closely and accurately fixed to the stump of the zygomatic arch; and (5) the artificial bone implant was wrapped with a vascularized tissue flap. Results: The follow-up period ranged from 12 to 94 months. The postoperative zygomatic contour was maintained satisfactorily in all patients with no signs of late complications.

Keywords::

• vascularized graft
• zygomaticomaxillary buttress
• free flap
• maxillary cancer
• hydroxyapatite

Acknowledgments

The authors thank Norihiro Ohba, Kiyotaka Yamanaka, Natsuko Ohashi, Takaharu Hatano, Rie Kobayashi, Yoko Maruyama, Teruichi Harada (Department of Plastic and Reconstructive Surgery, Osaka City University Graduate School of Medicine), Hideo Yamane (Department of Otolaryngology, Osaka City University Graduate School of Medicine), and Yoshihiro Kimata (Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine) for their support of the clinical work and the publication of this paper.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.