AAPS Main Site  |  Past & Future Meetings
American Association of Plastic Surgeons
89th Annual Meeting Abstracts

Back to Program Outline

Complex Mid-facial Reconstruction Using Virtual Planning, Rapid Prototype Modeling, and Stereotactic Navigation
Matthew M. Hanasono, M.D., Rhonda Jacob, D.D.S., Luc Bidaut, Ph.D., Roman J. Skoracki, M.D..
The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.

PURPOSE:
Restoration of the complex three-dimensional form of the mid-face in patients with extensive craniofacial defects is one of the most challenging reconstructive surgeries. Our goal was to improve the accuracy of our reconstructions using virtual planning, rapid prototype modeling, and stereotactic navigation.
METHODS:
Between 2004 and 2009, 27 reconstructions were performed for maxillary defects resulting from oncologic resection, including 16 bilateral and 4 unilateral defects. Virtual planning based on computed tomography (CT) data was performed preoperatively to help accurately replace missing bone with appropriately shaped vascularized bone flaps (Figure 1). Rapid prototype models were then created to use as a template for pre-bending titanium hardware. In the most recent five cases, intraoperative stereotactic navigation was used to assist with flap insetting through limited incisions.
RESULTS:
Ten reconstructions were performed immediately after maxillectomy and 17 reconstructions were delayed. In delayed cases, as well as cases in which the original architecture of the maxilla was distorted or destroyed by disease, the native maxilla would not have been available to act as a guide for shaping the reconstruction. A fibula osteocutaneous free flap was used for bony reconstruction in 25 cases, and a serratus anterior myo-osseous free flap was used in 2 cases (Figure 2). The mean operative time was 12.0±2.5 hours, mean intensive care unit stay was 2.6±1.8 days, and mean hospital stay was 10.4±3.8 days. Complications included: infection (n=5), hematoma (n=2), plate exposure (n=2), and pneumonia (n=1). All patients exhibited 100% speech intelligibility and only 1 patient exhibits hypernasal speech. Postoperatively, 17 patients consume a regular diet and 10 patients consume a soft diet. Of 25 patients with missing dentition, 13 patients have successfully undergone dental restoration with osseointegrated implants and 7 patients are awaiting implant placement. Comparison of postoperative three-dimensional CT reconstructions with preoperative virtual plans showed excellent concordance (Figure 3).
CONCLUSION:
Utilizing computer-based technologies, we have developed a technique that allows us to preoperatively design our bony reconstruction to mimic the native craniofacial skeleton in order to restore mid-facial height, width, and projection. This technique not only increases the reconstructive accuracy, but also the efficiency by decreasing the time spent making osteotomies and bending titanium plates. Stereotactic navigation allows accurate positioning of the free flap construct to within 1 mm through limited incisions.


Back to Program Outline