Surgical Reconstruction and Rehabilitation of Midface Defects using Osseointegrated Implant-supported Maxillofacial Prosthetics

John M. Lea, ... Anthony B. Morlandtd more
a John M. Le

DDS MD; Resident, Department of Oral and Maxillofacial Surgery – School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35233, USA. Correspondence: John M. Le, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, 1919 7th Ave S, Birmingham, AL 35233, USA. E-mail: johnmtle@gmail.com ORCID: https://orcid.org/0000-0002-4836-2487 Instagram: @surgeon_foodie ResearchGate: https://www.researchgate.net/profile/John-Le-9

b Yedeh P. Ying

DMD MD FACS; Assistant Professor, Section of Oral Oncology – Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35233, USA. E-mail: yying@uabmc.edu

c Michael T. Kase

DMD; Assistant Professor, Department of Maxillofacial Prosthodontics – School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35233, USA. E-mail: mkase@uabmc.edu

d Anthony B. Morlandt

DDS MD FACS; Associate Professor, Chief Section of Oral Oncology, Department of Oral and Maxillofacial Surgery – School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35233, USA. E-mail: morlandt@uab.edu

January 26, 2022

https://doi.org/10.23999/j.dtomp.2022.1.4

J Diagn Treat Oral Maxillofac Pathol 2022;6:9–25

Under a Creative Commons license

HOW TO CITE THIS ARTICLE

Le JM, Ying YP, Kase MT, Morlandt AB. Surgical reconstruction and rehabilitation of midface defects using osseointegrated implant-supported maxillofacial prosthetics. J Diagn Treat Oral Maxillofac Pathol 2022;6(1):9–25.

ABSTRACT

Midface defects can be life-changing, both functionally and psychologically, for the affected patient. Additionally, restoration of form, function, and aesthetics can be challenging for the reconstructive surgeon. For defects affecting facial subunits such as the nose and orbit, a maxillofacial prosthetic can both obturate the defect and achieve aesthetically pleasing outcomes. Osseointegrated implants placed into sound bone at the defect site allows the maxillofacial prosthodontist to optimize prosthesis retention without the need for adhesive or a mechanical device. In this article, we will share our multidisciplinary treatment protocol and outcome for addressing large midface defects using osseointegrated implant-retained maxillofacial prosthetics. Finally, we will also share our experience and challenges in the incorporation of digital technology in the prosthetic processes of the treatment plan. In the evolving digital age, rapid prototyping technologies have provided the reconstructive surgeon and maxillofacial prosthodontist the ability to accurately plan and execute predictable and reproducible results for a complex array of maxillofacial defects.

REFERENCES (35)

  1. Beumer J, Marunick MT, Esposito SJ. Maxillofacial rehabilitation: prosthodontic and surgical management of cancer-related, acquired, and congenital defects of the head and neck. 3rd edition. Quintessence Publishing Co. Inc; 2011. Google Scholar
  2. Becker C, Becker AM, Pfeiffer J. Health-related quality of life in patients with nasal prosthesis. J Craniomaxillofac Surg 2016;44(1):75–9. Crossref | Medline | Google Scholar
  3. Cobein MV, Coto NP, Crivello Junior O, Lemos JBD, Vieira LM, Pimentel ML,  Byrne HJ, Dias RB. Retention systems for extraoral maxillofacial prosthetic implants: a critical review. Br J Oral Maxillofac Surg 2017;55(8):763–9. Crossref | Medline | Google Scholar
  4. Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification. Lancet Oncol 2010;11(10):1001–8. Crossref | Medline | Google Scholar
  5. Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg 2000;105(7):2331-46; discussion 2347–8. Crossref | Medline | Google Scholar
  6. Burget GC, Walton RL. Optimal use of microvascular free flaps, cartilage grafts, and a paramedian forehead flap for aesthetic reconstruction of the nose and adjacent facial units. Plast Reconstr Surg 2007;120(5):1171–207. Crossref | Medline | Google Scholar
  7. Moreno MA, Skoracki RJ, Hanna EY, Hanasono MM. Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck 2010;32(7):860–8. Crossref | Medline | Google Scholar
  8. Researches O and Supervision T. “The glossary of prosthodontic terms.” J Prosthet Dent 94.1 (2005): 10–92.
  9. Brånemark PI, Hansson BO, Adell R, Breine U, Lindström J, Hallén O, Ohman A. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl 1977;16:1–132. Medline | Google Scholar
  10. Tolman DE, Desjardins RP. Extraoral application of osseointegrated implants. J Oral Maxillofac Surg 1991;49(1):33–45. Crossref | Medline | Google Scholar
  11. Ueda M, Hibino Y, Niimi A. Usefulness of dental implants in maxillofacial reconstruction. J Long Term Eff Med Implants 1999;9(4):349–66. Medline | Google Scholar
  12. Goiato MC, Pesqueira AA, Ramos da Silva C, Gennari Filho H, Micheline Dos Santos D. Patient satisfaction with maxillofacial prosthesis. Literature review. J Plast Reconstr Aesthet Surg 2009;62(2):175–80. Crossref | Medline | Google Scholar
  13. Markt JC, Lemon JC. Extraoral maxillofacial prosthetic rehabilitation at the M. D. Anderson Cancer Center: a survey of patient attitudes and opinions. J Prosthet Dent 2001;85(6):608–13. Crossref | Medline | Google Scholar
  14. Flood TR, Russell K. Reconstruction of nasal defects with implant-retained nasal prostheses. Br J Oral Maxillofac Surg 1998;36(5):341–5. Crossref | Medline | Google Scholar
  15. Joseph DL, Shumrick DL. Risks of head and neck surgery in previously irradiated patients. Arch Otolaryngol 1973;97(5):381–4. Crossref | Medline | Google Scholar
  16. Mücke T, Rau A, Weitz J, Ljubic A, Rohleder N, Wolff KD, Mitchell DA, Kesting MR. Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions. Oral Oncol 2012;48(4):367–71. Crossref | Medline | Google Scholar
  17. Schultze-Mosgau S, Grabenbauer GG, Radespiel-Tröger M, Wiltfang J, Ries J, Neukam FW, Rödel F. Vascularization in the transition area between free grafted soft tissues and pre-irradiated graft bed tissues following preoperative radiotherapy in the head and neck region. Head Neck 2002;24(1):42–51. Crossref | Medline | Google Scholar
  18. Morrish RB Jr, Chan E, Silverman S Jr, Meyer J, Fu KK, Greenspan D. Osteonecrosis in patients irradiated for head and neck carcinoma. Cancer 1981;47(8):1980–3. Crossref | Medline | Google Scholar
  19. Anderson L, Meraw S, Al-Hezaimi K, Wang HL. The influence of radiation therapy on dental implantology. Implant Dent 2013;22(1):31–8. Crossref | Medline | Google Scholar
  20. Le JM, Gigliotti J, Ying Y, Kase MT, Morlandt AB. Computer-assisted microvascular free flap reconstruction and implant rehabilitation of the maxilla—treatment of a rare post-orthognathic complication. J Maxillofac Oral Surg 2021:1–6. Crossref | Google Scholar
  21. Le JM, Chen PH, Seidenfaden JC, Morlandt AB, Kase MT. Zygomatic implants for restoration of complex nasal defects–a case report and outcome. J Diagn Treat Oral Maxillofac Pathol 2020;4(9):152–61. Crossref | Google Scholar
  22. Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: a systematic review and sensitivity meta-analysis. J Dent 2019;84:9–21. Crossref | Medline | Google Scholar
  23. Kandavalli SR, Wang Q, Ebrahimi M, Djavanroodi F, Attarilar S, Liu S. A brief review on the evolution of metallic dental implants: history, design, and application. Front Mater 2021;8:646383. Crossref | Google Scholar
  24. Raikar S, Talukdar P, Kumari S, Panda SK, Oommen VM, Prasad A. Factors affecting the survival rate of dental implants: a retrospective study. J Int Soc Prev Community Dent 2017;7(6):351–5. Crossref | Medline | Google Scholar
  25. Karakoca S, Aydin C, Yilmaz H, Bal BT. Survival rates and periimplant soft tissue evaluation of extraoral implants over a mean follow-up period of three years. J Prosthet Dent 2008;100(6):458–64. Crossref | Medline | Google Scholar
  26. Schoen PJ, Raghoebar GM, van Oort RP, Reintsema H, van der Laan BF, Burlage FR, Roodenburg JL, Vissink A. Treatment outcome of bone-anchored craniofacial prostheses after tumor surgery. Cancer 2001;92(12):3045–50. Crossref | Medline | Google Scholar
  27. Visser A, Raghoebar GM, van Oort RP, Vissink A. Fate of implant-retained craniofacial prostheses: life span and aftercare. Int J Oral Maxillofac Implants 2008;23(1):89–98. Medline | Google Scholar
  28. ElKhashab MA, Radi IAW, Elkhadem AH. Implant prognosis in irradiated versus non-irradiated nasal, orbital and auricular sites. Int J Oral Maxillofac Surg 2020;49(5):636–48. Crossref | Medline | Google Scholar
  29. Brook I. Late side effects of radiation treatment for head and neck cancer. Radiat Oncol J 2020;38(2):84–92. Crossref | Medline | Google Scholar
  30. Chrcanovic BR, Nilsson J, Thor A. Survival and complications of implants to support craniofacial prosthesis: a systematic review. J Craniomaxillofac Surg 2016;44(10):1536–52. Crossref | Medline | Google Scholar
  31. Abu-Serriah MM, McGowan DA, Moos KF, Bagg J. Outcome of extra-oral craniofacial endosseous implants. Br J Oral Maxillofac Surg 2001;39(4):269–75. Crossref | Medline | Google Scholar
  32. Elbashti ME, Sumita YI, Kelimu S, Aswehlee AM, Awuti S, Hattori M, Taniguchi H. Application of digital technologies in maxillofacial prosthetics literature: a 10-year observation of five selected prosthodontics journals. Int J Prosthodont 2019;32(1):45–50. Crossref | Medline | Google Scholar
  33. Sweeny L, Fuson AR, Curry JM. Current trends in midface reconstruction and use of virtual surgical planning. Plast Aesthet Res 2021;8:18. Crossref | Google Scholar
  34. Resnick CM, Inverso G, Wrzosek M, Padwa BL, Kaban LB, Peacock ZS. Is there a difference in cost between standard and virtual surgical planning for orthognathic surgery? J Oral Maxillofac Surg 2016;74(9):1827–33. Crossref | Medline | Google Scholar
  35. Rodby KA, Turin S, Jacobs RJ, Cruz JF, Hassid VJ, Kolokythas A, Antony AK. Advances in oncologic head and neck reconstruction: systematic review and future considerations of virtual surgical planning and computer aided design/computer aided modeling. J Plast Reconstr Aesthet Surg 2014;67(9):1171–85. Crossref | Medline | Google Scholar