Novel approach to maxillary reconstruction using osteocutaneous free tissue transfer with a customized stent.

Abstract

Computer-guided 3D virtual planning and customized templates are novel and effective methods aiding maxillary reconstruction, particularly during osteocutaneous free tissue transfer of complex defects. However, virtual planning and modelling is often expensive. We present a new method to reconstruct complex defects with a surgical stent designed from presurgical casts. We present 2 patients who underwent this technique. Reconstruction in both cases was aided by a surgical stent fashioned preoperatively to approximate the anatomic dimensions of the defect, guiding the shape and orientation of the flap during inset to aid in dental rehabilitation. Surgery was performed without evidence of malocclusion, oronasal separation, or osteoradionecrosis with both patients undergoing successful rehabilitation and showing good postoperative oral intake. Utilization of our novel surgical stent allowed reconstruction of complex maxillectomy defects and facilitated the design of a reconstructive flap without the need of pre-bent plates, cutting guides, or associated expenses.