CLINICAL EFFICACY COMPARATIVE EVALUATION OF THE TREATMENT METHODS OF COMBINED DEFECTS AND DEFORMITIES OF THE ZIGOMA AND ORBIT

  • Yu.V. Chepurnyi O.O. Bogomolets National Medical University, Kyiv, Ukraine
  • D.M. Chernohorskyi Communal non-commercial enterprise «Kyiv sity clinical hospital №1», Kyiv, Ukraine
  • O.I. Zhukovtseva O.O. Bogomolets National Medical University, Kyiv, Ukraine
  • A.V. Kopchak O.O. Bogomolets National Medical University, Kyiv, Ukraine
Keywords: reconstruction of the zygomatic complex, custom implants, orbital defects.

Abstract

Introduction. Zigoma and orbital defects still become an actual problem of maxilla-facial surgery due to limited possibilities to precise restoration of their complex anatomy. Functional unity of zigoma and orbit in aspects of eyeball support and protection increases requirements to reconstructive precision. The total and subtotal defects are the most difficult for reconstruction when traditional methods of reconstruction demonstrate unconvincing efficiency. Complex anatomy of zigoma and orbit, as combination of convexities, depressions limited an application of free or vascularised bone transplants for precise 3D restoration of the face. Facing this, new possibilities of reconstructed were developed, based on CAD/CAM technologies. Application of patient specific implants (PSI), designed according personal anatomy of the patient and manufactured by additive technologies, open new modalities to reconstruction in orthognatic surgery, cranioplasty and others, demonstrated promising results. So, these achievements and experience possible could be implemented for zigoma reconstruction. The aim of the study was to evaluate and compare clinical efficacy of zigoma and orbital defect treatment with traditional methods of reconstruction.

Materials and methods. To reach this purpose, fifty-one patients, who underwent reconstruction procedures regarding zigoma defects, were enrolled to retrospective study. All of them were clinically examined before and after surgery. CT examination was performed before, 1 week and 1 year after surgery in all cases. The patients, included to the study, were divided on two groups – main and control, equal concerning age, sex and anatomical-topographic patterns of the defects. The main group consisted of 27 patients, who underwent zigoma reconstruction with PSI. The rest of the patients, treated with traditional approach (free or vascularised bone grafting, reconstructive plates or reconstruction with temporal muscle), were included to control group.

Clinical efficacy was evaluated applying esthetical estimation of experts according to ranking scale. Additionally, frequency of complication and precision of reconstruction according to CT were analysed. Orbital volume differences were calculated for cases of orbital reconstruction.

Results. Comparative analysis of esthetical results revealed higher quality of reconstruction in a main group. The patients did not require any further surgical procedures in 66,7% of cases, in contrast, in a control group additional interventions were indicated or performed in 85,3% of patients (p<0,05). Mean rate of aesthetic estimation by experts were 3,15+1,2 in main group and 1,96+0,8 in control. Follow-up period was longer than 12 months for both main and control groups. Mean follow-up were 20,4 ±9,3 and 26,2 ± 13,5 months respectively. During follow-up any kind of complications were observed between the patients of the main group in 14,8% of cases as well in control – 54,2 % (p=0,01). The main complication between the patients of first group was exposure of the implants, which was noted only in 3 cases, and was caused mainly extension of soft tissues above the implant or compromised soft tissue covering due to incomplete vascularisation of the flaps. At the same time the most frequently observed complications of the main group were total or partial resorption of the grafts (two cases), implant exposure (n=7) and limitation of mouth opening. Additionally, deformity of the fixators with bone fragment displacement was noted in 25,0 % cases.

Eyeball displacement was defined in 66,7% of all cases. Mean volume difference in main group was 1,5±0,7 см3, when between patients of control it was 2,3±1,2см3 (р=0,032). The frequency of diplopia was equal for both group.

Conclusions. The main advantage of PSI application for zigoma reconstruction is the possibility of the precise 3D restoration of its complex anatomy, renewal of the correct position of the zigoma. Relatively to the clinical tasks, PSI could be used as fixator or endoprosthesis separately or with bone graft procedures. In some clinical situations separate application of PSI as endoprosthesis may be consider as effective alternative for free tissue transfer procedures.

Downloads

Download data is not yet available.

References

1. Markiewicz MR, Gelesko S, Bell RB. Zygoma reconstruction. Oral MaxillofacSurgClin North Am 2013; 25(2):167-201. doi: 10.1016/j.coms.2013.02.005. PMID: 23642668.

2. Schramm A, Suarez-Cunqueiro MM, Rücker M, Kokemueller H, Bormann KH, Metzger MC, et al. Computer-assisted therapy in orbital and mid-facial reconstructions. Int J Med Robot 2009; 5(2):111-124. doi: 10.1002/rcs.245.

3. Modabber A, Gerressen M, Ayoub N, Elvers D, Stromps JP, Riediger D, et al. Computer-assisted zygoma reconstruction with vascularized iliac crest bone graft. Int J Med Robot 2013; 9(4):497-502. doi:10.1002/rcs.1557

4. Nicot R, Schlund M, Sentucq C, Raoul G. A new orbito-zygomatic complex reconstruction technique using computer-aided design and manufacturing-assisted harvest of autologous calvarial bone in cases of orbito-zygomatic benign tumor. J Oral MaxillofacSurg 2019; 77(5):1082-1091. doi: 10.1016/j.joms.2018.12.024.

5. Trosman SJ, Haffey TM, Couto RA, Fritz MA. Large orbital defect reconstruction in the setting of globe-sparing maxillectomy: the titanium hammock and layered fibula technique. Microsurgery 2018; 38(4):354-361. doi:10.1002/micr.30199

6. Massa AF, Otero-Rivas M, Rodríguez-Prieto MÁ. Titanium mesh in the reconstruction of a malar defect: a case report. Int J Dermatol 2014; 53(10):1278-1280. doi: 10.1111/ijd.12551.

7. Parthasarathy J. 3D modeling, custom implants and its future perspectives in craniofacial surgery. Ann MaxillofacSurg 2014; 4:9-18.

8. Visscher DO, Farré-Guasch E, Helder MN, Gibbs S,Forouzanfar T, van Zuijlen PP, et al. Advances in Bioprinting Technologies for Craniofacial Reconstruction. Trends Biotechnol. 2016;34(9):700-710. doi:10.1016/j.tibtech.2016.04.001

9. Rogers GF, Greene AK. Autogenous bone graft: basic science and clinical implications. J CraniofacSurg 2012; 23(1):323-327. doi: 10.1097/SCS.0b013e318241dcba.

10. Tessier P, Kawamoto H, Matthews D, Posnick J, Raulo Y, Tulasne JF, et al. Autogenous bone grafts and bone substitutes--tools and techniques: a 20,000-case experience in maxillofacial and craniofacial surgery. PlastReconstrSurg 2005; 116(5, Suppl):6S-24S; discussion 92S-94S. doi: 10.1097/01.prs.0000173862.20563.12.

11. Rohner D, Tan BK, Song C, Yeow V, Hammer B. Repair of composite zygomatico-maxillary defects with free bone grafts and free vascularized tissue transfer. J CraniomaxillofacSurg 2001; 29(6):337-343. doi: 10.1054/jcms.2001.0253.

12. Ahn SJ, Hong JW, Kim YO, Lew DH, Lee WJ. Treatment of fibrous dysplasia of the zygomaticomaxillary complex with radical resection and three-dimensional reconstruction with autologous calvarial bone graft. Arch CraniofacSurg 2018; 19(3):200-204. doi: 10.7181/acfs.2018.00052.

13. Day KM, Phillips PM, Sargent LA. Correction of a posttraumatic orbital deformity using three-dimensional modeling, virtual surgical planning with computer-assisted design, and three-dimensional printing of custom implants. Craniomaxillofac Trauma Reconstr 2018 Mar;11(1):78-82. doi: 10.1055/s-0037-1601432. EPMID: 29387309; PMCID: PMC5790546.

14. Li J, Li P, Lu H, Shen L, Tian W, Long J, et al. Digital design and individually fabricated titanium implants for the reconstruction of traumatic zygomatico-orbital defects. J CraniofacSurg 2013; 24(2):363-368. doi: 10.1097/SCS.0b013e3182701243.

15. Moiduddin K, Al-Ahmari A, Kindi MA, Nasr ESA, Mohammad A, Ramalingam S. Customized porous implants by additive manufacturing for zygomatic reconstruction. Biocybern Biomed Eng 2016; 36(4):719-730. doi:10.1016/j.bbe.2016.07.005

16. Hernando J, Geijo D, Leizaola-Cardesa IO, Aguilar-Salvatierra A, Gómez MC, Erce C, et al. Reconstruction of liposarcoma resection defect with a made-to-measure polyethylene prosthesis using three-dimensional digital technology. J CraniofacSurg 2018; 29(1):e16-e17. doi: 10.1097/SCS.0000000000004013.

17. Scolozzi P. Maxillofacial reconstruction using polyetheretherketone patient-specific implants by "mirroring" computational planning. Aesthetic PlastSurg 2012; 36(3):660-5. doi: 10.1007/s00266-011-9853-2.

18. Rotaru H, Schumacher R, Kim SG, Dinu C. Selective laser melted titanium implants: a new technique for the reconstruction of extensive zygomatic complex defects. Version 2. MaxillofacPlastReconstrSurg 2015; 37(1):1. doi: 10.1186/s40902-015-0001-9.

19. Moubayed SP, Duong F, Ahmarani C, Rahal A. A novel technique for malar eminence evaluation using 3-dimensional computed tomography. Arch Facial PlastSurg 2012; 14(6):403-7. doi: 10.1001/archfacial.2012.510.

20. Chernogorskyi DM, Voller MV, Vasilyev AS, Chepurnyi YV, Kopchak AV. Clinical efficacy of patient-specific implants manufactured by direct metal laser sintering (DMLS) technology in patients with mandibular defects. J Diagn Treat Oral Maxillofac Pathol 2020; 4(9):162–77.

21. Mommaerts MY, Nicolescu I, Dorobantu M, De Meurechy N. Extended total temporomandibular joint replacement with occlusal adjustments: pitfalls, patient-reported outcomes, subclassification, and a new paradigm. Ann MaxillofacSurg 2020; 10:73-79.

22. Zhang Y, He Y, Zhang ZY, An JG. Evaluation of the application of computer-aided shape-adapted fabricated titanium mesh for mirroring-reconstructing orbital walls in cases of late post-traumatic enophthalmos. J Oral MaxillofacSurg 2010; 68(9):2070-2075. doi: 10.1016/j.joms.2009.08.029.

23. Stoor P, Suomalainen A, Mesimäki K, Kontio R. Rapid prototyped patient specific guiding implants in critical mandibular reconstruction. J Craniomaxillofac Surg. 2017;45(1):63-70. doi:10.1016/j.jcms.2016.10.021

24. Wilde F, Hanken H, Probst F, Schramm A, Heiland M, Cornelius CP. Multicenter study on the use of patient-specific CAD/CAM reconstruction plates for mandibular reconstruction. Int J ComputAssistRadiolSurg. 2015;10(12):2035-2051. doi:10.1007/s11548-015-1193-2

25. Wolff KD, Hölzle F, Kolk A, Hohlweg-Majert B, Steiner T, Kesting MR. Raising the osteocutaneous fibular flap for oral reconstruction with reduced tissue alteration. J Oral MaxillofacSurg 2011; 69(6): e260-e267. doi:10.1016/j.joms.2010.11.040
Published
2021-06-29
How to Cite
Chepurnyi, Y., Chernohorskyi, D., Zhukovtseva, O., & Kopchak, A. (2021). CLINICAL EFFICACY COMPARATIVE EVALUATION OF THE TREATMENT METHODS OF COMBINED DEFECTS AND DEFORMITIES OF THE ZIGOMA AND ORBIT. Ukrainian Dental Almanac, (2), 73-81. https://doi.org/10.31718/2409-0255.2.2021.14
Section
SURGICAL DENTISTRY