Recent advances in reconstructive oral and maxillofacial surgery.

Abstract

Reconstruction within the head and neck is challenging. Defects can be anatomically complex and may already be compromised by scarring, inflammation, and infection. Tissue grafts and vascularised flaps (either pedicled or free) bring healthy tissue to a compromised wound for optimal healing and are the current gold standard for the repair of such defects, but disadvantages are their limited availability, the difficulty of shaping the flap to fit the defect and, most importantly, donor site morbidity. The importance of function and aesthetics has driven advances in the accuracy of surgical techniques. We discuss current advances in reconstruction within oral and maxillofacial surgery. Developments in navigation, three-dimensional imaging, stereolithographic models, and the use of custom-made implants can aid and improve the accuracy of existing reconstructive methods. Robotic surgery, which does not modify existing techniques of reconstruction, allows access, resection of tumours, and reconstruction with conventional free flap techniques in the oropharynx without the need for mandibulotomy. Tissue engineering and distraction osteogenesis avoid the need for autologous tissue transfer and can therefore be seen as more conservative methods of reconstruction. Recently, facial allotransplantation has allowed whole anatomical facial units to be replaced with the possibility of sensory recovery and reanimation being completed in a single procedure. However, patients who have facial allotransplants are subject to life-long immunosuppression so this method of reconstruction should be limited to selected cases.

• Authors: Indran Balasundaram, Ihsaan Al-Hadad, Sat Parmar
• Journal: The British journal of oral & maxillofacial surgery (Br J Oral Maxillofac Surg) Vol. 50 Issue 8 Pg. 695-705 (Dec 2012) ISSN: 1532-1940 [Electronic] Scotland
• PMID: 22209448 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Topics

• Facial Transplantation (methods)
• Head and Neck Neoplasms (surgery)
• Humans
• Osteogenesis, Distraction (methods)
• Plastic Surgery Procedures (instrumentation, methods)
• Robotics (instrumentation, methods)
• Surgery, Computer-Assisted (instrumentation, methods)
• Surgery, Oral (instrumentation, methods, trends)
• Surgical Flaps (blood supply, innervation)
• Tissue Engineering (methods)