Computer-Assisted Microvascular Free Flap Reconstruction and Implant Rehabilitation of the Maxilla-Treatment of a Rare Post-orthognathic Complication.

Orthognathic surgery is generally a safe and predictable procedure. Major postoperative complications are rare and often non-life threatening. An example of a rare complication associated with the LeFort I osteotomy is avascular necrosis of the maxilla (ANM). While cases of ANM have been described in the literature, the majority involves only a portion or segment of the maxillary complex and is commonly treated with conservative measures such as strict oral hygiene, hyperbaric oxygen therapy and local debridement. Occasionally, larger segments of osteonecrosis may require extensive reconstruction such as bone grafting with local soft tissue flaps. Here, we present a patient that underwent a single-stage microvascular free tissue reconstruction with concomitant placement of dental implants and a patient-specific implant (PSI) for post-orthognathic ANM.

Using digital technology to create a custom esthetic bandage for patients after rhinectomy.

Patients undergoing partial or total rhinectomy surgeries are left with a lifelong facial defect that poses psychosocial and functional challenges. The extended postoperative healing period after rhinectomy can delay the timely restoration of a patient's nose by definitive prosthesis when conventional impression methods are used. The treatment workflow for fabricating a custom esthetic nasal bandage with the use of digital technology is introduced to avoid the conventional preoperative impression, as well as to allow for immediate delivery at the postoperative follow-up visit.

Fabricating a partial nasal prosthesis with a custom nasal dilator design.

Patients undergoing partial rhinectomy with limited size may have the major portion of the nasal structure preserved. However, the fibrosis or scar formation after the surgery may cause distortion of remaining tissues, followed by nasal airway obstruction. By physically expanding an affected nostril during the impression and using digital technology to design a custom flexible internal nasal dilator, embedded in the medical grade silicone during processing, a partial nasal prosthesis with airway-maintaining purpose can be fabricated to improve quality of life both esthetically and functionally.

Prosthetic Rehabilitation via Silicone Nasal Prosthesis with Internal Alar Support Following Partial Rhinectomy: A Short Communication.

PURPOSE: To describe prosthetic rehabilitation following partial rhinectomy with use of a novel retentive internal nasal keeper piece. MATERIALS AND METHODS: The reported novel nasal keeper piece engaged the intact inferior portions of the major alar cartilages and the alar fibrofatty tissues to aid in retention of the prosthesis. RESULTS/CONCLUSION: The reported prosthesis utilizes a retentive mechanism not previously reported in the literature to maximize function and esthetics.

Use of Orbital Conformer to Improve Speech in Patients with Confluent Maxillectomy and Orbital Defects.

The basic objective in prosthetic restoration of confluent maxillary and orbital defects is to achieve a comfortable, cosmetically acceptable prosthesis that restores speech, deglutition, and mastication. It is a challenging task complicated by the size and shape of the defects. The maxillary obturator prosthesis often satisfies the objective of adequate deglutition; however, orbital defects that are not obturated in the medial, septal, or posterior walls allow air to escape, negatively impacting phonation. This article describes a technique to achieve favorable prosthetic rehabilitation in a patient with a maxillectomy and ipsilateral orbital exenteration. The prosthetic components include maxillary obturator, orbital conformer, and orbital prosthesis connected using rigid magnetic attachments.