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Assessing Free Flap Reconstruction Accuracy of the Midface and Orbit Using Computer-Aided Modeling Software
Bovey Zhu1, Mary Han1, Chase Heaton1
1Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California.
Facial Plastic Surgery & Aesthetic Medicine
|February 19, 2020
Summary
Accurate maxilla reconstruction using free flaps is achievable. Precise infraorbital rim positioning is key to restoring midface projection and preventing lower eyelid and globe malposition after total maxillectomy.
Area of Science:
- Head and Neck Surgery
- Reconstructive Surgery
- Oral and Maxillofacial Surgery
Background:
- Total maxillectomy reconstruction presents significant challenges in head and neck surgery, requiring restoration of midface projection, contour, and cheek volume.
- Maintaining stable osseous support is crucial to prevent common complications like lower eyelid and globe malposition.
- Aesthetically pleasing and functionally stable reconstructions are paramount for patient outcomes.
Purpose of the Study:
- To evaluate the positional accuracy of the reconstructed infraorbital rim compared to the contralateral side.
- To assess the impact of infraorbital rim reconstruction on globe position, lower eyelid position, orbital volume, and soft tissue contour.
- To explore the utility of digital 3D modeling for quantifying reconstructive outcomes.
Main Methods:
- A case series of 12 adult patients undergoing free flap reconstruction for maxilla and inferior orbit defects (2011-2018).
- Utilized fibular free flaps with orbital floor plates (or anterolateral thigh flap with mesh in one case).
- Generated 3D models from postoperative CT scans using open-source software to compare reconstructed and contralateral sides.
Main Results:
- Mean differences observed: infraorbital rim height (3.5 mm), globe height (2.5 mm), lower lid height (3.2 mm), and orbital volume (2.4 cm³).
- Soft tissue contour difference averaged 10.3 mm in patients with >6 months follow-up.
- Significant correlations found between infraorbital rim height differences and globe height (R=0.77, p=0.004) and lower lid height (R=0.76, p=0.004).
Conclusions:
- Precise positioning of the reconstructed infraorbital rim is critical for successful orbitomaxillary reconstruction.
- Accurate infraorbital rim placement directly influences lower lid and globe position, contributing to functional and aesthetic restoration.
- Computer-aided 3D modeling offers a valuable methodology for quantifying facial reconstruction results and guiding future research.
