"Hybrid Reconstruction" for Zygomaticomaxillary Complex Defect Using CAD/CAM: A Case Report.

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery
• Biomaterials Engineering

Background:

• Reconstruction of large zygomaticomaxillary complex defects presents significant challenges.
• Current methods using solely autogenous tissue or alloplastic materials often yield suboptimal functional and aesthetic results.
• A novel approach is needed to address extensive defects effectively.

Observation:

• A patient with a large left zygomaticomaxillary complex defect underwent reconstruction.
• The reconstruction utilized a combination of an osteocutaneous free fibula flap and a patient-specific templated polymethyl methacrylate (PMMA) implant.
• Virtual surgical planning and 3D printing were employed for precise defect management.

Findings:

• The osteocutaneous free fibula flap was used for the alveolus reconstruction.
• The patient-specific PMMA implant reconstructed the orbital wall and zygoma.
• Secondary osseointegrated implants were placed in the fibula for dental rehabilitation, achieving a successful "hybrid reconstruction".

Implications:

• Hybrid reconstruction offers a viable solution for complex craniofacial defects where single-modality reconstruction is insufficient.
• The combined use of autogenous tissue and custom alloplastic implants can enhance both functional and aesthetic restoration.
• This technique, guided by virtual surgical planning, sets a precedent for managing extensive facial trauma and defects.