J reconstr Microsurg
DOI: 10.1055/s-0037-1607394
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Staged Reconstruction (Delayed-Immediate) of the Maxillectomy Defect Using CAD/CAM Technology

John Henry Pang*, 1, Sebastian Brooke*, 1, Mark W. Kubic2, Robert L. Ferris2, Matilda Dhima3, Matthew M. Hanasono4, Eric W. Wang2, Mario G. Solari1, 2, 5
  • 1Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 2Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 3Department of Prosthodontics, University of Pittsburgh, School of Dental Medicine, Pittsburgh, Pennsylvania
  • 4Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
  • 5McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Further Information

Publication History

12 June 2017

14 September 2017

Publication Date:
27 November 2017 (eFirst)


Background Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has become increasingly popular for free fibula reconstruction of the mandible. The same technology, however, has not been widely utilized in immediate complex midface reconstruction utilizing free fibula flaps. Maxillary defects are difficult to precisely predict or produce matched cutting guides for after the ablative surgery. We present a protocol for “delayed-immediate” two-stage reconstruction for complex mid-facial defects, by delaying lymph node neck dissection and using CAD/CAM technology for delayed bony reconstruction.

Methods Stage 1 includes the extirpative surgery, placement of a temporary obturator, and an immediate post-excision fine cut computed tomography (CT) of the defect that is used for CAD/CAM planning. The time interval between stages is used for virtual surgical planning (VSP) and provides an opportunity for the final pathologic margins to be evaluated. At stage 2, definitive reconstruction is performed in conjunction with the delayed neck dissection. Briefly delaying the neck dissection until stage 2 allows for recipient vessel dissection and microsurgical anastomoses to safely occur in a surgically naïve neck.

Conclusion A two-stage delayed-immediate reconstruction of complex mid-face defects can be safely and effectively performed. This protocol takes advantage of advancing CAD/CAM technology, provides an opportunity to evaluate final margins, and avoids recipient vessel dissection and microsurgery in previously operated or irradiated necks.

Financial Disclosure

No authors have financial interest in any products, devices, or drugs mentioned in this article.

* Co-first authors contributed equally to this work.