Abstract
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.
Keywords
CAD/CAM - head and neck cancer - free fibula
