Virtual Surgical Planning in Complex Composite Maxillofacial Reconstruction

Background: Complex osteocutaneous maxillofacial reconstruction requiring multiple free flaps and with an extensive zone of injury can be fraught with complications and difficulty. Often, the remnants of native mandible are malpositioned and the skeletal structure of the upper face is distorted. The authors seek to extend the use of virtual planning to complex maxillofacial reconstruction by presenting their early experience in these difficult patients. Methods: A retrospective chart review of 10 consecutive patients who underwent complex maxillofacial reconstruction using virtual surgical planning was undertaken. The authors define complex maxillofacial reconstruction as that requiring an osteocutaneous flap in which multiple osteotomies were required in addition to at least one of the following: need for multiple free flaps, history of osteoradionecrosis, and ballistic injury. Synthes Proplan CMF surgical planning was performed using computed tomographic scanning of the maxillofacial area and the donor site. Jigs and cutting guides were created and plates were prebent. The flap was harvested and osteotomized using the jigs and inset. Postoperative computed tomographic scanning was performed to evaluate the reconstruction. Results: Ten consecutive patients who met the criteria underwent review. There were no intraoperative complications. Postoperative computed tomographic scans showed excellent contour of the osseous flaps. All patients had functional mandibular range of motion. Conclusions: Use of virtual surgical planning allows for complex maxillofacial reconstruction with multiple simultaneous free flaps to be performed reliably and successfully. The use of prefabricated jigs and precontoured plates eases osteocutaneous flap molding and inset, allowing for a more complex procedure to be successful. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.