Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (2): 356-362. doi: 10.19723/j.issn.1671-167X.2022.02.025

Previous Articles     Next Articles

Relationship between prognosis and different surgical treatments of zygomatic defects: A retrospective study

LAN Lin,HE Yang(),AN Jin-gang,ZHANG Yi   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2020-04-13 Online:2022-04-18 Published:2022-04-13
  • Contact: Yang HE E-mail:fridaydust1983@163.com
  • Supported by:
    National Key R&D Program of China(2017YFB1104103)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To evaluate the effect and summarize the characteristics of different treatment methods in repairing zygomatic defect. Methods: A total of 37 patients with zygomatic defect were reviewed in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from August 2012 to August 2019. According to the anatomical scope of defect, the zygomatic defects were divided into four categories: Class 0, the defect did not involve changes in zygomatic structure or continuity, only deficiency in thickness or projection; Class Ⅰ, defect was located in the zygomatic body or involved only one process; Class Ⅱ, a single defect involved two processes; Class Ⅲa, referred to a single defect involving three processes and above; Class Ⅲb, referred to zygomatic defects associated with large maxillary defects. The etiology, defect time, defect size and characteristics of zygomatic defects, the repair and reconstruction methods, and postoperative complications were collected and analyzed. Postoperative computed tomography (CT) data were collected to evaluate the outcome of zygomatic protrusion. Chromatographic analysis was used to assess the postoperative stability. Results: Among the causes of defects, 25 cases (67.57%) were caused by trauma, and 11 cases (29.73%) were of surgical defects following tumor resection. We performed autologous bone grafts in 19 cases, 6 cases underwent vascularized tissue flap,5 cases underwent external implants alone, and 7 cases underwent vascularized tissue flap combined with external implants. After the recovery of the affected side, the average difference of the zygomatic projection between the navigation group and the non-navigation group was 0.45 mm (0.20-2.50 mm) and 1.60 mm (0.10-2.90 mm), with a significant difference (P=0.045). Two patients repaired with titanium mesh combined with anterolateral thigh flap had obvious deformation or fracture of titanium mesh; 2 patients with customized casting prosthesis had infection after surgery and fetched out the prosthesis finally. Conclusion: Autologous free grafts or alloplastic materials may be used in cases without significant structural changes. Pedicle skull flap or vascularized bone tissue flap is recommended for zygomatic bone defects with bone pillar destruction, chronic inflammation, oral and nasal communication or significant soft tissue insufficiency. Titanium mesh can be used to repair a large defect of zygomatic bone, and it is suggested to combine with vascularized bone flap transplantation.

Key words: Zygoma, Bone and bones, Reconstructive surgical procedures, Prognosis

CLC Number: 

  • R782.26

Figure 1

Classification of zygomatic defects Class 0, defects does not involve changes in the zygomatic structure, and involves in only thickness or suddenness; Class Ⅰ, defects are located in the zygomatic body or involved only one process; Class Ⅱ, a single defect involving two processes; Class Ⅲa, a single defect involving three processes and above; Class Ⅲb, zygomatic defects are associated with large maxillary defects (including Brown 3)."

Figure 2

Postoperative zygomatic protrusion was measured In ProPlan CMF 3.0, after calibration of the symmetric plane, the dif-ferences in the values of zygomatic arch protrusion on both sides were analyzed and compared."

Table 1

General information of different types of zygomatic bone defects"

Items 0 (n=1) Ⅰ (n=15) Ⅱ (n=7) Ⅲa (n=5) Ⅲb (n=9)
Gender
Male 0 14 5 4 6
Female 1 11 2 1 3
Age/years 22 44 (23-77) 41 (9-67) 31 (22-40) 36 (21-57)
Etiology
Skeletal dysplasia 1 0 0 0 0
Trauma 0 13 6 4 2
Tumor 0 2 1 1 7
CNTS
Yes 1 5 5 5 9
No 0 10 2 0 0

Figure 3

Some commonly used prosthodontic surgical methods A, cranial bone grafts repair the continuity of the zygomatic arch; B, pedicled cranial bone flap was prepared and transferred to repair the zygomatic body; C, vascularized iliac crest bone flap was used to repair the defects of right zygomatic bone caused by trauma; D, the defect of right zygomatic ma-xillary bone was repaired using preoperatively bent titanium mesh; E, after tumor resection of right zygomatic-maxillary bone, the titanium mesh was used to repair the defects of zygomatic-maxillary bone; F, Ti-mesh + anterolateral femoral flap was used to repair the defects after tumor resection of the left zygomatic maxilla."

Figure 4

Customized casting prosthesis A, the model of customized casting prosthesis of zygomatic-maxillary bone; B, under the guidance of intraoperative navigation, a customized titanium casting prosthesis was implanted into the zygomatic maxillary bone."

Figure 5

Chromatographic and CT data were used for stability evaluation A, the defects of zygomatic temporal process and zygomatic orbital process after trauma were repaired with cranial bone grafts 2 years later, and chromatographic analysis showed overall thickening of the local thickness of the zygomatic bone; B, C, the defects of zygomatic maxilla were repaired using personalized pre-curved Ti-mesh and anterolateral femoral flap after resection of adenoid cystic carcinoma, and chromatographic analysis showed obvious deformation of titanium mesh 2 years later; D, 2 years after the repair of left zygomatic maxilla with Ti-mesh and anterolateral thigh flap, CT showed fracture of the titanium mesh at the zygomatic arch and zygomatic frontal suture; E, Ti-mesh combined with iliac crest bone flap was used to repair the defect of zygomatic maxillary bone, and chromatographic analysis showed that the local thickness of the ilium was decreased one year later; F, Ti-mesh combined with fibular flap was used to repair the defect of zygomatic maxillary bone, showing no significant changes one year later."

[1] Kokemueller H, Tavassol F, Rücker M, et al. Complex midfacial reconstruction: A combined technique of computer-assisted surgery and microvascular tissue transfer[J]. J Oral Maxillofac Surg, 2008, 66(11):2398-2406.
doi: 10.1016/j.joms.2007.12.030
[2] Zunz E, Blanc O, Leibovitch I. Traumatic orbital floor fractures: Repair with autogenous bone grafts in a tertiary trauma center[J]. J Oral Maxillofac Surg, 2012, 70(3):584-592.
doi: 10.1016/j.joms.2011.02.048
[3] 白萍, 刘和荣, 郝月军. Medpor在眼眶重建和眼球内陷复位手术中的应用[J]. 中国美容医学, 2004, 13(3):353-354.
[4] Butscher A, Bohner M, Hofmann S, et al. Structural and material approaches to bone tissue engineering in powder-based three-dimensional printing[J]. Acta Biomater, 2011, 7(3):907-920.
doi: 10.1016/j.actbio.2010.09.039 pmid: 20920616
[5] Pensler J, McCarthy JG. The calvarial donor site: An anatomic study in cadavers[J]. Plast Reconstr Surg, 1985, 75(5):648-651.
pmid: 3983272
[6] Markowitz NR. Cranial bone grafting in oral and maxillofacial surgery[J]. J Am Dent Assoc, 1992, 123(7):206-211.
pmid: 1619161
[7] Tatum SA, Kellman RM. Cranial bone grafting in maxillofacial trauma and reconstruction[J]. Facial Plast Surg, 1998, 14(1):117-129.
pmid: 10371899
[8] Kusiak JF, Zins JE, Whitaker LA. The early revascularization of membranous bone[J]. Plast Reconstr Surg, 1985, 76(4):510-516.
pmid: 4034769
[9] Rogers GF, Greene AK. Autogenous bone graft: Basic science and clinical implications[J]. J Craniofac Surg, 2012, 23(1):323-327.
doi: 10.1097/SCS.0b013e318241dcba pmid: 22337435
[10] Movahed R, Pinto LP, Morales-Ryan C, et al. Application of cranial bone grafts for reconstruction of maxillofacial deformities[J]. Proc (Bayl Univ Med Cent), 2013, 26(3):252-255.
doi: 10.1080/08998280.2013.11928973 pmid: 23814382
[11] Vandervord JG, Watson JD, Teasdale GM. Forehead reconstruction using a bi-pedicled bone flap[J]. Br J Plast Surg, 1982, 35(1):75-79.
pmid: 7066592
[12] He W, Gong X, He Y, et al. Application of a lateral pedicled cranial bone flap for the treatment of secondary zygomaticomaxillary defects[J]. J Craniofac Surg, 2019, 30(7):e661-e664.
doi: 10.1097/SCS.0000000000005776
[13] Gerressen M, Pastaschek CI, Riediger D, et al. Microsurgical free flap reconstructions of head and neck region in 406 cases: A 13-year experience[J]. J Oral Maxillofac Surg, 2013, 71(3):628-635.
doi: 10.1016/j.joms.2012.07.002
[14] Ghassemi A, Ghassemi M, Riediger D, et al. Comparison of donor-site engraftment after harvesting vascularized and nonvascularized iliac bone grafts[J]. J Oral Maxillofac Surg, 2009, 67(8):1589-1594.
doi: 10.1016/j.joms.2009.04.013
[15] Takano M, Sugahara K, Koyachi M, et al. Maxillary reconstruction using tunneling flap technique with 3D custom-made titanium mesh plate and particulate cancellous bone and marrow graft: A case report[J]. Maxillofac Plast Reconstr Surg, 2019, 41(1):43.
doi: 10.1186/s40902-019-0228-y
[16] Ghanaati S, Al-Maawi S, Conrad T, et al. Biomaterial-based bone regeneration and soft tissue management of the individualized 3D-titanium mesh: An alternative concept to autologous transplantation and flap mobilization[J]. J Craniomaxillofac Surg, 2019, 47(10):1633-1644.
doi: S1010-5182(19)30459-7 pmid: 31420282
[17] Zhang WB, Yu Y, Mao C, et al. Outcomes of zygomatic complex reconstruction with patient-specific titanium mesh using computer-assisted techniques[J]. J Oral Maxillofac Surg, 2019, 77(9):1915-1927.
doi: 10.1016/j.joms.2019.03.014
[18] Mischkowski RA, Selbach I, Neugebauer J, et al. Lateral femoral cutaneous nerve and iliac crest bone grafts:Anatomical and clinical considerations[J]. Int J Oral Maxillofac Surg, 2006, 35(4):366-372.
doi: 10.1016/j.ijom.2005.08.010
[19] Wei FC, Celik N, Yang WG, et al. Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap[J]. Plast Reconstr Surg, 2003, 112(1):37-42.
doi: 10.1097/01.PRS.0000065911.00623.BD
[20] Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: A 10-year follow-up study[J]. Plastic Reconstr Surg, 2002, 110(2):438-449.
doi: 10.1097/00006534-200208000-00010
[21] Nickels L. World’s first patient-specific jaw implant[J]. Metal Powder Report, 2012, 67(2):12-14.
[22] Macheras G, Kateros K, Kostakos A, et al. Eight- to ten-year clinical and radiographic outcome of a porous tantalum monoblock acetabular component[J]. J Arthroplasty, 2009, 24(5):705-709.
doi: 10.1016/j.arth.2008.06.020 pmid: 18703310
[23] Whitehouse MR, Masri BA, Duncan CP, et al. Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years[J]. Clin Orthop Relat Res, 2015, 473(2):521-527.
doi: 10.1007/s11999-014-3861-x
[1] Junyong OU,Kunming NI,Lulin MA,Guoliang WANG,Ye YAN,Bin YANG,Gengwu LI,Haodong SONG,Min LU,Jianfei YE,Shudong ZHANG. Prognostic factors of patients with muscle invasive bladder cancer with intermediate-to-high risk prostate cancer [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 582-588.
[2] Shuai LIU,Lei LIU,Zhuo LIU,Fan ZHANG,Lulin MA,Xiaojun TIAN,Xiaofei HOU,Guoliang WANG,Lei ZHAO,Shudong ZHANG. Clinical treatment and prognosis of adrenocortical carcinoma with venous tumor thrombus [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 624-630.
[3] Yicen YING,Yicong DU,Zhihua LI,Yiming ZHANG,Xinfei LI,Bing WANG,Peng ZHANG,Hongjian ZHU,Liqun ZHOU,Kunlin YANG,Xuesong LI. Robot-assisted laparoscopic ureteroplasty with buccal mucosa graft for complex ureteral stricture [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 640-645.
[4] Le YU,Shaohui DENG,Fan ZHANG,Ye YAN,Jianfei YE,Shudong ZHANG. Clinicopathological characteristics and prognosis of multilocular cystic renal neoplasm of low malignant potential [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 661-666.
[5] Zezhen ZHOU,Shaohui DENG,Ye YAN,Fan ZHANG,Yichang HAO,Liyuan GE,Hongxian ZHANG,Guoliang WANG,Shudong ZHANG. Predicting the 3-year tumor-specific survival in patients with T3a non-metastatic renal cell carcinoma [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 673-679.
[6] Yangyi FANG,Qiang LI,Zhigao HUANG,Min LU,Kai HONG,Shudong ZHANG. Well-differentiated papillary mesothelial tumour of the tunica vaginalis: A case report [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 741-744.
[7] Yuanyuan ZENG,Yun XIE,Daonan CHEN,Ruilan WANG. Related factors of euthyroid sick syndrome in patients with sepsis [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 526-532.
[8] Xiaoying CHEN,Yi ZHANG,Yuke LI,Lin TANG,Yuhua LIU. Effects of different polymers on biomimetic mineralization of small intestine submucosal scaffolds [J]. Journal of Peking University (Health Sciences), 2024, 56(1): 17-24.
[9] Yuan PAN,Hang GU,Han XIAO,Lijun ZHAO,Yiman TANG,Wenshu GE. Ubiquitin-specific protease 42 regulates osteogenic differentiation of human adipose-derived stem cells [J]. Journal of Peking University (Health Sciences), 2024, 56(1): 9-16.
[10] Jian-bin LI,Meng-na LYU,Qiang CHI,Yi-lin PENG,Peng-cheng LIU,Rui WU. Early prediction of severe COVID-19 in patients with Sjögren’s syndrome [J]. Journal of Peking University (Health Sciences), 2023, 55(6): 1007-1012.
[11] Huan-rui LIU,Xiang PENG,Sen-lin LI,Xin GOU. Risk modeling based on HER-2 related genes for bladder cancer survival prognosis assessment [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 793-801.
[12] Zi-xuan XUE,Shi-ying TANG,Min QIU,Cheng LIU,Xiao-jun TIAN,Min LU,Jing-han DONG,Lu-lin MA,Shu-dong ZHANG. Clinicopathologic features and prognosis of young renal tumors with tumor thrombus [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 802-811.
[13] Jian-xun MA,You-chen XIA,Bi LI,Hong-mei ZHAO,Yu-tao LEI,Xi BU. Choice of immediate breast reconstructive methods after modified radical mastectomy [J]. Journal of Peking University (Health Sciences), 2023, 55(4): 612-618.
[14] Han LU,Jian-yun ZHANG,Rong YANG,Le XU,Qing-xiang LI,Yu-xing GUO,Chuan-bin GUO. Clinical factors affecting the prognosis of lower gingival squamous cell carcinoma [J]. Journal of Peking University (Health Sciences), 2023, 55(4): 702-707.
[15] Yun-fei SHI,Hao-jie WANG,Wei-ping LIU,Lan MI,Meng-ping LONG,Yan-fei LIU,Yu-mei LAI,Li-xin ZHOU,Xin-ting DIAO,Xiang-hong LI. Analysis of clinicopathological and molecular abnormalities of angioimmunoblastic T-cell lymphoma [J]. Journal of Peking University (Health Sciences), 2023, 55(3): 521-529.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd