Possibilities of the use of an animal pattern tray for microsurgical substitution of combined top jaw defects in cancer patients

Aesthetic appearance and restoration of the vital functions of the upper jaw is one of the main criteria when performing operations in reconstructive and maxillofacial surgery. Tumor of the upper jaw is a rare disease; therefore, there is no «gold standard» for reconstruction of defects after the performed maxillectomy. When choosing the type of flap to restore the resected area of the upper jaw, we rest on a complex of factors, based on which we carry out the tactics of individual selection of the flap depending on the size and type of defect, patient’s age, presence/absence of concomitant diseases in anamnesis, as well as the prospects for the rehabilitation period. This article will discuss the main indications for the use of a flap of scapula angle, its advantages compared with other types of autografts, the possibility of a rehabilitation period, the subsequent implantation of osteointegrated implants.

free flap of scapula angle, review, reconstruction of the upper jaw, composite free flap, dental implantation, rehabilitation, maxillectomy

1. Clark J, Vesely M, Gilbert R. Scapular angle osteomyogenous flap in postmaxillectomy reconstruction: defect, reconstruction, shoulder function, and harvest technique. Head Neck. 2007;30(1):10-20. DOI: 10.1002/hed.20649.

2. Brown JS, Rogers SN, McNally DN et al. A modified classification for the maxillectomy defect. Head Neck. 2000;22(1):17-26. DOI: 10.1002/(SICI)1097-0347(200001)22:1<17::AID-HED4>3.0.CO;2-2.

3. Choi N, Cho J, Jang J et al. Scapular Tip Free Flap for Head and Neck Reconstruction. Clin Exp Otorhinolaryngol. 2015;8(4):422. DOI: 10.3342/ceo.2015.8.4.422.

4. Wolff K, Holzle F. Raising Of Microvascular Flaps. New York: Springer; 2011.

5. Hanasono M, Skoracki R. The Scapular Tip Osseous Free Flap as an Alternative for Anterior Mandibular Reconstruction. Plast Reconstr Surg. 2010;125(4):164e-166e. DOI: 10.1097/ prs.0b013e3181d45e52.

6. Piazza C, Paderno A, Del Bon F et al. Palato-maxillary reconstruction by the angular branch-based tip of scapula free flap. European Archives of Otorhinolaryngology. 2016;274(2):939-945. DOI: 10.1007/s00405-016-4266-0.

7. Chepeha D, Khariwala S, Chanowski E et al. Thoracodorsal Artery Scapular Tip Autogenous Transplant. Archives of Otolaryngology - Head & Neck Surgery 2010;136(10):958. DOI: 10.1001/archoto.2010.166.

8. Modest M, Moore E, Abel K et al. Scapular flap for maxil-lectomy defect reconstruction and preliminary results using three-dimensional modeling. Laryngoscope. 2016;127(1):E8-E14. DOI: 10.1002/lary.26351.

9. Dowthwaite S, Theurer J, Belzile M et al. Comparison of Fibular and Scapular Osseous Free Flaps for Oromandibular Reconstruction. JAMA Otolaryngology - Head & Neck Surgery. 2013;139(3):285. DOI: 10.1001/jamaoto.2013.1802.

10. Ferrari S, Ferri A, Bianchi B, Varazzani A, Perlangeli G, Sesenna E. Donor site morbidity after scapular tip free flaps in head-and-neck reconstruction. Microsurgery. 2015;35(6):447-450. DOI: 10.1002/micr.22454.

11. Mertens C, Freudlsperger C, Bodem J, Engel M, Hoffmann J, Freier K. Reconstruction of the maxilla following hemimax-illectomy defects with scapular tip grafts and dental implants. Journal of Cranio-Maxillofacial Surgery. 2016;44(11):1806-1811. DOI: 10.1016/j.jcms.2016.08.010.

12. Oztel M, Rahmel B, Van Genechten M, Batstone M. A Tip for the Reconstruction of Larger Maxillary Defects in Complicated Cleft Patients. The Cleft Palate-Craniofacial Journal. 2017;55(1):132-135. DOI: 10.1177/1055665617723917.

13. Диков ЮЮ, Соболевский ВА, Кропотов МА и соавт. Применение трехмерного моделирования и 3D-печати при реконструкции нижней челюсти. Опухоли головы и шеи. 2015;5(1):22-26. DOI: 10.17650/2222-1468-2015-1-2226

14. Диков ЮЮ, Соболевский ВА, Кропотов МА и соавт. Трехмерное моделирование с использованием 3D-печати при реконструктивных операциях на нижней челюсти. Саркомы костей, мягких тканей и опухоли кожи. 2015;(1):50-54

15. Ferrari S, Ferri A, Bianchi B. Scapular tip free flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2015;23(2):115-120. DOI: 10.1097/moo.0000000000000137.

16. Pagedar N, Gilbert R, Chan H et al. Maxillary reconstruction using the scapular tip free flap: A radiologic comparison of 3D morphology. Head Neck. 2012;34(10):1377-1382. DOI: 10.1002/hed.21946.

17. Mertens C, Freudlsperger C, Bodem J et al. Reconstruction of the maxilla following hemimaxillectomy defects with scapular tip grafts and dental implants. Journal of Cranio-Maxillofacial Surgery. 2016;44(11):1806-1811. DOI: 10.1016/j. jcms.2016.08.010.

18. Мудунов АМ, Соболевский ВА, Удинцов ДБ и соавт. Флуоресцентная ангиография как метод интраоперационной оценки перфузии аутотрансплантата при реконструкции комбинированных дефектов у больных с опухолями головы и шеи. Анналы пластической, реконструктивной и эстетической хирургии. 2015;(4):31-37