Maxillofacial Reconstruction

1. MAXILLOFACIAL
RECONSTRUCTION
Dr. Hadi munib
Oral and Maxillofacial surgery resident

2. Outline
■ Introduction
■ Classification and treatment approaches for maxillary defects
■ Maxillary Defect Reconstruction
■ References

3. Introduction
■ Tumor
■ Trauma
■ Removable dental prostheses are felt to be superior to flaps or grafts for the
reconstruction of maxillary defects.

6. Brown Classification
■ Vertical components are classified as:
■ Class 1: Maxillectomy with no oro-antral fistula.
■ Class 2: Low Maxillectomy
■ Class 3: High Maxillectomy.
■ Class 4: Radical Maxillectomy.
■ Horizontal components are classified as:
 A: Unilateral alveolar maxilla and hard palate resected. Less than or equal to half the
alveolar and hard palate resection not involving the nasal septum or crossing the midline.
 B: Bilateral alveolar maxilla and hard palate resected. Includes a small resection that
crosses the midline of the alveolar bone including the nasal septum.
 C: Removal of the entire alveolar maxilla and hard palate.

8. Maxillary Defect Reconstruction
■ Brown class 1 defects can be treated with local flaps, or with an obturator if there is an oro-
antral or oronasal communication.
■ Class 2a defects can be obturated, or reconstructed with local and pedicle flaps, or a
combination of both.
■ As the horizontal extent increases, prosthetic rehabilitation with an obturator becomes more
difficult and implant support may become necessary to improve stability.
■ Class 3 defects; are usually not treated with obturators, because the weight and size of a
device presents challenges in achieving a functional and stable prosthesis.
■ For Classes 3b and 3c defects, a composite vascularized flap capable of addressing both
maxillary and orbital defects is the recommended treatment.
■ Class 4 defects; are almost never amenable to obturator rehabilitation without free flap
reconstruction.

9. Maxillary Reconstruction
■ Prosthetics
■ Flap; Any type of tissue is lifted from a donor site and moved to a recipient site with an
intact blood supply
■ Graft; Does not have an intact blood supply and therefore relies on growth of new blood
vessels.
■ Implants
■ Free-Vascularized Flaps

10. Prosthetics

11. Grafts

12. Flaps

14. Implants

15. ■ Zygoma implants experienced a 25% failure rate
■ Anterior endosseous implants incorporated into the design
failed 30% of the time.

17. References
■ Chapter 50: Reconstruction of Maxillary
Defects

18. THANKYOU