Reconstruction of extended orbitomaxillectomy and hemimandibulectomy defects with fibula flaps and patient-specific implants

Abstract

An extended orbitomaxillectomy and hemimandibulectomy for polyostotic juvenile ossifying fibroma resection were performed with the assistance of patient-specific cutting guides. The resulting defects were reconstructed in stages. First, a patientspecific mandibular reconstruction plate was fixed to the hemimandibulectomy defect in the same operation as the resection. After margins were proven to be free of tumor on histologic analysis, a free fibula flap contoured to the reconstruction plate was used to reconstruct the mandible. Reconstruction of the maxilla, alveolus, and orbit were performed with a second free fibula flap and patientspecific implants. The lining of the total nasal vault cavity was reconstructed with septal flaps. At 7 months postoperatively, the patient had an excellent esthetic result and resolved diplopia.