Evolution of Medical Modeling and 3D Printing in Microvascular Midface Reconstruction: Literature Review and Experience at MD Anderson Cancer Center

Abstract

Reconstruction of the midface represents a challenge for reconstructive microsurgeons given the formidable task of restoring both aesthetics and functionality. In particular, preservation of proper globe positioning and maintaining normal vision are as important as restoring the proper projection of the midface and enabling a patient to speak and eat as normally as possible. The introduction of virtual surgical planning (VSP) and medical modeling has revolutionized bony reconstruction of the craniofacial skeleton; however, the overwhelming majority of studies have focused on mandibular reconstruction. Here, we introduce some novel advances in utilizing VSP for bony reconstruction of the midface. The present review aims (1) to provide a review of the literature on the use of VSP in midface reconstruction and (2) to provide some insights from the authors' early experience.

Keywords: maxillectomy reconstruction; medical modeling; microvascular midface reconstruction; virtual surgical planning.

Figure 1

A customized 3D-printed titanium flap used for reconstruction of an orbital floor defect.

Figure 2

Three-dimensional reconstruction of computed tomography images of a maxillectomy reconstruction using medical modeling and virtual surgical planning. A scapula flap was used to reconstruct the maxilla with planning for immediate dental implants. “A scapula flap (light blue) was used to reconstruct the maxilla with planning for immediate dental implants (dark blue)”.

Figure 3

A chimeric scapula flap with a soft tissue thoracodorsal artery perforator (TDAP) flap. The bony component was utilized for the maxilla and the TDAP flap was used to reconstruct the palate.

Figure 4

An engineered chimeric flap using the distal lateral descending circumflex femoral vessels on an ALT flap as the recipient vessels for a flow-through MFC flap. The pedicle of the ALT flap provides the length necessary to reach recipient vessels and also the soft tissue can be used to obliterate the dead space in the maxillary sinus or to reconstruct the palate.