Abstract
Reconstruction within the head and neck is challenging. Defects can be anatomically
complex and may already be compromised by scarring, inflammation, and infection. Tissue
grafts and vascularised flaps (either pedicled or free) bring healthy tissue to a
compromised wound for optimal healing and are the current gold standard for the repair
of such defects, but disadvantages are their limited availability, the difficulty
of shaping the flap to fit the defect and, most importantly, donor site morbidity.
The importance of function and aesthetics has driven advances in the accuracy of surgical
techniques. We discuss current advances in reconstruction within oral and maxillofacial
surgery. Developments in navigation, three-dimensional imaging, stereolithographic
models, and the use of custom-made implants can aid and improve the accuracy of existing
reconstructive methods. Robotic surgery, which does not modify existing techniques
of reconstruction, allows access, resection of tumours, and reconstruction with conventional
free flap techniques in the oropharynx without the need for mandibulotomy. Tissue
engineering and distraction osteogenesis avoid the need for autologous tissue transfer
and can therefore be seen as more conservative methods of reconstruction. Recently,
facial allotransplantation has allowed whole anatomical facial units to be replaced
with the possibility of sensory recovery and reanimation being completed in a single
procedure. However, patients who have facial allotransplants are subject to life-long
immunosuppression so this method of reconstruction should be limited to selected cases.
Keywords
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Article info
Publication history
Published online: December 30, 2011
Accepted:
November 30,
2011
Identification
Copyright
© 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
