[Reconstruction of maxillary defect by prefabricated titanium mesh combined with pedicled buccal fat pad flap and bone autograft].

OBJECTIVE: To introduce individualized 3-dimensional (3-D) reconstruction of maxillary defect by prefabricated titanium mesh combined with pedicled buccal fat pad flap (PBFPF) and bone autograft.

METHODS: Since May, 2001, 16 patients with maxillary defect resulted from tumor or trauma were treated. The 3-D models were created through 3-D CT and rapid prototype technique. The maxilla on the unaffected side was copied to the affected side by CAD/CAM. Then the titanium mesh was prefabricated accurately on the 3-D model. The PBFPF served as lining of the titanium mesh and the autogenous bone graft was used to reconstruct the shape and function of maxilla.

RESULTS: The duration of follow-up was 6 to 36 months. All the wounds healed primarily with good facial symmetry. No food reflux to nasal cavity was observed. The dentitions in 8 of 16 cases were restored with good function by removable partial denture. They could have normal diet and were articulate. Nasopharyngoscopy showed normal tissue lining of the titanium mesh 5-12 months after operation in 3 cases.

CONCLUSIONS: Satisfactory aesthetic and functional result can be achieved with this 3-D reconstruction method for maxilla defect. The PBFPF was insert better titanium mesh and mucous of maxilla sinus to avoid exposure of titanium mesh. The fat pad flap with blood supply promotes wound healing and helps partially restoring the function of the maxillary sinus.