Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P175

Poster Presentations

The Use of Virtual Surgical Planning for
Osteocutaneous Fibular Free Flap Reconstruction of
a Bilateral Maxillectomy Defect
Jacob B. Kahane, MD (Presenter); Oluwafunmilola T.
Okuyemi, MD; Robert C. Wang, MD; Yuna Kim;
Nathan Harrison Reeve, MD
Bilateral maxillectomy is a rarely performed procedure that
poses significant reconstructive challenges because of the
extensive defect size, possible orbital involvement, and the
significant cosmetic and functional deficits that require rehabilitation via reconstruction. Although the fibula is the preferred donor site for maxillary reconstructions, prior reports
have highlighted higher than expected flap failure rates with
near total bilateral maxillectomy defects. Many authors recommend the use of prostheses for maxillary defects but maintaining retention and anterior projection can be problematic.
Virtual surgical planning makes use of 3-dimensional anatomic reconstruction with computed tomography imaging to
create predictive cutting guides and prefabricated reconstructive templates. This facilitates efficient inset of the free flap,
allowing for improved appearance and alignment similar to
the preoperative anatomy. However, the use of virtual surgical
planning has been described for more limited maxillectomy
defects. We present a case of a 57-year-old male patient undergoing right total and left subtotal maxillectomy for a large
bilateral palatal and maxillary adenoid cystic carcinoma.
Osteocutaneous free tissue transfer with a fibular flap, combined with virtual surgical planning, was used to facilitate the
reconstruction of the extensive left subtotal and right total
maxillectomy defect including the right orbital floor and lateral wall. In addition, a segment of free bone graft was incorporated to facilitate the reconstruction. Virtual surgical
planning enabled successful reconstruction of form and function of a difficult anatomic defect.
Unilateral Cleft Lip Repair
Jeewanjot Singh Grewal, MD (Presenter); Susan C. Yanik, MD;
Alexis M. Strohl, MD; Sherard A. Tatum, MD
Objectives: The goal of unilateral cleft lip repair is to create
a functional and cosmetically acceptable lip and nose, with the

lowest reasonable cost and burden to the families of these
patients. Presurgical nasoalveolar molding (PNAM) is a
development in cleft care that allows for shaping and contouring of the lip and nose for easier closure and delay in the timing of surgery. However, PNAM is time intensive, expensive,
and requires frequent visits to clinic for adjustments. In 2007,
we described our institution's 2-stage unilateral repair technique as an alternative to PNAM. We present a single-surgeon
case series of 23 children who underwent the 2-stage protocol
from the years 2001 to 2014 as a proof of concept.
Methods: Retrospective chart review of patients born with
complete, unilateral cleft lip deformity who underwent a
2-stage repair described as a stage 1 straight line repair and a
stage 2 modified Millard repair. Measurements were taken
from perioperative images of patients before and after each
stage.
Results: A 19% increase in the width of area of the presumptive C flap was obtained between the unrepaired and the post-
stage 1 images. The nostril width of the cleft side was 1.2× the
width of the unaffected side, demonstrating a 140% decrease
in nostril width at the completion of stage 2. The cleft side
nostril width was maintained slightly larger than the noncleft
side as desired. Symmetry of the upper lip length was achieved,
as the length of the cleft side lateral lip after stage 2 was 92%
of the unaffected side.
Conclusions: We believe this study provides evidence for our
observations that a 2-stage repair can be performed with functionally and esthetically pleasing outcomes as an alternative to
PNAM.
Volume Difference Along the External
Surface of the Zygomatic Bone: The
Zygomatic Asymmetry in Healthy Subjects
Samin Rahbin (Presenter); Anna-Maria Al-Khabbaz;
Julius Lindblom; Babak Alinasab, MD
Objectives: Understanding the zygomatic bones and their
3-dimensional (3D) relationship to each other may, in a clinical setting, prove valuable when deciding the optimal treatment of a zygomaticomaxillary complex (ZMC) fracture,
especially when there is a high risk of cosmetic sequelae.
Previous measurements have focused on either distances
between specific anatomic landmarks or the volume of the
entire zygoma, but the present study rests on the hypothesis
that the volume difference along the external surface (VDAES)
of the zygomatic bone is clinically more relevant and should
thus be taken into consideration.
Methods: To estimate normal zygomatic bone asymmetry,
100 healthy subjects were recruited to have their computed
tomography scans measured with regard to VDAES. The scans
were taken in 2018 to 2019 for diagnostic purposes, and no
ZMC fractures were discernable. Using the iPlan CMF software (BranLAB AG), a simple 4-step method was used to calculate the mean VDAES and the mean zygomatic volume.
Separate calculations were performed for male and female
participants.

Facial

generating a deformation or an allergic reaction in the patient,
with redness and numbness in the area. We can touch it and feel
it as hard as a rock, and because of its weight, the skin will
descend and open the pores. The goal is to demonstrate 16 years
of surgical experience with different techniques for patients
after they received a filler of methyl-polysiloxane in the face
several years previously. The result after years of injection was
deformation in different areas due to migration of products,
and they received several and complicated surgeries for product extraction. The purpose of this study is to describe the
experience of the extraction through open surgery, a minimal
combination of open surgery with diode laser, and only surgery
with diode fiber laser, showing different results.

P175

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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