The dynamic role of buttress reconstruction after maxillectomy.
BACKGROUND
The purpose of this study was to investigate the dynamic effect of maxillary reconstruction after partial resection of the maxilla.


METHODS
On a personal computer, three-dimensional maxilla models were designed based on computed tomographic data obtained from 10 edentulous skull models. Simulation surgery was performed on each model, creating 10 pairs of half-removed maxilla models and corresponding models after reconstruction with a rib. The three different patterns seen in the 10 models were termed normal maxilla, half-removed maxilla, and reconstructed maxilla. After an implant was fixed on the molar region of each model, a 300-N vertical load and a 50-N horizontal load were applied. Using finite element analysis software, the deviation and stress on each model were calculated and compared between different model patterns.


RESULTS
Regarding deformity of the maxilla, when a vertical load was applied, no significant difference was observed among the three model patterns. However, a difference was observed in response to a horizontal load in that there was a tendency for deformation to occur, with that of half-removed maxilla being the greatest followed by reconstructed and normal maxilla. Regarding stresses around the implant, when the vertical and horizontal loads were applied, no significant difference was observed among the three model patterns in maximum stress around the implant.


CONCLUSIONS
A buttress reconstruction is effective in increasing the stability of the maxilla against a horizontal load. However, the maximum stress around the implant in the molar region is unaffected whether or not removal or reconstruction is performed.
Nagasao
Tomohisa
T
Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan. nagasao@sc.itc.keio.ac.jp
Nakajima
Tatsuo
T
Kimura
Akiko
A
Kaneko
Tsuyoshi
T
Jin
Hongmei
H
Tamaki
Tamotsu
T
D003196:Computer Graphics; D003198:Computer Simulation; D020342:Finite Element Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional; D008409:Mastication; D008437:Maxilla / Q000502:physiology / Q000601:surgery*; D008953:Models, Anatomic; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures; D012272:Ribs / Q000637:transplantation; D012886:Skull / Q000033:anatomy & histology; D013314:Stress, Mechanical