Image-Guided Placement of Osseointegrated Implants for Challenging Auricular, Orbital, and Rhinectomy Defects.
OBJECTIVE
Prosthetic reconstruction can restore the preoperative form and function after surgery for head and neck malignancies. We demonstrate the use of preoperative planning and intraoperative image guidance for placement of osseointegrated implants to restore craniofacial defects.


METHODS
A retrospective review of patients with craniofacial defects treated with image-guided placement of osseointegrated prosthetic implants was performed.


RESULTS
Case 1: 55-year-old male who underwent total auriculectomy with anterolateral thigh reconstruction. Case 2: 64-year-old male who required orbital exenteration and total auriculectomy with latissimus dorsi reconstruction. Case 3: 74-year-old male presented after a total rhinectomy. Cases 1 and 3 received adjuvant radiation prior to implantation. Case 2 underwent simultaneous placement of osseointegrated hearing and prosthetic implants. Computed tomography scans were used to perform preoperative planning to determine the optimal implant trajectories and sites. Complications included tissue overgrowth, delayed nonunion of implant, wound infection, and dehiscence.


CONCLUSIONS
Defects following oncologic resection of head and neck malignancies can be difficult to achieve with native tissue alone. Osseointegrated implants offer an excellent means for reconstruction but can be challenging due to limited bone stock and anatomic landmarks. This can be overcome using intraoperative image guidance techniques for prosthetic reconstruction.
Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA kevin.choi@dm.duke.edu.
Kevin J
KJ
Choi
Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Mirabelle B
MB
Sajisevi
The Anaplastology Clinic, Durham, North Carolina, USA.
Jay
J
McClennen
Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
David M
DM
Kaylie
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D054644:Ear Auricle / Q000601:surgery; D004428:Ear Neoplasms / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009669:Nose Neoplasms / Q000601:surgery*; D017233:Orbit Evisceration; D009918:Orbital Neoplasms / Q000601:surgery*; D016348:Osseointegration; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D000077195:Squamous Cell Carcinoma of Head and Neck; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed
osseointegrated hearing implant; osseointegrated prosthetic implant; preoperative surgery planning; prosthetic reconstruction; stereotactic image guidance