In reconstructive surgery, timing matters enormously. Primary reconstruction — carried out during the same procedure as tumour removal — consistently delivers better outcomes than secondary reconstruction, which happens after a gap of weeks, months, or years. Scar tissue, radiation fibrosis, and lost soft-tissue volume make late-stage work harder in every dimension. But not every patient chooses reconstruction at the time. And when they return, the job of restoring them still needs to be done.
The patient was in his mid-twenties when a malignant tumour was removed from his left upper jaw. He was offered immediate reconstruction and declined — he lacked awareness of the procedure and its potential. He then received radiation therapy. The radiation left his face significantly deformed: loss of support to the eyeball, shrinkage of the surrounding fat tissue causing enophthalmos, inability to eat or swallow normally due to the loss of the palate, and nasal speech from the open upper jaw space. His mouth opening was so restricted that no obturator could be fitted. His self-esteem had fallen sharply.
He was seen by a head and neck surgeon, who confirmed that secondary reconstruction was possible. A maxillofacial surgeon assessed the deformity and the availability of blood vessels in the neck for the anastomosis that would be required. Before planning the surgical approach, a 3D printed model of the upper jaw defect was requested from Osteo3d.
The model revealed the extent of the loss precisely: the absent eye support, the lack of cheekbone prominence, the upper jaw bone and teeth gone, the complete hollowness of the left upper jaw area. It gave the surgical team a physical object from which to plan the reconstruction — dimensions, margins, and the structures that would need to be restored.
Microvascular maxillary reconstruction is among the most demanding procedures in head and neck surgery. The blood vessels available in a previously irradiated neck may be scarce and short. In this case, a microvascular free flap reconstruction was performed. The procedure was lengthy and technically complex.
The patient returned for follow-up with his self-esteem restored. His face looked significantly better. Speech had improved. Eating and swallowing were functional. His remaining questions for the team were characteristically human: "Can you not add a little prominence to the cheek? Can you do something for the shrunken eye? And when will you fix the teeth?" The work of restoring him would continue. But the foundation had been laid.
Osteo3d Team
Clinical Affairs