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Reconstruction of facial and jaw structures affected by trauma, tumours, previous surgery or malformations.
Maxillofacial reconstructive surgery restores bone and soft-tissue structures of the face and jaws that have been lost or altered. It may be required after tumour resection, following trauma, in cases of infection or osteonecrosis, after previous surgery, or in certain malformations.
The primary objective is functional: to restore the ability to chew, speak, swallow and breathe, together with a balanced facial anatomy.
Assessment considers the size and location of the defect, the quality of the surrounding tissues, the patient's general condition and any previous treatment received, such as radiotherapy.
Three-dimensional imaging makes it possible to measure the defect and study the available donor sites.
Depending on the size of the defect and the patient's condition, reconstruction may be approached with bone grafts, regenerative materials, plates or patient-specific devices, or with microvascular free flaps that provide bone and tissue with their own blood supply.
Each option has its own indications, requirements and timeframes; there is no single solution applicable to every case.
Virtual planning allows the reconstruction to be designed before surgery: defining the osteotomies, orienting the bone segments and anticipating future implant rehabilitation when this forms part of the plan.
Reconstruction is usually carried out in stages. Once the bone structure has consolidated, dental rehabilitation can be considered, sometimes with implants, provided local conditions allow it.
These are complex treatments with long timeframes, and outcomes depend on each patient's starting situation; they require continued clinical and radiological follow-up.
Reconstruction may be necessary when there is a significant loss or alteration of bone and tissue that compromises the anatomy or function of the maxilla or mandible.
The causes are varied. They may include resection of lesions or tumors, trauma, infections, severe atrophy, sequelae of previous treatments, or certain congenital defects.
The reconstructive goal depends on the problem. In some cases it is to restore bone continuity and stability; in others, to re-establish facial contour, separate cavities, provide support to the soft tissues, or create conditions for future dental rehabilitation.
Reconstructing therefore does not simply mean "filling" a defect. It is necessary to understand which structures have been lost and which functions must be restored. The more complex the defect, the more important it becomes to plan, from the outset, the final functional result to be achieved.
The reconstructive strategy depends on the location, size and three-dimensional characteristics of the defect, the soft tissue available, its cause, and the subsequent functional goals.
Smaller defects can be treated with different bone regeneration techniques or bone grafts. When the loss is extensive, more complex reconstructions may be necessary, including larger-volume grafts or transfer of vascularized tissue.
In certain segmental reconstructions, microvascular free flaps are used, capable of providing bone and tissue with their own blood supply. Virtual planning can help determine the geometry of the reconstruction and the position of the segments.
There is no universally superior technique. An appropriate reconstruction is one that responds to the specific characteristics of the defect and considers, from the beginning, the function that the reconstructed structure will need to fulfill afterward.
A bone graft is material used to augment, reconstruct or promote bone formation in an area where the available volume is insufficient for the therapeutic goal.
Depending on the situation, the patient's own bone, materials of different origin, or bone substitutes may be used, alone or in combination. Each option has different properties, indications and limitations.
In maxillofacial surgery and implantology, a graft may be necessary when bone loss prevents an implant from being placed in an adequate position, or when a particular anatomy needs to be reconstructed. However, not every bone deficiency requires the same procedure.
The decision depends on the volume that needs to be restored, the shape of the defect, the soft tissues, the stability required, and the future rehabilitation. A graft is a reconstructive tool, not an identical treatment for every bone loss.
A microvascular free flap is a portion of tissue — which may include bone, muscle, skin or other components — transferred from another region of the body to the area requiring reconstruction, while preserving its blood vessels. These vessels are connected using microsurgical techniques to recipient vessels in the reconstructed region.
This ability to provide tissue with its own blood supply is especially valuable in certain complex or large defects.
In mandibular reconstruction, for example, flaps containing bone can be used to restore lost segments of the mandible. The choice of donor tissue depends on the characteristics of the defect and the reconstructive needs.
These are highly complex procedures that require specific planning. Their indication is reserved for situations in which their reconstructive advantages justify the magnitude of the intervention.
In many cases it is possible to reconstruct the mandible after resection, although the strategy depends on the extent and location of the defect, the diagnosis, the affected tissues, and the overall oncological treatment.
When the resection results in loss of mandibular continuity, one of the goals is to re-establish a stable structure that helps restore facial contour and functions such as chewing. In extensive defects, vascularized bone from another region may be required.
Planning can begin before the resection. Virtual techniques allow, in certain cases, the anatomy to be removed to be studied and the subsequent reconstruction of the segment to be designed in advance.
The priority remains appropriate treatment of the disease. Reconstruction must be integrated into that plan and must consider, from the outset, the functional needs, the soft tissues and the possibilities for subsequent rehabilitation.
Mandibular reconstruction restores continuity, form and function after complex defects, using microsurgical techniques and 3D planning tailored to each patient.
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3D virtual planning makes it possible to analyze anatomy, simulate procedures and accurately transfer the plan to the operating room, without replacing the surgeon's judgment.
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