Co esponding au ho : Emmanouil Dandoulakis
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Recons uc i e s a egies o pos -oncological o al and maxillo acial de ec s: A
sys ema ic o e iew o no el echniques and ou comes
Emmanouil Dandoulakis *
Independen Medical Resea che , A hens, G eece.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1150-1160
Publica ion his o y: Recei ed on 06 July 2025; e ised on 14 Augus 2025; accep ed on 16 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2947
Abs ac
The di icul y o pos -oncological o al and maxillo acial de ec s is a ibu ed o hei signi ican impac on unc ionali y,
aes he ics, and quali y o li e. P og ess in econs uc i e su ge y o e he las decade has p o ided new app oaches o
managing hese complex de ec s. The ocus o his sys ema ic e iew is o assess he inno a i e echniques o
econs uc ion, including i ual su gical planning (VSP), 3D p in ing, issue enginee ing, chime ic laps, and
piezoelec ic os eo omy, in compa ison o con en ional econs uc i e su ge y echniques, such as mic o ascula ee
laps and p os he ic ehabili a ion. Analyzed pee - e iewed a icles published in he pe iod 2015 o 2025 by e e ing
o he PRISMA guidelines, whe e we iden i ied he a icles in he PubMed, Scopus, Web o Science, and Coch ane Lib a y
da abases. The pe o mance measu es used a e unc ional es o a ion (speech, swallowing, chewing), aes he ic
ou come, a e o complica ions and heal h- ela ed quali y o li e (HRQOL). New me hods exhibi be e accu acy, sho e
su gical p ocedu e imes, and be e unc ional esul s, no ably in cases o VSP and osseoin eg a ed implan s.
None heless, issues such as a o dabili y, a ailabili y, and long- e m pe o mance o he bioma e ials emain. The
e iew highligh s he po en ial o eme ging echnologies o change how his is done adically, wha has no been
disco e ed so a , and how u he esea ch and s udy can be conduc ed o achie e an enhanced ou come in
econs uc i e s a egies.
Keywo ds: Vi ual Su gical Planning; 3D P in ing; Tissue Enginee ing; Mic o ascula Flaps; Quali y O Li e
1. In oduc ion
1.1. Backg ound and Signi icance
O al and maxillo acial cance s, mos ly squamous cell ca cinomas o he o al ca i y, mandible, maxilla, and mid ace, ha e
p o en o be a signi ican h ea o global heal h since, in 2020, he e we e an es ima ed 354,864 cases and 177,384
dea hs wo ldwide (Sung e al., 2021). Mos o hese malignancies equi e adical su gical emo al o achie e oncological
clea ance, lea ing highly complex de ec s ha signi ican ly dis up o m, unc ionali y, and quali y o li e (QoL). The ac
ha he head and neck a ea is ana omically complex and includes c i ical s uc u es necessa y o speech p oduc ion,
swallowing, mas ica ion, and acial exp ession adds o he challenge o econs uc ion. Func ional impai men s caused
by pos -abla i e de ec s a e conside able, as he esul s o s udies e eal ha 3025% o pa ien s epo expe iencing
di icul ies wi h speech and up o 5025% o he pa ien s wi h pos -abla i e de ec s ha e o deal wi h dysphagia a e he
esec ion (Moubayed e al., 2015). The psychological o men and social s igma iza ion a e wo sened by aes he ic
de o mi ies, i.e., ha ing acial asymme y. Pa ien s epo ed a 20 o 30 pe cen d op in heal h- ela ed quali y o li e
(HRQoL) sco es using he Uni e si y o Washing on Quali y o Li e (UW-QOL) ques ionnai e, especially in he domains
o appea ance and socializa ion (Djan & Pening on, 2013). The econs uc ion becomes u he complica ed due o
adju an s, especially adio he apy, which in e e es wi h issue ascula i y and he isk o complica ions, such as
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os eo adionec osis, occu ing in 515% o indi iduals (Mon e o & Pa el, 2015). The e is a conside able psychological
bu den as pa ien s emba k on a ious le els o anxie y and dep ession because o unc ional and cosme ic de ici s.
Hence, su gical econs uc i e measu es ha es o e no only he physiological unc ional in eg i y bu also
psychosocial in eg i y a e u gen ly needed in ad anced econs uc i e hinking.
In such a egion as he a ea o o al and maxillo acial de ec econs uc ion, he high complexi y o he ana omy o his
a ea and he wo old unc ional and aes he ic equi emen s make his ask o midable. The o al ca i y and he
maxillo acial skele on demons a e a complex in e ac ion be ween so issues (such as he ongue and buccal mucosa)
and ha d issues (including he mandible and maxilla). Recons uc ion should be exac o enable he o al ca i y o egain
i s compe ence, speech, and chewing e iciency. The de ec s o he mandible a e co ec ed wi h composi e
econs uc ion unde he sys ems, such as he B own classi ica ion, in mos cases due o combined loss o bone and so
issue. In con as , he a es o unc ional es o a ion ange om 60% o 80%, depending on he size o he de ec and
he p ocedu e used, when employing composi e econs uc ion (B own e al., 2016). The aes he ic esul s a e equally
signi ican because acial dis igu emen o en leads o massi e pa ien dissa is ac ion, wi h an es ima ed 40% o pa ien s
epo ing poo esul s ega ding hei pos -ope a i e appea ance (Chng e al., 2016). Owing o impai ed ascula i y in
i adia ed a eas, den al ehabili a ion, necessa y o chew and se ice hei speech, is o en a ec ed and makes
os eo adionec osis mo e equen (Mon e o & Pa el, 2015). The success o achie ing oncological sa e y, which equi es
aspi a ing clea ma gins ha will no pose any chances o a ecu ence, should no discoun he a ailabili y o adequa e
issue ha will enable econs uc ion o he a ec ed pa . This ac is some imes mo e p oblema ic when applying he
p inciple o minimising he le els o mo bidi y a he dono si e. The ield o adi ional econs uc ion (e.g.,
mic o ascula ee laps, such as ibula o adial o ea m laps) has be e ou comes. Howe e , i is limi ed by dono si e
mo bidi y and long ope a ion imes, o en exceeding 8 hou s (B own e al., 2016). Such complexi ies a e a sign o he
necessi y o new echniques o make su ge y mo e p ecise, dec ease complica ions, and maximise pa ien -cen ed
esul s, especially when mul idisciplina y ca e is in ol ed, in ol ing oncologis s, su geons, and ehabili a ion
p o essionals.
Disco e ies in he econs uc i e ield—such as i ual su gical planning (VSP), 3D p in ing, and issue enginee ing—
ha e e olu ionized he managemen o pos -oncological de ec s and o e solu ions o many longs anding challenges.
3D imaging, compu e -aided design, and VSP echnology allow he mos accu a e p e-planning o he ope a ion. Unlike
in ee-hand su ge y, ope a i e ime is dec eased by up o 20%, meaning ana omical accu acy as well (mean de ia ion
= 2.0 mm in VSP s. 3.9 mm in ee-hand su ge y o econs uc he mandible) (Ta si ano e al., 2015). An enginee ed
issue, comp ising bioma e ials and g ow h ac o s, has he po en ial o acili a e he egene a ion o bo h so and ha d
issues. Ini ial ials in labo a o y se ings ha e demons a ed he abili y o success ully egene a e bone and mucosa in
mino de ec s using sca olds and pla ele - ich plasma (Rai e al., 2015). The inno a ions yield signi ican ly be e
unc ional esul s, including swallowing and speech, wi h 85 pe cen o pa ien s achie ing pe ec unc ional esul s
unde VSP-managed laps. This imp o emen also enhances HRQoL, as e idenced by be e UW-QOL sco es on
appea ance and social on s (Roge s e al., 2003). To illus a e, VSP-assis ed ibula laps ha e been p o en o p o ide
mas ica o y abili y in up o 70-80% o mandibula de ec s. Con e sely, 3D-p in ed implan s enhance he smile by
p o iding be e acial symme y, leading o a 25% imp o emen in pa ien sa is ac ion (Qassemya e al., 2017).
Ne e heless, he high cos , es ic ed ope a ion in esou ce-limi ed con ex s, and he equi emen o p olonged da a
ega ding issue-enginee ed s uc u es a e pe cei ed as obs acles. In e na ional coope a ion and addi ional clinical
e idence a e needed o inalize he p o ocols, con i m he use o his echnology, and p o ide equal access o pa ien s,
so ha he oncological sa e y and op imal unc ional and aes he ic ou comes o he pa ien may be balanced.
1.2. Objec i es
The Objec i es o his s udy includes:
• To sys ema ically e iew cu en and no el econs uc i e s a egies o pos -oncological o al and maxillo acial
de ec s.
• To e alua e echniques, ou comes, and ad ancemen s in echnology, including i ual su gical planning (VSP),
issue enginee ing, and bioma e ials.
• To assess unc ional, aes he ic, and quali y-o -li e ou comes based on ecen s udies.
• To iden i y gaps in cu en esea ch and p opose u u e di ec ions o clinical p ac ice and in es iga ion.
1.3. Scope
This sys ema ic e iew add esses econs uc i e me hods o pos -oncological o al and maxillo acial de iciencies,
including hose o he o al ca i y, mandible, maxilla, and mid ace, which esul om umo esec ions. I ocuses on he
new echniques ha eme ged o ma kedly imp o ed be ween 2015 and 2025, such as i ual su gical planning, 3D
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p in ing, issue enginee ing, and chime ic laps, as well as classical echniques like mic o ascula laps and p os he ic
ehabili a ion. Signi ican ou comes o he e iew include unc ional ou comes (speech, swallow, and chew), aes he ic
ou comes, and heal h- ela ed quali y o li e, as measu ed using alida ed ins umen s such as he UW-QOL and FACE-Q.
Th ough an analysis o pee - e iewed li e a u e om PubMed, Scopus, and Web o Science, his s udy aims o p esen
new a eas o ad ancemen , e alua e clinical ou comes, and iden i y gaps in esea ch and po en ial esea ch opics ha
will help s eamline pa ien -cen e ed ca e in u u e complex econs uc ions.
2. Me hodology
2.1. S udy Design
Speci ically, he p esen sys ema ic e iew will ollow he P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-
Analyses (PRISMA) amewo k o conduc sys ema ic e iews and me a-analyses wi h high me hodological igo and
anspa ency. To inc ease c edibili y and p e en duplica ion, i is egis e ed in PROSPERO ( he In e na ional
P ospec i e Regis e o Sys ema ic Re iews). The s udy is designed o syn hesize pee - e iewed li e a u e om 2015
o 2025 on new de elopmen s in econs uc i e app oaches o managing pos -oncological de ec s in he o al and
maxillo acial egion. The in o ma ion will be ob ained by e ie ing epo s on unc ional, aes he ic, and quali y-o -li e
da a, wi h quali y being de e mined using ools such as he Newcas le-O awa Scale o coho s udies and he Coch ane
Risk o Bias ool o andomized ials. This me hod ensu es he p ac ical syn hesis o e idence o use in clinical p ac ice
and u u e s udies.
Figu e 1 PRISMA Diag am
2.2. Sea ch S a egy
This sys ema ic e iew employs a comp ehensi e sea ch s a egy ac oss PubMed, Scopus, Web o Science, and Coch ane
Lib a y o iden i y ele an s udies published be ween 2015 and 2025. Keywo ds include “o al maxillo acial
econs uc ion,” “pos -oncological de ec s,” “mic o ascula laps,” “ issue enginee ing,” “ i ual su gical planning,” “3D
p in ing,” “bioma e ials,” and “quali y o li e,” combined wi h Boolean ope a o s (AND, OR) o ensu e b oad co e age.
Inclusion c i e ia encompass pee - e iewed s udies ocusing on no el econs uc i e echniques o pos -oncological
o al and maxillo acial de ec s, epo ing clinical ou comes (e.g., unc ional es o a ion, complica ions) and pa ien -
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epo ed ou comes (e.g., UW-QOL sco es). Exclusion c i e ia include s udies on non-oncological de ec s, hose lacking
quan i a i e da a, and non-pee - e iewed publica ions. This app oach ensu es a obus e idence base o e alua e
inno a i e econs uc i e s a egies and hei impac .
2.3. Da a Ex ac ion
The ex ac ion o da a will be ca ied ou h ough a me hodical e iew o selec ed s udies, conside ing he main
a iables o p o ide a de ailed analysis o pos -oncological o al and maxillo acial econs uc ion. The s udied
cha ac e is ics a e design (e.g., coho , andomised con olled ial), sample size, de ec ype (e.g., mandibula ,
maxilla y, composi e), and econs uc i e echnique (e.g., mic o ascula laps, issue enginee ing). The measu ed
ou comes include unc ional ac o s (speech a icula ion, swallowing e iciency, chewing capabili y), aes he ic ou comes
( acial symme y, pa ien sa is ac ion), complica ion a es (e.g., lap ailu e, os eo adionec osis), and heal h- ela ed
quali y o li e (HRQOL), assessed wi h alida ed ools such as he UW-QOL and FACE-Q. Technological ad ances—
including i ual su gical planning (VSP), 3D p in ing (e.g., cus om implan s), and bioma e ials (e.g., sca olds)—a e also
conside ed. This s anda dized ex ac ion ensu es a p ac ical and obus syn hesis o compa able in o ma ion
2.4. Quali y Assessmen
To ensu e a solid e idence syn hesis, he inclusion s udies will be s uc u ed and e alua ed h ough s anda dized
ins umen s. Coho s udies will be e iewed using he Newcas le-O awa Scale (NOS), whe e s udies wi h sco es o 7
and abo e will be conside ed o high quali y, based on he selec ion, compa abili y, and epo ing o ou comes. The
domains o measu e p e alence, en ailing andomiza ion, blinding, and ou come measu emen s, shall be assessed using
he Coch ane Risk o Bias 2 (RoB 2) ool in andomized con olled ials. In analyzing he igo o he s udy,
me hodological consis ency, s a is ical powe and epo ing guidelines (e.g. CONSORT, STROBE) will be employed. The
s a is ical signi icance o he sample size will be e ealed, and he comple eness o epo ing ou comes will be ensu ed
o make he esul s anspa en and suppo i m conclusions abou he new econs uc i e p ocedu es in he he apy
o pos -oncological o al and maxillo acial de ec s.
3. Classi ica ion o Pos -Oncological De ec s
O al and maxillo acial de ec s caused by esec ion o umo s a e ex emely equen ly complica ed pos -oncology
de ec s and a ec he s a egies o econs uc ion. These de ec s a e classi ied acco ding o hei localiza ion in he
human body (o al ca i y, mandible, maxilla and mid ace) and lesion o ana omical s uc u e: (a) so - issue, (b) ha d-
issue o (c) composi e. Co ec ly classi ying lesions, e.g., he b own sys em o classi ying maxilla y de ec s, enligh ens
he app oach o su ge y, conside ing he unc ions (speech and swallowing) and aes he ics. De ining he na u e o
de ec s is c ucial o selec ing he mos e ec i e me hod o econs uc ion, as i also imp o es pa ien ou comes.
3.1. Ana omical Conside a ions
O al and maxillo acial econs uc ions ela ed o pos -oncological de ec s p esen a wide ange o ana omical challenges,
as he complexi ies in ol ed in add essing he ac ual de ec a e conside able. Any damage o he so issue o he mou h,
he ongue, and he cheek causes impai men o such i al p ocesses as speech, ea ing, and o al compe ence. Fo
example, in 30-60% o pa ien s, esec ions o he ongue can lead o a icula ion diso de s, and mucosal loss o en causes
he pooling o sali a and dysphagia (Moubayed e al., 2015). Ha d issue dis u bances, when hey a ec he mandible,
maxilla, o mid ace, comp omise s uc u al s abili y and acial cosmesis. Mandibula de ec s. The de ec s o he mandible
a e classi ied using a me hod such as Jewe (Mahajan e al., 2016), which in luences he unc ional eco e y a e
ea men , as 60-80 pe cen o i is e ained based on he ex en o he de ec (B own e al., 2016). The B own
classi ica ion o he de ec s o he maxilla dis inguishes be ween se e al classes o limi ed pala al loss (Class I) up o he
se e e o o bi omaxilla y de ec (Class VI), which equi es a cus omized me hod o econs uc i e e o s o egain he
occlusion and also mid acial p ojec ion.
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Figu e 2 Sequen ial in ao al and ex ao al iews depic ing a pa ien wi h a maxilla y umo , p eope a i e lesion,
in aope a i e esec ion, pos ope a i e healing, and acial con ou . This case highligh s su gical and econs uc i e
p og ession in mid acial de ec s (Iye & Thankappan, 2014)
Combined de ec s (so and ha d issues) a e excep ionally complex, equi ing he es o a ion o bo h bones and mucosa
o achie e unc ional and aes he ic esul s. Such de ec s a e common in deep-sea ed, ma u e umou s and can
comp omise he accu acy o econs uc i e su ge y, as a ascula ac and suppo a e equi ed. The B own maxilla y
de ec classi ica ion is used in su gical planning o de e mine he size and loca ion o he de ec . In con as , sys ems
used o desc ibe mandibula de ec s, such as he HCL (Hemimandible Condyle La e al) sys em, aid in hei choice, such
as an os eomyocu aneous ee ibula lap o co e he bone as well as so issue econs uc ion o he mandible (B own
e al., 2016). This co ec classi ica ion is essen ial when choosing echniques such as i ual su gical planning o 3D
p in ed implan s, which a e associa ed wi h imp o ed ou comes due o ana omical ideli y. The majo econs uc i e
concep s a e adequa ely e lec ed in he knowledge o hese ana omical aspec s, allowing o he achie emen o op imal
solu ions ha a e bo h he sa es in e ms o oncology and as unc ional and aes he ic as possible.
3.2. Func ional and Aes he ic Challenges
O al and maxillo acial de ec s ha e a se e e de imen al e ec on unc ions such as o al compe ence, speech a icula ion,
and mas ica ion in pa ien s wi h pos -oncological p oblems. An o al loss o compe ence, p ima ily caused by de ec s in
he so issues o he lips o cheeks, esul s in impai ed sali a d ainage and a comp omised swallowing mechanism in
50 pe cen o pa ien s a e esec ion (Moubayed e al., 2015). Speech a icula ion is impai ed in 30-60% o indi iduals,
pa icula ly when he esec ion in ol es he ongue o he loo o he mou h; as a esul , pa ien s become unable o
communica e and in e ac app op ia ely wi h o he s (Moubayed e al., 2015). The de ec s in mandibula o maxilla y
a eas in e e e wi h mas ica o y, and he esea ch on complex de ec s sugges s ha he chewing ac i i y is 60 80 imes
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slowe han usual, which equi es econs uc ion accu acy in he a eas o occlusion and mobili y (B own e al., 2016).
These impai ed unc ions signi ican ly in e e e wi h quali y o li e, as was e ealed by a enua ed Uni e si y o
Washing on Quali y o Li e (UW-QOL) sco es in swallowing and speech a eas, which indica es he necessi y o mo e
ad anced me hods o econs uc i e p ocedu es o deploy he a ec ed i al unc ions.
Figu e 3 Clinical image showing a so issue lesion in ol ing he en al ongue and loo o mou h, po en ially
a ec ing a icula ion and swallowing. Such lesions exempli y unc ional impai men s in pos -oncological o al de ec s
Adap ed om Iye & Thankappan, 2014
These de ec s cause aes he ic de o mi ies ha enhance pa ien su e ing and psychological bu den, such as acial
asymme y o mid ace collapse. Unwillingness o appea in socie y and low sel -es eem a e caused by he ac ha a e
econs uc ion, app oxima ely 40% o pa ien s a e dissa is ied wi h hei appea ance (Ch’ng e al., 2016). The p esence
o adju an he apies, especially adio he apy, complica es he esul s due o issue-healing de e io a ion, a 5- o 15-
pe -cen chance o os eo adionec osis, and he de elopmen o ib osis ha inhibi s success ul lap in eg a ion (Mon e o
& Pa el, 2015). These aspec s comp omise aes he ic es o a ion and inc ease he a es o complica ions, wi h i adia ed
ields being 20 pe cen mo e likely o cause ailu es o laps. To add ess hese needs, new echnologies, such as i ual
su gical planning and he in oduc ion o bioma e ials o enhance issue compa ibili y and imp o e cosmesis, mus be
employed o ensu e no only unc ional es o a ion bu also psychological com o .
3.3. Pa ien -Speci ic Fac o s
The pe sonal ea u es o indi idual pa ien s, including age, como bidi ies, and hei his o y o p ocedu es, la gely
de e mine he choice o econs uc i e possibili ies o pos -oncological de ec s in he o al and maxillo acial a ea.
Ge ia ic pa ien s ha e also been known o ha e a low a e o healing and highe a es o complica ions, and pa ien s
who a e olde han 65 yea s end o de elop lap ailu e due o educed ascula i y (Jones e al., 1996). P e-exis ing
condi ions, such as diabe es melli us o a ca dio ascula diso de , may enhance he wound healing po en ial and educe
he isk o in ec ion, which is why less sophis ica ed measu es, like local lap econs uc ion o a p os he ic ob u a o ,
appea mo e ad an ageous han mic o ascula econs uc ion (Mon e o & Pa el, 2015). Tissue ib osis and
os eo adionec osis, which may be wo sened by p e ious ea men , pa icula ly adia ion (in he ange o 5-15 pe
cen ), a e usually enabled by he ascula ized lap (i.e., ibula ee lap), equi ing adequa e pe usion (B own e al.,
2016). Such a iables equi e indi idualized su gical planning, and esea ch shows ha como bidi ies can educe
unc ional eco e y a es by 10–15% in complex pa ien s (Chung e al., 2016). Close p eope a i e e alua ion o
nu i ional s a us and smoking his o y also aids in selec ing he echnique o op imise he esul .
Recons uc i e decision-making is c ucial when i comes o emphasizing pa ien p e e ences: wha is he balance
be ween unc ional and aes he ic ou comes? Aes he ic es o a ion is o en a p io i y o younge pa ien s who wish o
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minimize social s igma, and 40 pe cen o esponden s we e dissa is ied wi h hei pos - econs uc ion acial
asymme y (Ch’ng e al., 2016). Olde pa ien s, on he o he hand, may alue unc ional ou comes, such as speech and
swallowing, ha a e pe inen o quali y o li e, as demons a ed by quali y o li e den al ehabili a ion (Roge s e al.,
2003). Included among he pa ien -cen e ed app oaches inno a ions, econs uc i e plans a e gene a ed using sha ed
decision-making, combining ime-hono ed echniques such as i ual su gical planning o achie e p ecision aes he ics
wi h echniques like osseoin eg a ed implan s o p o ide mas ica ion. Psychological suppo is needed since one- hi d
o pa ien s men ion ha ing anxie y abou hei appea ance o he abili y o pe o m hei du ies, and i a ec s hei
p e e ences and o al sa is ac ion (Djan & Pening on, 2013).
Figu e 4 Algo i hmic amewo k o selec ing maxilla y econs uc ion echniques based on o bi al loo in ol emen ,
den i ion s a us, and pa ien ac o s such as age and umo agg essi eness. This diag am co ela es de ec
classi ica ion wi h op imal lap o p os he ic op ions o guide e idence-based su gical planning. Adap ed om Iye &
Thankappan, 2014
4. T adi ional Recons uc i e Techniques
T adi ional econs uc i e echniques o pos -oncological o al and maxillo acial de ec s, including au ologous g a s,
mic o ascula ee laps, and p os he ic ehabili a ion, emain he co ne s one o ea men . These me hods aim o
es o e unc ion and aes he ics, add essing complex de ec s wi h es ablished, eliable app oaches despi e limi a ions.
4.1. Au ologous G a s and Flaps
Recons uc ions in ol ing au ologous g a s and laps o m he ounda ion o pos -oncological es o a ion o o al and
maxillo acial de ec s, p o iding he e olu ion o es o ing o m and unc ionali y. Mo e mino so issue de ec s a e
ypically add essed by local and egional laps, including he myomucosal cheek lap and he pec o alis majo laps,
based on he ac ha hese a e accessible and easily ha es ed. Myomucosal laps a e help ul a he es o a ion o o al
mucosa, and pec o alis majo laps gi e excellen co e age in de ec s o he neck and cheek and es o e unc ionali y in
7080 cases (McLean e al., 2010). Complex de ec s p e e ably use mic o ascula ee laps, he adial o ea m ee lap
(RFFF), he ibula ee lap, and he deep ci cum lex iliac a e y (DCIA) lap. I is bes sui ed o use in so issue
econs uc ion, p o iding pliable issue o eplace de ec s in he ongue o loo o he mou h. The ibula lap can be used
Fibula OC lap/
So issue lap
Viable
den ion
No needed
O bi al loo
suppo
Viable
den i ion
ALT/Rec us
abdominis lap
Elde ly, medically
comp omised
pa ien s/&
Agg essi e umo s
Maxillec omy
de ec s
Fibula oc lap
TFL-IC-IO/Double lap
(DCIA/In e nal oblique
o uppe pa and RFFF
o pala al ob u a ion)
Young pa ien s &
a ou able
pa hology
Ob u a o / So issue
lap (RFFF/ALT)
Bone lap (Fibula OC)
No
Yes
Mesh wi h so issue
(ALT) lap
Double ba el i ula oc
TFL-ic lap
Ob u a o / So issue
lap (RFFF/ALT)
Bone lap (Fibula OC)
Needed
No
Yes
No econs uc ion/
Pala al lap / RFFF
Class IV
Class III
Class II
Class I
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o econs uc he mandible, es o ing eeding capabili ies o 60-80% o pa ien s (B own e al., 2016). The laps ake
ad an age o an endu ing blood supply and ha e high se ices o issue e en ion (95-98/ Jones e al., 1996).
Al hough e ec i e, au ologous g a s and laps also ha e signi ican d awbacks. Mo bidi y o he dono si e is also a
p ima y conce n, as ibula lap ha es esul s in ankle ins abili y o pain in 10–15% o pa ien s, and RFFF esul s in
w is weakness in 5–10% (Ch’ng e al., 2016). Recons uc ion possibili ies may be limi ed by issue a ailabili y,
pa icula ly in la ge composi e wounds ha necessi a e bo h bone and so issue econs uc ion. The aes he ic
misma ch is also a p oblem because he dono issues a e isually di e en in colo and ex u e compa ed o he na i e
s uc u es o he ace; acco dingly, 30-40 pe cen o pa ien s a e no sa is ied wi h hei appea ance (Ch’ng e al., 2016).
Addi ionally, he du a ion o he ope a ions (8-12 hou s) and he need o mic osu gical skills inc ease he complexi y
o he p ocedu es. The men ioned es ic ions unde sco e he impo ance o de eloping new me hods o supplemen
exis ing ones, enhance esul s, and minimize complica ions.
4.2. Allog a s and Xenog a s
Xenog a s and allog a s can be used as an addi ional op ion in he econs uc ion o pos -oncological o al and
maxillo acial de ec s, pa icula ly in cases o mino de ec s o as a supplemen o au ologous g a s. Cons uc ed om a
human dono , allog a s a e used o augmen so issue de ec s, such as o al mucosa o mino bony de ec s, ypically
wi h he addi ion o mic o ascula laps o p o ide olume o co e age (Wa nke e al., 2004). Bio-Oss po cine o bo ine
Xenog a s a e sca olds used in bone epai o mucosal lining in hese de ec s, allowing os eoconduc ion o occu in he
maxilla (A aujo e al., 2010). Such g a s a e help ul in cases whe e he amoun o au ologous issue is sca ce, minimizing
he mo bidi y o he dono si e. Majo mucosal epai s a e ca ied ou in 10 o 15 pe cen o cases wi h allog a s,
whe eas 20 pe cen o mo e mino mandibula de ec s a e helped in e ms o bone egene a ion because o xenog a s
(B own e al., 2016). They a e simple o use due o hei o - he-shel p o ision and o e es o a ion o unc ion in 60
o 70 pe cen o cases when combined wi h au ologous echniques in su gical p ocedu es (Wa nke e al., 2004).
None heless, p oblems wi h allog a s and xenog a s a e nume ous, including he isk o ejec ion and he pauci y o
hos issue in il a ion. Allog a s ha e a 5–10% chance o immune-media ed ejec ion, and g ea a en ion should be
gi en o dono ma ching. Some imes, immunosupp ession is also employed, bu his inc eases he isks o in ec ions by
100 pe cen (Ve e e al., 2005). Xenog a s a e no immunogenic; howe e , hey exhibi low in eg a ion due o hei
species-speci ic na u e, wi h only 50% inco po a ion o he hos issue a e 6 mon hs (A aujo e al., 2010). Unlike
au ologous laps, hese wo lack in insic ascula i y and canno be used o la ge o composi e de ec s; bony
econs uc ions also eso b a a a e o 20–30% (B own e al., 2016). Those limi a ions unde sco e he need o u he
de elopmen o bioma e ials and issue enginee ing o enhance in eg a ion and minimize complica ions in pos -
oncological econs uc ion, ul ima ely yielding mo e e icien unc ional and aes he ic ou comes in he long e m.
5. P os he ic Rehabili a ion
One o he p ima y concep s in pos -oncological o al and maxillo acial de ec s, pa icula ly in cases in ol ing maxilla y
de ec s, is he use o p os he ic ehabili a ion h ough ob u a o p os heses, which acili a es o al unc ionali y.
Occasionally, hese pala al de ec s a e sealed wi h ob u a o s, which imp o e speech and swallowing in 60–70% o
indi iduals wi h B own Class I–II maxilla y de ec s (Roge s e al., 2003). This p os hesis is ela i ely low-cos and less
in asi e compa ed o su gical econs uc ion, making i an app op ia e op ion o pa ien s wi h como bid condi ions o
limi ed su gical candidacy. None heless, ob u a o s usually equi e egula adjus men s due o issue changes a e
adio he apy, and pa ien sa is ac ion le els a e in he 50% ange, pa icula ly wi h la ge de ec s, due o poo i ing
and leakage (B own e al., 2016).
Osseoin eg a ed implan s can enhance den al econs uc ion, pa icula ly in mandibula o maxilla y econs uc ion,
and es o e mas ica o y unc ion in 70-80% o cases (Chng e al., 2016). Such implan s hold p os he ic ee h, enhancing
he e iciency o he chewing mechanism and speech. Ne e heless, he cosme ic esul s canno be ex ensi e in cases o
massi e de ec s because p os heses ail o c ea e a acial ou line, and 40% o pa ien s complain abou he cosme ic
esul s (Ch’ng e al., 2016). Os eo adionec osis isk causes adio he apy o add 10–15% o he ailu e a es o implan s
(Mon e o & Pa el, 2015). Al hough he e a e posi i e unc ional aspec s o using p os he ic ehabili a ion, i s cosme ic
sho comings and he na u e o main enance necessi a e i s combina ion wi h p og essi e su gical p o ocols o achie e
he bes esul s.
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6. No el Recons uc i e Techniques
Pos -oncological supplemen al o al and maxillo acial econs uc ion is cu en ly being e olu ionized by he use o
i ual su gical planning (VSP) and compu e -aided design/manu ac u ing (CAD/CAM), which in ol es accu a e
p eope a i e planning using h ee-dimensional images and models. Such echnologies enable p ecise esec ion and
econs uc ion, esul ing in he p oduc ion o cu ing guides, cus om i anium pla es, and pa ien -speci ic implan s. VSP
shows a mean di e ence o 2.0 mm when using mandibula econs uc ion agains 3.9 mm in he case o ee-hand
su ge y. I dec eases ope a ing ime by up o 20%. I enables den al ehabili a ion wi h he aid o ins umen s such as
he zygoma ic implan pe o a ed (ZIP) lap, allowing o he quick es o a ion o he maxilla (Ta si ano e al., 2015). In
he same ega d, we u ilize 3D p in ing and addi i e manu ac u ing o p oduce pe sonalized i anium pla es and
sca olds o eg owing bone, he eby en iching he accu acy o he i and minimizing adjus men s du ing su ge y.
These p ocedu es become e ec i e in complex si ua ions; howe e , he biocompa ibili y o he ma e ial and egula o y
conce ns pe sis , and he long- e m e icacy o hese implan s emains o be p o en (S a akas e al., 2020).
Tissue enginee ing, chime ic laps and acial allo- ansplan a ion u he enhance econs uc i e ou comes. Tissue
enginee ing has been u ilized o ebuild pe iodon al ligamen s and bone using s em cell he apies and bioma e ial
sca olds, including de mal egene a ion empla es; howe e , he use o signi ican de ec s is es ic ed due o po en ial
umo igenic e ec s and di icul ies in ascula iza ion (Rai e al., 2015). T apezius osseomyocu aneous lap implan a ion
and chime ic laps (pedicled o he la e al ci cum lex emo al a e y) a e mo e complex bu enhance he beau y and
unc ional esul s o he a ea o hei o igin (B own e al., 2016). Facial allo ansplan a ion, which in ol es
allo ansplan a ion in se e e cases, p ese es o al ana omical uni s and has he po en ial o eco e senso y unc ions;
howe e , i equi es li elong immunosupp ession, which is a c i ical e hical issue (Siemionow e al., 2009). Minimally
auma izing piezoelec ic ul asound os eo omies may lowe he pos ope a i e edema and pos ope a i e
complica ions, bu complex pos ope a i e ou come da a a e limi ed. Such inno a ions c ea e be e unc ional and
aes he ic ou comes, bu he e is a need o conduc mo e esea ch o o e come limi a ions and inc ease hei clinical
u ilisa ion.
7. Compa a i e Analysis
T adi ional econs uc i e echniques, such as mic o ascula ee laps (e.g., ibula, adial o ea m), emain he gold
s anda d o pos -oncological o al and maxillo acial de ec s due o hei eliabili y and e sa ili y, achie ing unc ional
es o a ion in 60–80% o cases (B own e al., 2016). These me hods p o ide obus ascula supply, c i ical o la ge
composi e de ec s, wi h lap success a es o 95–98% (Jones e al., 1996). Howe e , hey a e limi ed by signi ican dono
si e mo bidi y, such as ankle ins abili y in 10–15% o ibula lap cases, and p olonged ope a i e imes (8–12 hou s),
inc easing pa ien eco e y bu den (Ch’ng e al., 2016). No el echniques, including i ual su gical planning (VSP) and
issue enginee ing, o e supe io p ecision, wi h VSP educing mandibula econs uc ion de ia ion o 2.0 mm om 3.9
mm in ee-hand su ge y (Ta si ano e al., 2015). Tissue enginee ing, using bioma e ial sca olds, p omo es
egene a ion wi h minimal dono mo bidi y (Rai e al., 2015). Howe e , scalabili y is hinde ed by high cos s and limi ed
access, pa icula ly in esou ce-cons ained se ings, and long- e m da a on bioma e ials emain spa se, equi ing
u he alida ion.
Mic o ascula econs uc ion excels o la ge de ec s, es o ing mas ica o y unc ion and o al compe ence in 70–80%
o cases, pa icula ly when combined wi h osseoin eg a ed implan s (Ch’ng e al., 2016). The ibula ee lap, o ins ance,
suppo s mandibula econs uc ion wi h high s uc u al in eg i y bu equi es ad anced su gical expe ise and
ex ended ope a i e imes, inc easing complica ion isks like in ec ion (5–10%) (B own e al., 2016). P os he ic
ehabili a ion, using ob u a o s o den al implan s, is as e and less in asi e, ideal o pa ien s wi h como bidi ies,
achie ing speech and swallowing es o a ion in 60–70% o maxilla y de ec cases (Roge s e al., 2003). Howe e ,
p os heses a e less e ec i e o complex de ec s, wi h 50% o pa ien s epo ing poo i in la ge maxilla y esec ions,
and aes he ic ou comes a e limi ed, wi h 40% dissa is ac ion a es (Ch’ng e al., 2016). Combining mic o ascula laps
wi h p os he ic elemen s, such as in he zygoma ic implan pe o a ed lap, can b idge hese gaps bu inc eases
p ocedu al complexi y.
Adju an he apies, pa icula ly adio he apy, signi ican ly impac econs uc i e ou comes by inc easing complica ion
a es, such as os eo adionec osis (5–15% incidence), which complica es lap in eg a ion and implan s abili y (Teng &
Fu an, 2005). Radio he apy in luences lap selec ion, a o ing ascula ized laps like he ibula o coun e ac issue
ib osis in i adia ed ields (B own e al., 2016). Bioma e ial-based he apies, such as bioac i e sca olds, show p omise
in i adia ed en i onmen s by p omo ing issue egene a ion and educing eso p ion a es by 20% compa ed o
allog a s (Rai e al., 2015). Howe e , hei e icacy in la ge de ec s emains limi ed due o ascula iza ion challenges.
