Mandibular (Jaw) Reconstruction
Destruction or loss of a portion of the lower jaw (mandible) most commonly occurs as a result of tumor removal. However, it may also be due to damage from prior radiation treatment, necrosis (localized tissue death) of the jaw bone resulting from medicines for osteoporosis, congenital deformities, or trauma.
In the most common scenario, a portion of the jaw is taken out for the removal of a cancerous tumor. In these cases, our dedicated reconstruction team replaces the missing portion of the jaw with a transplant from elsewhere in the patient’s body. This is done during the same surgery as the tumor removal, and requires the kind of coordinated effort between the cancer and reconstructive team in which our center excels. The result is often a near-perfect match to the patient’s pre-surgical jaw shape and a well-healed neck scar.
Following recovery from these complex tissue transfers (commonly referred to as “microvascular free flaps”), patients are reevaluated by our prosthodontics and dentistry specialists – who they have typically met prior to surgery – and partial dentures or dental implants can be fitted from pre-surgical dental impressions.
For patients who have more extensive jaw and tooth loss from tumor removal surgeries, our team is experienced with pre-fabricated plates, created from three dimensional models of the patient’s own jaw. This can allow for more extensive implantation of dental implant posts at the time of the tumor removal and jaw reconstruction; the actual prosthetic teeth are placed onto the implanted posts after postoperative healing has occurred.
The expert ability of our reconstructive surgeons to adapt bone from the leg or shoulder blade to recreate the portion of the jaw that has been removed, makes the need for these computer modeled plates infrequent. However, the experience of our team with this cutting-edge technology provides assurance that, as these technologies improve, we will be at the forefront of applying them in appropriately selected patients.
Nasal Reconstruction
Nasal deformities may be the result of skin cancer, Mohs surgery, trauma, autoimmune disease, or congenital malformations. As the nose is the centerpiece of the face, any deformity or defect can have profound psychosocial and functional consequences.
Our team is trained to manage the entire spectrum of nasal deformities, with the principle goal of restoring aesthetic form and function to the nose. We treat everything from small defects as a result of skin cancer removal to total nasal deformities due to large and invasive cancers. Our specialists are considered leaders in this field and have pioneered techniques in nasal reconstructive surgery.
Orbitomaxillary Reconstruction (Cheek, Palate and Eye Socket)
Arguably, one of the most critical and difficult areas of the face to reconstruct is the orbitomaxillary region. This includes the roof of the mouth (hard palate), the cheekbone (maxilla), and the bones surrounding and supporting the eye (orbit).
Loss of the structure may occur for a variety of reasons. These include oral tumors, sinus tumors, skin cancers that invade deeply from the cheek, or massive trauma to the central face. The three-dimensional nature of these bones and the surrounding tissue – as well as their function in separation of the mouth from the nose and sinus, support of the eye for functions of vision, and the overall importance of the appearance of the face – make this a crucial and challenging area to rebuild.
This is an area where our team particularly excels. Our patients benefit from individualized treatment, which often includes advances and techniques that were designed here at Cleveland Clinic.
Reconstruction Following Parotid Gland Surgery
The management of parotid tumors is primarily surgical. This involves removal of a portion of or the entirety of the affected parotid gland (one of the major salivary glands). Some parotid tumors may also involve the facial nerve, the nerve responsible for movement of the face.
Without reconstruction following removal of the tumor, patients may, in some instances, be left with disfiguring facial asymmetry. Furthermore, if the tumor involves the facial nerve, patients may suffer from a postoperative facial paralysis.
Our surgeons offer comprehensive management of parotid tumors. This often entails a two-team approach between our cancer and reconstructive surgeons. Through a variety of techniques, our methods minimize potential scarring, facial contour deformities, and facial nerve paralysis.
Our reconstructive approach is tailored to the needs of each individual patient and our team of specialists will collaborate to optimize the outcome and results.
Advanced/Recurrent Skin Cancers
Large and/or recurrent skin cancers of the face and head present multiple challenges for patients and surgeons. First, removing the cancer with the best chance of permanent cure requires full surgical margin clearance and coordination of additional care (eg radiation therapy) as needed. Additionally, large skin and soft tissue defects created by removal of the tumor require complex and often multi-stage reconstruction to achieve an acceptable appearance.
It is well established that dermatologic surgeons using Mohs margin techniques provide the best chance for control of skin cancers. This method allows for confident reading of 100% of the tissue edges surrounding the tumor to ensure full removal. However, at most hospitals, coordination of this technical tissue read large cancer removal /reconstruction under anesthesia is not logistically possible. As a result, many larger cancers receive less reliable oncologic management. At Cleveland Clinic, we have an established coordinated effort which combines the expertise of dermatologic and cancer surgeons with reconstructive surgeons. This allows for the best tumor removal and chance of cure and simultaneous facial reconstruction under one anesthesia.
Facial Paralysis and Facial Nerve Disorders
Facial paralysis can be a devastating development with profound functional and social implications. Treatment methods can range from noninvasive physical therapy and Botox injections to major free innervated muscle transfers to restore a smile. We have several reconstructive surgeons with extensive training and experience in managing paralysis and facial weakness. If paralysis is caused by tumor or vascular compression, head and neck oncologic surgeons, neuro-otologists and neurosurgeons can care for the root problems, while our reconstructive team provides simultaneous nerve repair and further reconstruction when indicated. Our surgeons have developed reconstructive algorithms and have pioneered new techniques to maintain facial contour symmetry, optimize nerve restoration through grafting and provide dynamic facial motion when lost.
Physical therapy plays a major role in achieving optimal recovery after most types of facial paralysis. Our team, which includes experts in sports rehabilitation and muscle recovery, guides individuals through this process. As recovery from facial nerve injury progresses, we often combine non-invasive techniques, such as Botox injections, with physical therapy to achieve the best outcome possible.
Post-Traumatic Facial Deformities
Significant facial deformities following trauma, such as severe motor vehicle accidents or gunshot injuries, can present some of the most challenging reconstructions that are encountered. Many individuals have undergone multiple and often major operations to achieve some return to normalcy, however, in severe injuries, acceptable return of facial appearance and function may not be achieved. Our specialists have extensive experience with primary and revision facial and head and neck reconstruction in these settings, and can often bring new ideas and techniques to push severely injured patients closer to normalcy. Profound facial injuries arguably present the most difficult challenges to reconstructive surgeons, and it is quite rare that a perfect result can be achieved with one or even a few operations. With this knowledge, a stepwise approach of restoring the facial structure, then function and then form (appearance) is often required.
