General principles of reconstruction

• Restore function: Regain mobility and the ability to chew, swallow, breathe, and articulate words.
• Recover aesthetics: Seek symmetry and natural-looking facial features.

Reconstructive surgical treatment options

Techniques vary depending on the type of defect. Below are described with practical examples, including procedures focused on functional recovery and movement restoration.

Grafts

• Technique: Transfer of skin or mucosa from a healthy area. For example, using thigh skin to reconstruct the inner lining of the mouth after a tumor resection.
• Example: In superficial facial burns, a split-thickness skin graft is applied, which heals quickly and reduces aesthetic sequelae.
• Limitations: Grafts do not provide volume or mobility; they are used for shallow defects.

• Technique: Mobilization of adjacent tissue while preserving its blood supply. A classic example: an advancement flap in the cheek to close a wound after removal of a skin tumor.
• Functional example: In lip reconstruction, muscles and skin are repositioned to restore lip mobility and the ability to pronounce sounds.
• Limitations: Useful for small to moderate defects; they may restrict movement if not properly planned.

• Technique: Transfer of tissue blocks, such as the pectoralis major muscle, to cover large mandibular or cervical defects.
• Example: In pharynx or floor-of-mouth reconstruction, a pectoralis flap provides bulk and vascularization and, in some cases, allows speech rehabilitation with voice prostheses.
• Functionality: These flaps can restore the ability to swallow and protect the airway.

• Technique: Transfer of complex tissues (skin, muscle, bone) from distant sites, connected to blood vessels via microsurgery. Example: A free fibula flap to reconstruct the mandible, allowing not only restoration of facial form but also chewing function through subsequent placement of dental implants.
• Dynamic functional surgery: In cases of facial paralysis, the gracilis muscle (from the thigh) is transplanted to the face, connecting its nerves to active branches such as the masseteric nerve, enabling the person to regain smile movement. Example of movement recovery: The use of functional muscle free flaps allows, with retraining and physical therapy, recovery of facial expressions and part of the lost mobility.

• Standard surgical prostheses: Devices commonly used during surgery to replace or splint bony segments and restore facial structure. Example: titanium plates or metal meshes to reconstruct the mandible or maxilla, mainly after trauma or tumor resections. Their function is to stabilize the bones and allow proper integration.
• Custom prostheses or implants: Designed in a personalized way using imaging and 3D modeling technology, precisely adapting to each person’s anatomical defect. Example: custom titanium or polyethylene implants for replacement of parts of the skull, eye socket, or facial symmetrization, achieving superior aesthetic results and better functionality.
• Epitheses: External prostheses made of silicone or similar materials, intended to replace visible parts such as the nose, auricle, lips, or eyelids when biological reconstruction is not feasible or as a complement. They adhere with special adhesives or magnet systems anchored to bone and are custom-made to match color, shape, and texture, providing a highly valuable aesthetic and functional solution.

• Nerve and muscle transfer technique: For example, in facial paralysis, a technique called a cross-face nerve graft is performed, connecting a healthy nerve from the opposite side to the damaged facial muscles, allowing voluntary movement to return over time.
• Dynamic muscle transposition: Transplanting the temporalis or gracilis muscle to the oral commissure, anchored to bone and connected to a nerve, enables recovery of the smile and other facial expressions.
• Functional rehabilitation: Includes physical therapy, electrical stimulation, and neuromuscular retraining, essential to restore mobility and coordination after surgery.

Preoperative planning strategies

• Three-dimensional imaging and biomodels: Allow simulation of the surgery and selection of the best technique and the size of flaps or grafts to be used.
• Planning of functional movements: In dynamic surgeries, nerve and muscle connections are studied in advance to maximize recovery of complex functions such as smiling, blinking, or chewing.
• Trial of custom prostheses: They are manufactured and fitted prior to the procedure to achieve optimal integration and functionality.