Complex Maxillofacial Reconstruction – Evolution, Efficiency & Optimized Esthetics Through Digital Technology

Explore the evolution of complex maxillofacial reconstruction with Dr. Brecht. Learn how digital planning, surgical guides, and a multidisciplinary approach deliver efficient, esthetic, and functional outcomes, including immediate implant-supported rehabilitation.

Esthetic reconstruction of patients with cancer or a destructive maxillofacial lesion are perhaps the most challenging of procedures. From WWI until 1975, there were few options available to make these patients whole again in an esthetic as well as functional manner. 2024 marked the 50^th anniversary of the first fibula free flap microvascular tissue (MVFF) transfer. This procedure revolutionized the reconstruction of the patient with a defect or deformity of the maxillofacial region. The art and science of reconstruction of the mandible and maxilla subsequently progressed rapidly after developments in computational sciences and eventually virtual surgical planning. The development of computer-aided, three-dimensional planning along with computer-fabricated surgical splints and cutting guides now allow for a prosthetically-driven, occlusally-based rehabilitation in combination with unprecedented precision in surgical reconstruction of form and function. The culmination of technology employed in an active multidisciplinary team setting has resulted in the ability to deliver an implant-supported prosthetic rehabilitation for the mandibular or maxillary resection patient during a single reconstructive surgical episode. This presentation reviews the evolution of the collaborative effort of our team of a maxillofacial surgeon, microvascular head and neck surgeon and maxillofacial prosthodontist in optimizing the outcomes in our reconstruction patients.

Learning Objectives:

At the conclusion of this presentation participants will be able to or will have gained an understanding of:

1. The history of reconstructive efforts for the patient with a maxillofacial defect.
2. The benefits of an integrated team approach for addressing complex maxillofacial reconstruction.
3. The important role of digital technology in planning and executing complex maxillofacial reconstructions.
4. The value of immediate implant reconstruction of the maxilla and mandible for rehabilitation of dental function.

Biosketch:

Dr. Brecht is currently the Director of Maxillofacial Prosthetics at Northwell Health System, the largest hospital system in New York State. In addition, he serves as the Director of Maxillofacial Prosthetics in the Postgraduate Prosthodontic Program of NYU College of Dentistry where he is an Associate Clinical Professor of Prosthodontics. Dr. Brecht also has the privilege of an appointment in the Department of Head & Neck Surgery at MD Anderson Cancer Center of The University of Texas.

Prior to its dissolution in 2015, for over 25 years, Dr. Brecht was the Director of Dental Services at the Institute of Reconstructive Plastic Surgery at NYU Langone Medical Center with appointments at NYU School of Medicine in the Department of Plastic Surgery and the Department of Otolaryngology/Head & Neck Surgery.

Dr. Brecht maintains a private practice in Manhattan limited to maxillofacial prosthetics and prosthodontics.

He has authored numerous articles and book chapters on the maxillofacial reconstruction and oral rehabilitation of patients with cancer or craniofacial anomalies. He is part of the team that developed the ”Jaw-in-a-Day” (JIAD) technique for immediate reconstruction of the maxilla or mandible. He was also part of the team that developed nasoalveolar molding (NAM) for the care of infants with a cleft. He is a past-president of the Greater New York Academy of Prosthodontics and the American Academy of Maxillofacial Prosthetics (AAMP). He is also a Fellow of the Academy of Prosthodontics as well as the ITI (USA). In addition, Dr. Brecht has received numerous awards, most notably the Andrew J. Ackerman Award from the AAMP for outstanding contributions to the field of maxillofacial prosthetics. He co-authored the textbook, “The Immediacy Concept” published in 2022 by Quintessence. He lectures regularly both nationally and internationally on the topics of immediate reconstruction throughout the oral cavity and maxillofacial region.

Dr. Brecht serves as the president of The Maxillofacial Foundation as well as the NextGenFace Foundation.