A comparison of facial contour and patient-reported outcomes following zygomatic implant perforated (ZIP) flaps and fibular osseous flaps for maxillary reconstruction

The zygomatic implant perforated (ZIP) flap is an alternative to the fibular free flap (FFF) for maxillary reconstruction with dental rehabilitation. The aim of this study was to compare facial contour and patient-reported outcomes in matched cases of ZIP flap or FFF maxillary reconstruction. Inclusion criteria were patients who underwent ZIP flap reconstruction between February 2017 and April 2023 with high-resolution preoperative and postoperative computed tomography (CT) imaging, and who had completed the FACE-Q questionnaire, matched with patients who had undergone maxillary FFF reconstruction. Accuracy of facial contour restoration was assessed in CloudCompare® by comparing preoperative and postoperative segmentations of the complete facial mask and midface subsites. Associations with patient-reported outcomes were assessed using linear regression. Twenty patients (10 ZIP, 10 FFF) were included. Mean difference between preoperative and postoperative facial contour did not differ significantly between groups for complete facial mask (1.0 mm ZIP vs 1.1 mm FFF, p = 0.30), or subsite analysis (malar eminence p = 0.49, nose p = 0.29, upper lip p = 0.31). Patient-reported outcomes were similar between groups except for saliva function, which was superior in the FFF group (p = 0.043). ZIP flaps are a valuable option for maxillary reconstruction in carefully-selected patients.