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Aftabi H, Zaraska K, Eghbal A, McGregor S, Prisman E, Hodgson A, Fels S. Computational models and their applications in biomechanical analysis of mandibular reconstruction surgery. Comput Biol Med 2024; 169:107887. [PMID: 38160502 DOI: 10.1016/j.compbiomed.2023.107887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
Advanced head and neck cancers involving the mandible often require surgical removal of the diseased parts and replacement with donor bone or prosthesis to recreate the form and function of the premorbid mandible. The degree to which this reconstruction successfully replicates key geometric features of the original bone critically affects the cosmetic and functional outcomes of speaking, chewing, and breathing. With advancements in computational power, biomechanical modeling has emerged as a prevalent tool for predicting the functional outcomes of the masticatory system and evaluating the effectiveness of reconstruction procedures in patients undergoing mandibular reconstruction surgery. These models offer cost-effective and patient-specific treatment tailored to the needs of individuals. To underscore the significance of biomechanical modeling, we conducted a review of 66 studies that utilized computational models in the biomechanical analysis of mandibular reconstruction surgery. The majority of these studies employed finite element method (FEM) in their approach; therefore, a detailed investigation of FEM has also been provided. Additionally, we categorized these studies based on the main components analyzed, including bone flaps, plates/screws, and prostheses, as well as their design and material composition.
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Affiliation(s)
- Hamidreza Aftabi
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada.
| | - Katrina Zaraska
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Atabak Eghbal
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sophie McGregor
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Eitan Prisman
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Antony Hodgson
- Department of Mechanical Engineering, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sidney Fels
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
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Betancourt MC, Araújo C, Marín S, Buriticá W. The Quantitative Impact of Using 3D Printed Anatomical Models for Surgical Planning Optimization: Literature Review. 3D PRINTING AND ADDITIVE MANUFACTURING 2023; 10:1130-1139. [PMID: 37886412 PMCID: PMC10599434 DOI: 10.1089/3dp.2021.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
3D printing has entered the medical field as a visualization tool that allows the manufacture of three-dimensional (3D) models that physically represent the anatomy of a patient in need of analysis to improve surgical results. This article analyzes the literature around reported study cases that make use of anatomical models for their surgical processes' planning, focusing on obtaining the quantitative results of each one of them. A search of case studies was carried out in the main medical databases such as PubMed, ScienceDirect, SpringerLink, among others; to obtain the most relevant results of the 56 selected articles, the information of each study was analyzed and categorized. These articles presented figures and data about the benefits that are considered more representative to measure the positive impact of this technology. These benefits are summarized in variables such as the decrease in surgical time, greater accuracy in the diagnosis of pathology, blood loss reduction, and decreasing operating room costs; owed to an improvement in the surgery planning. It was found that in all the cases analyzed there was an improvement in the surgical results related to these variables, which were summarized in macro figures that combine this improvement quantitatively. In the analyzed studies, it was evident that there is great potential in the use of 3D printing for presurgical planning, being as the results of these analyzed interventions were better when using this technology. In addition, it was found that the results obtained initially, before applying the inclusion and exclusion criteria, were mostly of a qualitative nature; expressing the perception of researchers regarding the positive use of this tool in the field and evidencing an opportunity for this research to focus on concrete and technical information to show in numerical terms the effectiveness of this tool, to demonstrate the cost-benefit that it has for the field.
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Ahmed M, Melaragno LE, Nyirjesy SC, von Windheim N, Fenberg R, Herster R, Sheldon A, Binzel K, Knopp MV, Herderick ED, VanKoevering KK. Higher Computed Tomography (CT) Scan Resolution Improves Accuracy of Patient-specific Mandibular Models When Compared to Cadaveric Gold Standard. J Oral Maxillofac Surg 2023; 81:1176-1185. [PMID: 37315925 DOI: 10.1016/j.joms.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND 3D-printed patient-specific anatomical models are becoming an increasingly popular tool for planning reconstructive surgeries to treat oral cancer. Currently there is a lack of information regarding model accuracy, and how the resolution of the computed tomography (CT) scan affects the accuracy of the final model. PURPOSE The primary objective of this study was to determine the CT z-axis resolution necessary in creating a patient specific mandibular model with clinically acceptable accuracy for global bony reconstruction. This study also sought to evaluate the effect of the digital sculpting and 3D printing process on model accuracy. STUDY DESIGN This was a cross-sectional study using cadaveric heads obtained from the Ohio State University Body Donation Program. INDEPENDENT VARIABLES The first independent variable is CT scan slice thickness of either 0.675 , 1.25, 3.00, or 5.00 mm. The second independent variable is the three produced models for analysis (unsculpted, digitally sculpted, 3D printed). MAIN OUTCOME VARIABLE The degree of accuracy of a model as defined by the root mean square (RMS) value, a measure of a model's discrepancy from its respective cadaveric anatomy. ANALYSES All models were digitally compared to their cadaveric bony anatomy using a metrology surface scan of the dissected mandible. The RMS value of each comparison evaluates the level of discrepancy. One-way ANOVA tests (P < .05) were used to determine statistically significant differences between CT scan resolutions. Two-way ANOVA tests (P < .05) were used to determine statistically significant differences between groups. RESULTS CT scans acquired for 8 formalin-fixed cadaver heads were processed and analyzed. The RMS for digitally sculpted models decreased as slice thickness decreased, confirming that higher resolution CT scans resulted in statistically more accurate model production when compared to the cadaveric gold standard. Furthermore, digitally sculpted models were significantly more accurate than unsculpted models (P < .05) at each slice thickness. CONCLUSIONS Our study demonstrated that CT scans with slice thicknesses of 3.00 mm or smaller created statistically significantly more accurate models than models created from slice thicknesses of 5.00 mm. The digital sculpting process statistically significantly increased the accuracy of models and no loss of accuracy through the 3D printing process was observed.
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Affiliation(s)
- Maariyah Ahmed
- Undergraduate Student, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH; Undergraduate Student, The Ohio State University College of Engineering, Department of Biomedical Engineering, Columbus, OH
| | - Luigi E Melaragno
- Undergraduate Student, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH; Undergraduate Student, The Ohio State University College of Engineering, Department of Biomedical Engineering, Columbus, OH
| | - Sarah C Nyirjesy
- Resident, The Ohio State University Department of Otolaryngology- Head and Neck Surgery, Columbus, OH
| | - Natalia von Windheim
- Post-Doctoral Fellow, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH
| | - Rachel Fenberg
- Clinical Researcher, The Ohio State University Department of Otolaryngology- Head and Neck Surgery, Columbus, OH; Medical Student, Albert Einstein College of Medicine, College of Medicine, New York, NY
| | - Rachel Herster
- Research Specialist, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH
| | - Alexandra Sheldon
- Medical Student, The Ohio State University College of Medicine, Columbus, OH
| | - Katherine Binzel
- Professor, Wright Center of Innovation in Biomedical Imaging, Department of Radiology, OSUWMC, Columbus, OH
| | - Michael V Knopp
- Professor, Wright Center of Innovation in Biomedical Imaging, Department of Radiology, OSUWMC, Columbus, OH
| | - Edward D Herderick
- Director of Additive Manufacturing, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH
| | - Kyle K VanKoevering
- Assistant Professor, The Ohio State University Department of Otolaryngology- Head and Neck Surgery, Columbus, OH.
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Hwang BY, Noh K, Lee JW. Long-Term Follow-Up of a Novel Surgical Option Combining Fibula Free Flap and 3D-Bioprinted, Patient-Specific Polycaprolactone (PCL) Implant for Mandible Reconstruction. Bioengineering (Basel) 2023; 10:684. [PMID: 37370615 DOI: 10.3390/bioengineering10060684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
As the fibula free flap became the gold standard in mandibular reconstruction that required both hard tissue and soft tissue, various methods have been sought to solve the height discrepancy between the mandible and fibula. The purpose of this paper was to propose a surgical option that combined the microvascular fibula free flap with a 3D-bioprinted, patient-specific polycaprolactone (PCL) implant as a safe and simple novel method that achieved the best functional and aesthetic results in mandibular reconstruction surgery for young patients with malignant tumors. The patient's reconstructed mandible maintained volume symmetry without any deformation or complications for over 6 years. Computer-aided design/computer-aided manufacturing (CAD/CAM) and 3D printing technology enabled accurate and safe surgical results.
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Affiliation(s)
- Bo-Yeon Hwang
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul 02447, Republic of Korea
| | - Kwantae Noh
- Department of Prosthodontics, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
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Gillingham RL, Mutsvangwa TEM, van der Merwe J. Reconstruction of the mandible from partial inputs for virtual surgery planning. Med Eng Phys 2023; 111:103934. [PMID: 36792246 DOI: 10.1016/j.medengphy.2022.103934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
Statistical Shape Models (SSMs) and Sparse Prediction Models (SPMs) based on regressions between cephalometric measurements were compared against standard practice in virtual surgery planning for reconstruction of mandibular defects. Emphasis was placed on the ability of the models to reproduce clinically relevant metrics. CT scans of 50 men and 50 women were collected and split into training and testing datasets according to an 80:20 ratio. The scans were segmented, and anatomical landmarks were identified. SPMs were constructed based on direct regressions between measurements derived from the anatomical landmarks. SSMs were developed by establishing correspondence between the segmented meshes, performing alignment, and principal component analysis. Anterior and bilateral defects were simulated by removing sections of the mandibles in the testing set. Measurement errors after reconstruction ranged from 1.07˚ to 2.2˚ and 0.66 mm to 2.02 mm for mirroring, from 0.45˚ to 3.67˚ and 0.66 mm to 2.54 mm for the SSMs, and from 1.74˚ to 5.01˚ and 0.64 mm to 2.89 mm for the SPMs. Surface-to-surface errors ranged from 1.01 mm to 1.29 mm and 1.06 mm to 1.33 mm for mirroring and SSMs, respectively. Based on the results, SSMs are recommended for VSP in the absence of normal patient anatomy.
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Affiliation(s)
- Ryan L Gillingham
- Department of Mechanical & Mechatronic Engineering, University of Stellenbosch, Stellenbosch, 7600, South Africa
| | - Tinashe E M Mutsvangwa
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, 7935, South Africa
| | - Johan van der Merwe
- Department of Mechanical & Mechatronic Engineering, University of Stellenbosch, Stellenbosch, 7600, South Africa.
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Establishing a Point-of-Care Virtual Planning and 3D Printing Program. Semin Plast Surg 2022; 36:133-148. [PMID: 36506280 PMCID: PMC9729064 DOI: 10.1055/s-0042-1754351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Virtual surgical planning (VSP) and three-dimensional (3D) printing have become a standard of care at our institution, transforming the surgical care of complex patients. Patient-specific, anatomic models and surgical guides are clinically used to improve multidisciplinary communication, presurgical planning, intraoperative guidance, and the patient informed consent. Recent innovations have allowed both VSP and 3D printing to become more accessible to various sized hospital systems. Insourcing such work has several advantages including quicker turnaround times and increased innovation through collaborative multidisciplinary teams. Centralizing 3D printing programs at the point-of-care provides a greater cost-efficient investment for institutions. The following article will detail capital equipment needs, institutional structure, operational personnel, and other considerations necessary in the establishment of a POC manufacturing program.
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Design and implementation of a surgical planning system for robotic assisted mandible reconstruction with fibula free flap. Int J Comput Assist Radiol Surg 2022; 17:2291-2303. [PMID: 36166164 DOI: 10.1007/s11548-022-02748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Free fibula flap is the gold standard for the treatment of mandibular defects. However, the existing preoperative planning protocol is cumbersome to execute, costly to learn, and poorly collaborative with the robot-assisted cutting of the fibular osteotomy plane. METHODS A surgical planning system for robotic assisted mandibular reconstruction with fibula free flap is proposed in this study. A fibular osteotomy planning algorithm is presented so that the virtual surgical planning of the fibular osteotomy segments can be obtained automatically with selected mandibular anatomical landmarks. The planned osteotomy planes are then converted into the motion path of the robotic arm, and the automatic fibula osteotomy is completed under optical navigation. RESULTS Surgical planning was performed on 35 patients to verify the feasibility of our system's virtual surgical planning module, with an average time of 13 min. Phantom experiments were performed to evaluate the reliability and stability of this system. The average distance and angular deviations of the osteotomy planes are 1.04 ± 0.68 mm and 1.56 ±1.10°, respectively. CONCLUSIONS Our system can achieve not only precise and convenient preoperative planning, but also safe and reliable osteotomy trajectory. The clinical applications of our system for mandibular reconstruction surgery are expected soon.
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Tran KL, Mong ML, Durham JS, Prisman E. Benefits of Patient-Specific Reconstruction Plates in Mandibular Reconstruction Surgical Simulation and Resident Education. J Clin Med 2022; 11:jcm11185306. [PMID: 36142953 PMCID: PMC9501640 DOI: 10.3390/jcm11185306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/21/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
Poorly contoured mandibular reconstruction plates are associated with postoperative complications. Recently, a technique emerged whereby preoperative patient-specific reconstructive plates (PSRP) are developed in the hopes of eliminating errors in the plate-bending process. This study’s objective is to determine if reconstructions performed with PSRP are more accurate than manually contoured plates. Ten Otolaryngology residents each performed two ex vivo mandibular reconstructions, first using a PSRP followed by a manually contoured plate. Reconstruction time, CT scans, and accuracy measurements were collected. Paired Student’s t-test was performed. There was a significant difference between reconstructions with PSRP and manually contoured plates in: plate-mandible distance (0.39 ± 0.21 vs. 0.75 ± 0.31 mm, p = 0.0128), inter-fibular segment gap (0.90 ± 0.32 vs. 2.24 ± 1.03 mm, p = 0.0095), mandible-fibula gap (1.02 ± 0.39 vs. 2.87 ± 2.38 mm, p = 0.0260), average reconstruction deviation (1.11 ± 0.32 vs. 1.67 ± 0.47 mm, p = 0.0228), mandibular angle width difference (5.13 ± 4.32 vs. 11.79 ± 4.27 mm, p = 0.0221), and reconstruction time (16.67 ± 4.18 vs. 33.78 ± 8.45 min, p = 0.0006). Lower plate-mandible distance has been demonstrated to correlate with decreased plate extrusion rates. Similarly, improved bony apposition promotes bony union. PSRP appears to provide a more accurate scaffold to guide the surgeons in assembling donor bone segments, which could potentially improve patient outcome and reduce surgical time. Additionally, in-house PSRP can serve as a low-cost surgical simulation tool for resident education.
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Chen MY, Fang JJ, Lee JN, Periasamy S, Yen KC, Wang HC, Hsieh DJ. Supercritical Carbon Dioxide Decellularized Xenograft-3D CAD/CAM Carved Bone Matrix Personalized for Human Bone Defect Repair. Genes (Basel) 2022; 13:755. [PMID: 35627140 PMCID: PMC9141546 DOI: 10.3390/genes13050755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/04/2022] Open
Abstract
About 30-50% of oral cancer patients require mandibulectomy and autologous fibula reconstruction. Autograft is the gold standard choice because of its histocompatibility; however, it requires additional surgery from the patient and with possible complications such as loss of fibula leading to calf weakening in the future. Allograft and xenograft are alternatives but are susceptible to immune response. Currently, no personalized bone xenografts are available in the market for large fascial bone defects. In addition, a large-sized complex shape bone graft cannot be produced directly from the raw material. We propose the use of porcine bones with 3D CAD/CAM carving to reconstruct a personalized, wide range and complex-shaped bone. We anticipate that patients can restore their native facial appearance after reconstruction surgery. Supercritical CO2 (SCCO2) technology was employed to remove the cells, fat and non-collagenous materials while maintaining a native collagen scaffold as a biomedical device for bone defects. We successfully developed 3D CAD/CAM carved bone matrices, followed by SCCO2 decellularization of those large-sized bones. A lock-and-key puzzle design was employed to fulfil a wide range of large and complex-shaped maxillofacial defects. To conclude, the 3D CAD/CAM carved bone matrices with lock and key puzzle Lego design were completely decellularized by SCCO2 extraction technology with intact natural collagen scaffold. In addition, the processed bone matrices were tested to show excellent cytocompatibility and mechanical stiffness. Thus, we can overcome the limitation of large size and complex shapes of xenograft availability. In addition, the 3D CAD/CAM carving process can provide personalized tailor-designed decellularized bone grafts for the native appearance for maxillofacial reconstruction surgery for oral cancer patients and trauma patients.
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Affiliation(s)
- Meng-Yen Chen
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan;
| | - Jing-Jing Fang
- Department of Mechanical Engineering, College of Engineering, National Cheng Kung University, Tainan 701401, Taiwan;
| | - Jeng-Nan Lee
- Department of Mechanical Engineering, Cheng Shiu University, Kaohsiung 833301, Taiwan;
| | - Srinivasan Periasamy
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
| | - Ko-Chung Yen
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
| | - Hung-Chou Wang
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
| | - Dar-Jen Hsieh
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
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Truscott A, Zamani R, Akrami M. Comparing the use of conventional and three-dimensional printing (3DP) in mandibular reconstruction. Biomed Eng Online 2022; 21:18. [PMID: 35305669 PMCID: PMC8934485 DOI: 10.1186/s12938-022-00989-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background There are a number of clinical disorders that require mandibular reconstruction (MR). Novel three-dimensional (3D) printing technology enables reconstructions to be more accurate and beneficial to the patient. However, there is currently no evidence identifying which techniques are better suited for MR, based on the type of clinical disorder the patient has. In this study, we aim to compare 3D techniques with conventional techniques to identify how best to reconstruct the mandible based on the clinical cause that necessitates the reconstructive procedure: cancerous or benign tumours, clinical disorders, infection or disease and trauma or injury. Methods PubMed, Scopus, Embase and Medline were searched to identify relevant papers that outline the clinical differences between 3D and conventional techniques in MR. Data were evaluated to provide a clear outline of suitable techniques for surgery. Results 20 of 2749 papers met inclusion criteria. These papers were grouped based on the clinical causes that required MR into four categories: malignant or benign tumour resection; mandibular trauma/injury and other clinical disorders. Conclusions The majority of researchers favoured 3D techniques in MR. However, due to a lack of standardised reporting in these studies it was not possible to determine which specific techniques were better for which clinical presentations.
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He J, Zhang Y, Wang F, Li Z, Sun B. Digital assisted mandibular resection and reconstruction with vascularized iliac bone flap through intraoral approach. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Implementation of 3D Printing and Computer-Aided Design and Manufacturing (CAD/CAM) in Craniofacial Reconstruction. J Craniofac Surg 2022; 33:1714-1719. [DOI: 10.1097/scs.0000000000008561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/28/2022] [Indexed: 11/27/2022] Open
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Kho Y, Yoon HS, Park DH, Do MT, Jung G, Cho SY. Effectiveness of a newly-developed training module using 3D printing for the navigation during retrograde intrarenal surgery. Investig Clin Urol 2022; 63:554-562. [PMID: 36068001 PMCID: PMC9448668 DOI: 10.4111/icu.20220205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/24/2022] [Accepted: 08/01/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose This study aimed to evaluate the feasibility of the newly-developed three-dimensional (3D) printed training module for navigation during retrograde intrarenal surgery. Materials and Methods Two specialists provided orientation to all trainees. The 3D printing model consisted of eight calyces in each kidney. One navigation time started from the moment when the endoscope entered the ureter. After navigation was completed, the navigation time was recorded. The goal was to perform ten navigation times for each side, starting from the right or the left side at random. After the experiment, all trainees were asked to fill out a questionnaire. Results The average training period of all 17 trainees was 3.05±1.80 years. Eleven trainees (64.7%) had the experience of assisting surgery for <100 cases, and six trainees (35.3%) had the experience of assisting surgery for 100 to 500 cases. Nine trainees (52.9%) began training from the right, and eight trainees (47.1%) started from the left. The average navigation time of 308 trials was 153.4±92.6 seconds. The maximum and minimum navigation times were 354.3±177.2 seconds and 80.1±25.6 seconds. The mean navigation time of the first and the last trials of all trainees significantly decreased from 251.4±108.0 seconds to 93.9±33.2 seconds. The average reduction in navigation time was 201.3±133.3 seconds. Almost all trainees were satisfied with the training. Conclusions The newly-developed 3D printing navigation training module seems to be adequate to improve surgical skills of flexible ureteroscopy.
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Affiliation(s)
- Yongseok Kho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyun Sik Yoon
- Department of Urology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Dae Hyoung Park
- Department of Urology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Minh-Tung Do
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Gyoohwan Jung
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Möllmann HL, Apeltrath L, Karnatz N, Wilkat M, Riedel E, Singh DD, Rana M. Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction. Front Oncol 2021; 11:719028. [PMID: 34900674 PMCID: PMC8660676 DOI: 10.3389/fonc.2021.719028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives This retrospective study compared two mandibular reconstruction procedures-conventional reconstruction plates (CR) and patient-specific implants (PSI)-and evaluated their accuracy of reconstruction and clinical outcome. Methods Overall, 94 patients had undergone mandibular reconstruction with CR (n = 48) and PSI (n = 46). Six detectable and replicable anatomical reference points, identified via computer tomography, were used for defining the mandibular dimensions. The accuracy of reconstruction was assessed using pre- and postoperative differences. Results In the CR group, the largest difference was at the lateral point of the condyle mandibulae (D2) -1.56 mm (SD = 3.8). In the PSI group, the largest difference between preoperative and postoperative measurement was shown at the processus coronoid (D5) with +1.86 mm (SD = 6.0). Significant differences within the groups in pre- and postoperative measurements were identified at the gonion (D6) [t(56) = -2.217; p = .031 <.05]. In the CR group, the difference was 1.5 (SD = 3.9) and in the PSI group -1.04 (SD = 4.9). CR did not demonstrate a higher risk of plate fractures and post-operative complications compared to PSI. Conclusion For reconstructing mandibular defects, CR and PSI are eligible. In each case, the advantages and disadvantages of these approaches must be assessed. The functional and esthetic outcome of mandibular reconstruction significantly improves with the experience of the surgeon in conducting microvascular grafts and familiarity with computer-assisted surgery. Interoperator variability can be reduced, and training of younger surgeons involved in planning can be reaching better outcomes in the future.
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Affiliation(s)
- Henriette L Möllmann
- Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Laura Apeltrath
- Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Nadia Karnatz
- Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Max Wilkat
- Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Erik Riedel
- Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Daman Deep Singh
- Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Majeed Rana
- Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
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Turek P, Pakla P, Budzik G, Lewandowski B, Przeszłowski Ł, Dziubek T, Wolski S, Frańczak J. Procedure Increasing the Accuracy of Modelling and the Manufacturing of Surgical Templates with the Use of 3D Printing Techniques, Applied in Planning the Procedures of Reconstruction of the Mandible. J Clin Med 2021; 10:jcm10235525. [PMID: 34884227 PMCID: PMC8658254 DOI: 10.3390/jcm10235525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
The application of anatomical models and surgical templates in maxillofacial surgery allows, among other benefits, the increase of precision and the shortening of the operation time. Insufficiently precise anastomosis of the broken parts of the mandible may adversely affect the functioning of this organ. Applying the modern mechanical engineering methods, including computer-aided design methods (CAD), reverse engineering (RE), and rapid prototyping (RP), a procedure used to shorten the data processing time and increase the accuracy of modelling anatomical structures and the surgical templates with the use of 3D printing techniques was developed. The basis for developing and testing this procedure was the medical imaging data DICOM of patients treated at the Maxillofacial Surgery Clinic of the Fryderyk Chopin Provincial Clinical Hospital in Rzeszów. The patients were operated on because of malignant tumours of the floor of the oral cavity and the necrosis of the mandibular corpus, requiring an extensive resection of the soft tissues and resection of the mandible. Familiarity with and the implementation of the developed procedure allowed doctors to plan the operation precisely and prepare the surgical templates and tools in terms of the expected accuracy of the procedures. The models obtained based on this procedure shortened the operation time and increased the accuracy of performance, which accelerated the patient’s rehabilitation in the further course of events.
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Affiliation(s)
- Paweł Turek
- Faculty of Mechanical Engineering and Aeronautics, Rzeszów University of Technology, 35-959 Rzeszów, Poland; (G.B.); (Ł.P.); (T.D.)
- Correspondence:
| | - Paweł Pakla
- Department of Maxillofacial Surgery, Fryderyk Chopin Clinical Voivodeship Hospital No.1 in Rzeszów, 35-055 Rzeszów, Poland; (P.P.); (B.L.); (J.F.)
| | - Grzegorz Budzik
- Faculty of Mechanical Engineering and Aeronautics, Rzeszów University of Technology, 35-959 Rzeszów, Poland; (G.B.); (Ł.P.); (T.D.)
| | - Bogumił Lewandowski
- Department of Maxillofacial Surgery, Fryderyk Chopin Clinical Voivodeship Hospital No.1 in Rzeszów, 35-055 Rzeszów, Poland; (P.P.); (B.L.); (J.F.)
- Collegium Medicum, University of Rzeszów, 35-315 Rzeszów, Poland
| | - Łukasz Przeszłowski
- Faculty of Mechanical Engineering and Aeronautics, Rzeszów University of Technology, 35-959 Rzeszów, Poland; (G.B.); (Ł.P.); (T.D.)
| | - Tomasz Dziubek
- Faculty of Mechanical Engineering and Aeronautics, Rzeszów University of Technology, 35-959 Rzeszów, Poland; (G.B.); (Ł.P.); (T.D.)
| | - Sławomir Wolski
- Faculty of Mathematics and Applied Physics, Rzeszów University of Technology, 35-959 Rzeszów, Poland;
| | - Jan Frańczak
- Department of Maxillofacial Surgery, Fryderyk Chopin Clinical Voivodeship Hospital No.1 in Rzeszów, 35-055 Rzeszów, Poland; (P.P.); (B.L.); (J.F.)
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Madeja R, Bajor G, Klima O, Bialy L, Pometlova J. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report. Open Med (Wars) 2021; 16:1597-1601. [PMID: 34722895 PMCID: PMC8546289 DOI: 10.1515/med-2021-0338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/18/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Reports on the use of computer-assisted trauma surgery of comminuted scapula fracture are still quite rare. In this article, we present a case of comminuted scapula fracture, the surgical reconstruction of which was pre-operatively planned using a complex software solution. Materials and methods For surgical planning of the fracture, we used the TraumaTech software facilitating virtual reconstruction (both manual and automatic), surgery planning, design of the implant, planning of screw placement and lengths, and production of a 3D print model of the fracture and the implant. The software also supported ordering such custom-made plate from a plate producer who was capable of fast and precise production of the plate. Results The surgery using the custom-ordered plate was successful. The actual used screw lengths did not differ from the planned ones by more than 2 mm. One year after the surgery, the patient was capable of more demanding activities and doing sports activities. Conclusion This approach provides a great way to prevent complications of the surgery and to shorten its duration. To the best of our knowledge, this is the first description of the treatment of a scapula comminuted fracture utilizing computer-assisted preoperative planning.
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Affiliation(s)
- Roman Madeja
- Institute of Emergency Medicine, Faculty of Medicine, University of Ostrava, Ostrava 703 00, Czech Republic.,Trauma Center, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava 708 52, Czech Republic
| | - Grzegorz Bajor
- Department of Human Anatomy, Faculty of Medical Science in Katowice, Medical University in Katowice, Katowice 40-752, Poland
| | - Ondrej Klima
- IT4Innovations Centre of Excellence, Brno University of Technology, Brno 708 00, Czech Republic
| | - Lubor Bialy
- Institute of Emergency Medicine, Faculty of Medicine, University of Ostrava, Ostrava 703 00, Czech Republic.,Trauma Center, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava 708 52, Czech Republic
| | - Jana Pometlova
- Trauma Center, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava 708 52, Czech Republic.,Department of Medicine of Disasters, Faculty of Medicine, University of Ostrava, Ostrava 703 00, Czech Republic
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A Novel Approach to Virtual Surgical Planning for Mandibular and Midfacial Reconstruction With a Fibula Free Flap. J Craniofac Surg 2021; 33:759-763. [PMID: 34560742 DOI: 10.1097/scs.0000000000008169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The fibula free flap is a major workhorse in facial reconstruction. To decrease operative times, virtual surgical planning (VSP) has been implemented. Traditional VSP is costly and may delay operative planning. In this study, the authors present a novel algorithm using readily accessible software packages to perform VSP in a manner that is quick and cost-effective. METHODS A 6-part survey was administered to physicians with prior training in facial reconstruction. Fourteen physicians participated regarding outcomes on 10 patients who underwent mandibular or midfacial fibula free flap reconstruction. Participants were asked to match the true postoperative and VSP models and rate the similarity of the models using the Likert scale (0-10). The goal was to determine whether the VSP models accurately depicted the actual reconstruction, and whether they would use VSP in future clinical practice. RESULTS The physicians surveyed were able to match the models correctly 93.6% of the time. The mean score for the similarity between virtual and actual models ranged between 7.60 and 8.80. Most participants (90.9%) who answered stated they would use our VSP algorithm if they were trained in the protocol. CONCLUSIONS AND RELEVANCE Virtual surgical planning models were created utilizing our novel algorithm. Participants matched the preoperative VSP plan with the postoperative model most of the time and rated the similarity well. Participants in our study are interested in learning more about physician performed VSP. The authors believe this model may be financially and clinically relevant and serve as an excellent educational tool.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the evolution of three-dimensional computer-aided reconstruction and its current applications in craniofacial surgery. 2. Recapitulate virtual surgical planning, or computer-assisted surgical simulation, workflow in craniofacial surgery. 3. Summarize the principles of computer-aided design techniques, such as mirror-imaging and postoperative verification of results. 4. Report the capabilities of computer-aided manufacturing, such as rapid prototyping of three-dimensional models and patient-specific custom implants. 5. Evaluate the advantages and disadvantages of using three-dimensional technology in craniofacial surgery. 6. Critique evidence on advanced three-dimensional technology in craniofacial surgery and identify opportunities for future investigation. SUMMARY Increasingly used in craniofacial surgery, virtual surgical planning is applied to analyze and simulate surgical interventions. Computer-aided design and manufacturing generates models, cutting guides, and custom implants for use in craniofacial surgery. Three-dimensional computer-aided reconstruction may improve results, increase safety, enhance efficiency, augment surgical education, and aid surgeons' ability to execute complex craniofacial operations. Subtopics include image analysis, surgical planning, virtual simulation, custom guides, model or implant generation, and verification of results. Clinical settings for the use of modern three-dimensional technologies include acquired and congenital conditions in both the acute and the elective settings. The aim of these techniques is to achieve superior functional and aesthetic outcomes compared to conventional surgery. Surgeons should understand this evolving technology, its indications, limitations, and future direction to use it optimally for patient care. This article summarizes advanced three-dimensional techniques in craniofacial surgery with cases highlighting clinical concepts.
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Formulating an Easy, Affordable, and Reproducible Method for Virtual Planning and 3D Reconstruction: A State Institution's Approach for Mandibular Reconstruction. Ann Plast Surg 2021; 87:65-72. [PMID: 34133366 DOI: 10.1097/sap.0000000000002832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Free fibula flap is now regarded as the criterion standard for mandibular reconstruction after oncological resection. However, the results are often confounded due to inappropriate estimate of defect or inappropriate angulation of osteotomy. Three-dimensional (3D) printing and virtual planning can be an effective tool to help in planning osteotomies, therefore simplifying the process. Unfortunately, in developing countries, it is considered to be an expensive and a time-consuming affair, refraining the surgeons to use this technology. We have devised a cheap (less than $35), rapid, and reproducible method for this process that can be performed by residents with the help of the operating surgeon using a freely available software. MATERIALS AND METHODS The study was conducted over a span of 5 years from 2016 to 2020. Forty patients were randomly categorized into 2 groups of 20 each, one of which underwent conventional free fibula flap and the other group consisted of those for whom 3D printing and virtual planning were used. Aesthetic outcome was measured by preoperative and postoperative CT scans with 3D reconstruction. Furthermore, the reconstruction time and total operative time were also measured in both these groups. RESULTS Comparative study clearly demonstrated a significantly better aesthetic outcome in the 3D printing and virtual planning group. The use of this modality significantly reduced the reconstruction time, which was 83.9 minutes in the cases group and 124 minutes in the control group. CONCLUSIONS Three-dimensional printing and virtual planning help to improve the quality of mandibular reconstruction giving a better aesthetic outcome. Besides, it also reduces the operative time and gives us a chance to use prebent implants used for reconstruction. Our methodology is simple, quick, and cost-effective; therefore, we believe that this tool can be incorporated often in free fibula flaps for mandibular reconstruction in developing countries such as ours.
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Talanki VR, Peng Q, Shamir SB, Baete SH, Duong TQ, Wake N. Three-Dimensional Printed Anatomic Models Derived From Magnetic Resonance Imaging Data: Current State and Image Acquisition Recommendations for Appropriate Clinical Scenarios. J Magn Reson Imaging 2021; 55:1060-1081. [PMID: 34046959 DOI: 10.1002/jmri.27744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
Three-dimensional (3D) printing technologies have been increasingly utilized in medicine over the past several years and can greatly facilitate surgical planning thereby improving patient outcomes. Although still much less utilized compared to computed tomography (CT), magnetic resonance imaging (MRI) is gaining traction in medical 3D printing. The purpose of this study was two-fold: 1) to determine the prevalence in the existing literature of using MRI to create 3D printed anatomic models for surgical planning and 2) to provide image acquisition recommendations for appropriate clinical scenarios where MRI is the most suitable imaging modality. The workflow for creating 3D printed anatomic models from medical imaging data is complex and involves image segmentation of the regions of interest and conversion of that data into 3D surface meshes, which are compatible with printing technologies. CT is most commonly used to create 3D printed anatomic models due to the high image quality and relative ease of performing image segmentation from CT data. As compared to CT datasets, 3D printing using MRI data offers advantages since it provides exquisite soft tissue contrast needed for accurate organ segmentation and it does not expose patients to unnecessary ionizing radiation. MRI, however, often requires complicated imaging techniques and time-consuming postprocessing procedures to generate high-resolution 3D anatomic models needed for 3D printing. Despite these challenges, 3D modeling and printing from MRI data holds great clinical promises thanks to emerging innovations in both advanced MRI imaging and postprocessing techniques. EVIDENCE LEVEL: 2 TECHNICAL EFFICATCY: 5.
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Affiliation(s)
- Varsha R Talanki
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Qi Peng
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephanie B Shamir
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven H Baete
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Q Duong
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nicole Wake
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
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21
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May MM, Howe BM, O'Byrne TJ, Alexander AE, Morris JM, Moore EJ, Kasperbauer JL, Janus JR, Van Abel KM, Dickens HJ, Price DL. Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: Decreased nonunion and complication rates. Head Neck 2021; 43:2342-2352. [PMID: 33786910 DOI: 10.1002/hed.26688] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To determine whether virtual surgical planning and three-dimensional printed cutting guides (3D/VSP) improved radiographic bone union compared to conventional methods (CM) in fibula free flap (FFF) reconstruction of the mandibles. METHODS Retrospective study from the years 2000-2018 at a tertiary hospital. Osseous union was evaluated by a radiologist blinded to each patient's treatment. RESULTS Two hundred sixty patients who underwent FFF tissue transfer, 28 with VSP and 3D cutting guides. Bony union was not achieved in 46 (20%) patients who underwent CM compared to 1 (4%) of patients with VSP and guides (p = 0.036). FFF complication was significantly higher in CM with 87 patients (38%) compared to three patients (11%) in 3D/VSP (p = 0.005). Median time to bony union for patients who underwent CM was 1.4 years compared to 0.8 years in 3D/VSP. CONCLUSIONS 3D/VSP reduced the rate of radiographic nonunion and flap-related complications in FFF reconstruction for mandibular defects.
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Affiliation(s)
- Matthew M May
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Alexander
- Anatomical Modeling Lab, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathon M Morris
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Anatomical Modeling Lab, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Multicentre evaluation of the interest in planned surgery for mandibular reconstruction with fibula free flap: a retrospective cohort study. Eur Arch Otorhinolaryngol 2021; 278:3451-3457. [PMID: 33398547 DOI: 10.1007/s00405-020-06536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to determine the impact and cost-effectiveness of virtual surgical planning during fibula free flap mandibular reconstruction on peri- and postoperative data. METHODS We conducted a retrospective cohort study from January 2012 to December 2016 in four French university centres. RESULTS Three hundred fibula free flaps for mandibular reconstruction were performed in 294 patients. Surgeries were planned in 29.7% of cases (n = 89). There was no significant difference in the rate of negative-margins excision, median length of hospital stay, operative time, and early complications between planned and non-planned surgeries. Morphological analysis revealed a higher rate of centred occlusion in planned patients (satisfactory alignment of interincisal points: Planned 65.5% vs Non-Planned 33.3%, p = 0.006). CONCLUSION In mandibular reconstruction by fibula free flap, the additional cost generated by virtual surgical planning does not seem to be balanced by savings resulting from a shorter operative course, a reduced hospital stay, or a reduction in postoperative complications. However, virtual surgical planning may provide a higher rate of centred occlusion. Long-term benefits should be assessed by further studies.
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Qureshi UA, Calaguas S, Frank E, Inman J. Implications of Applying New Technology in Cosmetic and Reconstructive Facial Plastic Surgery. Facial Plast Surg 2020; 36:760-767. [PMID: 33368133 DOI: 10.1055/s-0040-1721116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The field of facial plastic and reconstructive surgery is privy to a myriad of technological advancements. As innovation in areas such as imaging, computer applications, and biomaterials progresses at breakneck speed, the potential for clinical application is endless. This review of recent progress in the implementation of new technologies in facial plastic surgery highlights some of the most innovative and impactful developments in the past few years of literature. Patient-specific surgical modeling has become the gold standard for oncologic and posttraumatic reconstructive surgery, with demonstrated improvements in operative times, restoration of anatomical structure, and patient satisfaction. Similarly, reductions in revision rates with improvements in learner technical proficiency have been noted with the use of patient-specific models in free flap reconstruction. In the cosmetic realm, simulation-based rhinoplasty implants have drastically reduced operative times while concurrently raising patient postoperative ratings of cosmetic appearance. Intraoperative imaging has also seen recent expansion in its adoption driven largely by reports of eradication of postoperative imaging and secondary-often complicated-revision reconstructions. A burgeoning area likely to deliver many advances in years to come is the integration of bioprinting into reconstructive surgery. Although yet to clearly make the translational leap, the implications of easily generatable induced pluripotent stem cells in replacing autologous, cadaveric, or synthetic tissues in surgical reconstruction are remarkable.
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Affiliation(s)
| | - Shannon Calaguas
- Department of Otolaryngology, Loma Linda University, Loma Linda, California
| | - Ethan Frank
- Department of Otolaryngology, Loma Linda University, Loma Linda, California
| | - Jared Inman
- Department of Otolaryngology, Loma Linda University, Loma Linda, California
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Liu D, Li Y, Li T, Yu Y, Cai G, Yang G, Wang G. The use of a 3D-printed individualized navigation template to assist in the anatomical reconstruction surgery of the anterior cruciate ligament. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1656. [PMID: 33490168 PMCID: PMC7812217 DOI: 10.21037/atm-20-7515] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background To explore the location accuracy and early clinical outcomes of using a 3D-printed individualized navigation template to assist in the reconstruction of the anterior cruciate ligament (ACL). Methods A single center randomized control study was conducted. Patients with ACL injury were treated with a conventional operation or an operation assisted by a 3D-printed individualized navigation template (the 3D group). The primary endpoint was the accuracy of the actual reconstruction compared with the planned position. Results There were 20 and 23 participants in the conventional group and the 3D group, respectively. There were no differences in the bone tunnel position between the actual postoperative position and the preoperative design in the 3D group (P>0.05). Compared with the 3D group, the positioning of the femoral tunnel was more inferior and shallower in the conventional group (P<0.05). The position of the tibia tunnel was closer to the anterior and medial edge of the tibial platform in the conventional group compared to the 3D group (P<0.05). The intraoperative positioning time was shorter in the 3D group than in the conventional group (3.3±1.0 vs. 5.9±1.8 minutes, P<0.001). The Lysholm and International Knee Documentation Committee scores did not differ between the two groups (P>0.05 for both), and all patients improved after surgery (P<0.001). Conclusions The 3D-printed individualized navigation template showed good location accuracy and resulted in reduced intraoperative positioning time compared to the traditional method for ACL reconstruction.
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Affiliation(s)
- Dejian Liu
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanlin Li
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Li
- Department of Trauma Surgery, Affiliated Hospital of Yunnan University, Kunming, China
| | - Yang Yu
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guofeng Cai
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guiran Yang
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guoliang Wang
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Meglioli M, Naveau A, Macaluso GM, Catros S. 3D printed bone models in oral and cranio-maxillofacial surgery: a systematic review. 3D Print Med 2020; 6:30. [PMID: 33079298 PMCID: PMC7574578 DOI: 10.1186/s41205-020-00082-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
AIM This systematic review aimed to evaluate the use of three-dimensional (3D) printed bone models for training, simulating and/or planning interventions in oral and cranio-maxillofacial surgery. MATERIALS AND METHODS A systematic search was conducted using PubMed® and SCOPUS® databases, up to March 10, 2019, by following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol. Study selection, quality assessment (modified Critical Appraisal Skills Program tool) and data extraction were performed by two independent reviewers. All original full papers written in English/French/Italian and dealing with the fabrication of 3D printed models of head bone structures, designed from 3D radiological data were included. Multiple parameters and data were investigated, such as author's purpose, data acquisition systems, printing technologies and materials, accuracy, haptic feedback, variations in treatment time, differences in clinical outcomes, costs, production time and cost-effectiveness. RESULTS Among the 1157 retrieved abstracts, only 69 met the inclusion criteria. 3D printed bone models were mainly used as training or simulation models for tumor removal, or bone reconstruction. Material jetting printers showed best performance but the highest cost. Stereolithographic, laser sintering and binder jetting printers allowed to create accurate models with adequate haptic feedback. The cheap fused deposition modeling printers exhibited satisfactory results for creating training models. CONCLUSION Patient-specific 3D printed models are known to be useful surgical and educational tools. Faced with the large diversity of software, printing technologies and materials, the clinical team should invest in a 3D printer specifically adapted to the final application.
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Affiliation(s)
- Matteo Meglioli
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Adrien Naveau
- Department of Prosthodontics, Dental Science Faculty, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Dental and Periodontal Rehabilitation Unit, Saint Andre Hospital, Bordeaux University Hospital, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France
| | - Guido Maria Macaluso
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy.,IMEM-CNR, Parco Area delle Scienze 37/A, 43124, Parma, Italy
| | - Sylvain Catros
- Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Department of Oral Surgery, UFR d'Odontologie, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Service de Chirurgie Orale, CHU de Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.
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Three-Dimensional Bioprinting: Role in Craniomaxillary Surgery Ethics and Future. J Craniofac Surg 2020; 31:1114-1116. [PMID: 32433136 DOI: 10.1097/scs.0000000000006553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Three-dimensional (3D) printing and bioprinting is gaining lot of momentum, especially in surgical specialties. These two technologies have wide array of applications in presurgical, surgical, and in vitro scenarios. Bioprinting can generate customized patient specific tissue engineered from specialized cells. This technology can be a gold standard in reconstructive and regenerative surgeries, if used in regulated and ethical environment. This communication focuses on basics of these technologies, their role in surgical specialties, ethical issues specific to these technologies, and its future.
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Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study. Clin Oral Investig 2020; 25:2905-2914. [PMID: 33025147 PMCID: PMC8060197 DOI: 10.1007/s00784-020-03607-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022]
Abstract
Objectives The purpose of this study was to evaluate the incidence of complications following mandibular reconstruction and to analyse possible contributing factors. Materials and methods Clinical data and computed tomography scans of all patients who needed a mandibular reconstruction with a reconstruction plate, free fibula flap (FFF) or iliac crest (DCIA) flap between August 2010 and August 2015 were retrospectively analysed. Results One hundred and ninety patients were enrolled, encompassing 77 reconstructions with reconstruction plate, 89 reconstructions with FFF and 24 reconstructions with DCIA flaps. Cutaneous perforation was most frequently detected in the plate subgroup within the early interval and overall (each p = 0.004). Low body mass index (BMI) and total radiation dosage were the most relevant risk factors for the development of analysed complications. Conclusions Microvascular bone flaps have overall less skin perforation than reconstruction plates. BMI and expected total radiation dosage have to be respected in choice of reconstructive technique. Clinical relevance A treatment algorithm for mandibular reconstructions on the basis of our results is presented. Electronic supplementary material The online version of this article (10.1007/s00784-020-03607-8) contains supplementary material, which is available to authorized users.
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Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2020; 146:686e-687e. [PMID: 32852473 DOI: 10.1097/prs.0000000000007295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kasper R, Winter K, Pietzka S, Schramm A, Wilde F. Biomechanical In Vitro Study on the Stability of Patient-Specific CAD/CAM Mandibular Reconstruction Plates: A Comparison Between Selective Laser Melted, Milled, and Hand-Bent Plates. Craniomaxillofac Trauma Reconstr 2020; 14:135-143. [PMID: 33995834 DOI: 10.1177/1943387520952684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Design An experimental in vitro study. Objective Plate fractures are a recurrent problem in alloplastic mandibular reconstruction. Hypothetically it can be assumed that computer-aided design (CAD)/computer-aided manufacturing (CAM) reconstruction plates have a higher stability than conventional hand-bent plates. The aim of the study was to compare additive and subtractive fabricated CAD/CAM mandibular reconstruction plates as well as conventional plates with regard to their biomechanical properties. Methods In a chewing simulator, plates of 2 conventional locking plate systems and 2 CAD/CAM-fabricated plate systems were compared. The plates were loaded in a fatigue test. The maximum number of cycles until plate fracture and the plate stiffness were compared. Results While all conventional plates fractured at a maximum load between 150 and 210 N (Newton) after a number of cycles between 40 000 and 643 000, none of the CAD/CAM plates broke despite a nearly doubled load of 330 N and 2 million cycles. Both CAD/CAM systems proved to be significantly superior to the hand-bent plates. There was no difference between the 2 CAD/CAM systems. Conclusions Concerning the risk of plate fracture, patient-specific CAD/CAM reconstruction plates appear to have a significant advantage over conventional hand-bent plates in alloplastic mandibular reconstruction.
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Affiliation(s)
- Robin Kasper
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sebastian Pietzka
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany.,Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Ulm, Germany
| | - Alexander Schramm
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany.,Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Ulm, Germany
| | - Frank Wilde
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany.,Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Ulm, Germany
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Ballard DH, Mills P, Duszak R, Weisman JA, Rybicki FJ, Woodard PK. Medical 3D Printing Cost-Savings in Orthopedic and Maxillofacial Surgery: Cost Analysis of Operating Room Time Saved with 3D Printed Anatomic Models and Surgical Guides. Acad Radiol 2020; 27:1103-1113. [PMID: 31542197 DOI: 10.1016/j.acra.2019.08.011] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVE Three-dimensional (3D) printed anatomic models and surgical guides have been shown to reduce operative time. The purpose of this study was to generate an economic analysis of the cost-saving potential of 3D printed anatomic models and surgical guides in orthopedic and maxillofacial surgical applications. MATERIALS AND METHODS A targeted literature search identified operating room cost-per-minute and studies that quantified time saved using 3D printed constructs. Studies that reported operative time differences due to 3D printed anatomic models or surgical guides were reviewed and cataloged. A mean of $62 per operating room minute (range of $22-$133 per minute) was used as the reference standard for operating room time cost. Different financial scenarios were modeled with the provided cost-per-minute of operating room time (using high, mean, and low values) and mean time saved using 3D printed constructs. RESULTS Seven studies using 3D printed anatomic models in surgical care demonstrated a mean 62 minutes ($3720/case saved from reduced time) of time saved, and 25 studies of 3D printed surgical guides demonstrated a mean 23 minutes time saved ($1488/case saved from reduced time). An estimated 63 models or guides per year (or 1.2/week) were predicted to be the minimum number to breakeven and account for annual fixed costs. CONCLUSION Based on the literature-based financial analyses, medical 3D printing appears to reduce operating room costs secondary to shortening procedure times. While resource-intensive, 3D printed constructs used in patients' operative care provides considerable downstream value to health systems.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110.
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffery A Weisman
- University of Illinois at Chicago Occupational Medicine, Chicago, Illinois
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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Does an In-House Computer-Aided Design/Computer-Aided Manufacturing Approach Contribute to Accuracy and Time Shortening in Mandibular Reconstruction? J Craniofac Surg 2020; 31:1928-1932. [DOI: 10.1097/scs.0000000000006699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Mahendru S, Jain R, Aggarwal A, Aulakh HS, Jain A, Khazanchi RK, Sarin D. CAD-CAM vs conventional technique for mandibular reconstruction with free fibula flap: A comparison of outcomes. Surg Oncol 2020; 34:284-291. [PMID: 32891344 DOI: 10.1016/j.suronc.2020.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/25/2020] [Accepted: 04/10/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Mandibular reconstruction always pose a challenge to the reconstructive surgeon. With the use of Computer aided designing and computer aided manufacturing (CAD-CAM) it is now possible to reconstruct mandibular defects to near normal configuration with good function and aesthetic outcomes. AIMS/OBJECTIVES To compare the efficacy of CAD-CAM technique vs conventional technique in mandibular reconstruction with free fibula flap. MATERIALS AND METHODS 40 consecutive patients that required mandibular reconstruction using free fibula flap were included in the study. All patients were treated using CAD-CAM technique and then compared retrospectively with 40 patients treated with conventional technique. Comparison was done between total intraoperative time, aesthetic outcome and post-operative occlusion. RESULTS Total intraoperative time in the CAD-CAM group was significantly reduced (562 min) as compared to the conventional group (662 min). Patients in the CAD-CAM group also obtained a better Aesthetic score (3.6/5) when compared to the conventional group (2.5/5). Postoperative malocclusion was noted in 1 patient in the CAD-CAM group as opposed to 6 patients in the conventional group. CONCLUSION Use of CAD-CAM technology in mandibular reconstruction with free fibula flap offers reduced surgical time with precise and accurate reconstruction that produces better functional and aesthetic outcomes.
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Affiliation(s)
- Sanjay Mahendru
- Department of Plastic, Aesthetic and Reconstructive Surgery, Medanta-The Medicity, Gurugram, India.
| | - Rahul Jain
- Department of Plastic, Aesthetic and Reconstructive Surgery, Medanta-The Medicity, Gurugram, India
| | - Aditya Aggarwal
- Department of Plastic, Aesthetic and Reconstructive Surgery, Medanta-The Medicity, Gurugram, India
| | - Hardeep S Aulakh
- Department of Plastic, Aesthetic and Reconstructive Surgery, Medanta-The Medicity, Gurugram, India
| | - Ankit Jain
- Department of Plastic, Aesthetic and Reconstructive Surgery, Medanta-The Medicity, Gurugram, India
| | - Rakesh K Khazanchi
- Department of Plastic, Aesthetic and Reconstructive Surgery, Medanta-The Medicity, Gurugram, India
| | - Deepak Sarin
- Department of Head and Neck Oncology, Medanta-The Medicity, Gurugram, India
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Abstract
PURPOSE OF REVIEW To review the recent literature on the use of multiple flaps in head and neck reconstruction with attention to form, function, outcomes, and complications. RECENT FINDINGS Multiple free flap reconstructions are technically feasible with high flap survival rates, tolerable complication rates, and overall adequate functional and aesthetic outcomes, given the large extent of the defects and the high surgical complexity of these cases. SUMMARY Multiple free flap reconstructions should be considered in cases of large defects involving multiple functional regions and tissue types, which most often arises following resection of advanced malignancies. As there is mortality benefit with clear surgical margins and eradication of malignant lymph nodes, larger resections should be pursued if necessary, followed by a multiple flap reconstruction.
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Nilsson J, Hindocha N, Thor A. Time matters – Differences between computer-assisted surgery and conventional planning in cranio-maxillofacial surgery: A systematic review and meta-analysis. J Craniomaxillofac Surg 2020; 48:132-140. [DOI: 10.1016/j.jcms.2019.11.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/18/2019] [Accepted: 11/25/2019] [Indexed: 12/23/2022] Open
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Development of a template tool for facilitating fibula osteotomy in reconstruction of mandibular defects by digital analysis of the human mandible. Clin Oral Investig 2020; 24:3077-3083. [PMID: 31955270 DOI: 10.1007/s00784-019-03177-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Mandibular reconstruction after segmental mandibulectomy can be challenging without virtual surgical planning and osteotomy guides. The purpose of this study was to analyze anatomic parameters to facilitate the evaluation of ideal fibula wedge osteotomies to reconstruct the neomandibula in a simple and cost-effective manner without the need for preoperative virtual planning. MATERIALS AND METHODS Computed tomography scans were acquired from randomly selected patients, and all images were obtained from routine clinical diagnostics, e.g., tumor staging, or preoperatively before reconstruction. Data was used to calculate stereolithographic models of the mandible for length and angle measurements. Statistical analysis was performed (p < 0.05). RESULTS CT scans of 100 patients were analyzed: 39 were female and 61 were male patients, mean age was 59.08a. The mandibular arch angle proved to be constant with 241.07 ± 2.39°. The outside B-segment length was 80.05 ± 5.16 mm; the anterior S-segment length was 27.69 ± 3.16 mm. The angle of the mandibular arch showed differences in means (p = 0.004) between age groups, but effect was proved low. No relevant statistical significances were detected. CONCLUSIONS The development of a mandible reconstruction template tool would benefit the majority of head and neck patients, which is due to a constant mandibular arch angle and symphysis segment length throughout the general patient population, allowing the mimicking of a harmonic mandibular arch with up to three fibula segments. CLINICAL RELEVANCE The developed mandible reconstruction template tool can facilitate the fibula wedge osteotomies necessary for reconstruction of an ideal neomandibula providing a novel approach which is simple and cost-effective.
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Powcharoen W, Yang WF, Yan Li K, Zhu W, Su YX. Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap. Plast Reconstr Surg 2019; 144:1417-1428. [DOI: 10.1097/prs.0000000000006261] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Huang Y, Xia Z, Zhang X, Liao X, Guo Z, Ji S, Long J. Combined Use of Specially-Designed Digital Surgical Guides and Pre-Formed Reconstruction Plate to Treat Bilateral Mandibular Fracture. J Craniofac Surg 2019; 30:2253-2256. [DOI: 10.1097/scs.0000000000005996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Goormans F, Sun Y, Bila M, Schoenaers J, Geusens J, Lübbers HT, Coucke W, Politis C. Accuracy of computer-assisted mandibular reconstructions with free fibula flap: Results of a single-center series. Oral Oncol 2019; 97:69-75. [DOI: 10.1016/j.oraloncology.2019.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/30/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
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Chan A, Sambrook P, Munn Z, Boase S. Effectiveness of computer-assisted virtual planning, cutting guides and pre-engineered plates on outcomes in mandible fibular free flap reconstructions: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:2136-2151. [PMID: 31403550 DOI: 10.11124/jbisrir-2017-003875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to synthesize the best available evidence on the outcomes of mandibular fibular free flap (MFFF) reconstructions using computer-assisted techniques versus traditional freehand techniques. INTRODUCTION Fibular free flaps are the most commonly used free flap for mandible reconstruction and are considered best practice for mandible reconstructions following resection of head and neck cancers. There are several reported advantages of computer-assisted MFFF reconstructions, including increased accuracy, decreased operation time, decreased ischemia time, decreased overall cost and improved patient outcomes. It is important to assess the advantages and potential harms of these techniques in a systematic review. INCLUSION CRITERIA Eligible studies will consider patients of all ages undergoing MFFF reconstruction. Studies will compare computer-assisted techniques to traditional freehand techniques for the primary outcomes of flap failure, patient-reported outcomes and bony resection margin status. Studies published in English from 2008 will be included. Experimental, quasi-experimental, prospective and retrospective cohort, case-control and analytical cross-sectional studies will be considered. METHODS MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials will be searched. Gray literature sources will include Google Scholar and the World Health Organization International Clinical Trials Registry Platform. Two independent reviewers will screen titles and abstracts, assess full-text papers against the inclusion criteria, evaluate methodological quality using standardized critical appraisal instruments and extract data using a customized form. If possible, data will be pooled for statistical meta-analysis, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings will be presented.
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Affiliation(s)
- Andrew Chan
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence
| | | | - Zachary Munn
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence
| | - Sam Boase
- Royal Adelaide Hospital, Adelaide, Australia
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Serrano C, van den Brink H, Pineau J, Prognon P, Martelli N. Benefits of 3D printing applications in jaw reconstruction: A systematic review and meta-analysis. J Craniomaxillofac Surg 2019; 47:1387-1397. [DOI: 10.1016/j.jcms.2019.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/08/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022] Open
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Tang NSJ, Ahmadi I, Ramakrishnan A. Virtual surgical planning in fibula free flap head and neck reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2019; 72:1465-1477. [PMID: 31324403 DOI: 10.1016/j.bjps.2019.06.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/12/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The traditional approach to head and neck reconstruction is considered challenging, requiring a subjective assessment of an often-complex defect followed by careful modelling of a bony flap to match this. The introduction of Virtual Surgical Planning (VSP) has provided the surgeon with a means to increase efficiency, precision and overall patient outcomes. This study aims to compare VSP and traditional head and neck reconstructions utilising fibula free flaps with regards surgical efficiency and patient outcomes. METHODS A systematic search of the PubMed and Medline databases was performed from the date of their inception through to August 2018 to evaluate and compare VSP and non-VSP cohorts in the context of fibula free flap head and neck reconstruction. Primary comparative outcomes included operative and ischaemic time, with secondary outcomes including complications rates, measures of accuracy and financial benefits. RESULTS One hundred and fifty-three articles were identified. Twenty-three articles were included in the review, comprising a total of 713 patients. VSP was associated with significantly decreased intraoperative time (Standardised Mean Difference -1.01; 95% CI -1.23 to 0.80; p = 0.000) and ischaemic time (Standardised Mean Difference -1.55; 95% CI -1.87 to -1.23, p = 0.002). VSP was also associated with reduced orthognathic deviation from an ideal outcome when compared to conventional techniques. No statistically significant differences in complication rates between conventional and VSP techniques were identified. CONCLUSION The results of this meta-analysis suggests that VSP confers significant benefits with respect to improved orthognathic accuracy, ischaemic times and intraoperative times without any significant increase in complications. Recommendations for ongoing research are suggested.
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Affiliation(s)
- Nicholas S J Tang
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Australia.
| | - Iraj Ahmadi
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Australia
| | - Anand Ramakrishnan
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Australia
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Goodson AM, Kittur MA, Evans PL, Williams EM. Patient-specific, printed titanium implants for reconstruction of mandibular continuity defects: A systematic review of the evidence. J Craniomaxillofac Surg 2019; 47:968-976. [PMID: 30885527 DOI: 10.1016/j.jcms.2019.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/04/2019] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alexander Mc Goodson
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
| | - Madhav A Kittur
- Morriston Hospital, Heol Maes Eglwys, Swansea, SA6 6NL, United Kingdom
| | - Peter L Evans
- Morriston Hospital, Heol Maes Eglwys, Swansea, SA6 6NL, United Kingdom
| | - E Mark Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 1DL, United Kingdom.
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Miniplates Versus Reconstruction Plates in Vascularized Osteocutaneous Flap Reconstruction of the Mandible. J Craniofac Surg 2019; 30:e119-e125. [DOI: 10.1097/scs.0000000000005020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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44
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Ren Y, Xi Q, Zhang L, Liu H, Shi Y, Zhang M. Computer-Aided Design and Three-Dimensional-Printed Surgical Templates for Second-Stage Mandibular Reconstruction. J Craniofac Surg 2018; 29:2101-2105. [PMID: 30320699 DOI: 10.1097/scs.0000000000005055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
It is extremely difficult in clinical practice to accurately reset the physiologic positions of the mandibular condyle and ramus because of ongoing bone remodeling, muscle stretching, occlusal disorders, and other factors; this makes it difficult to obtain a good shape for a reconstructed mandible, as well as a good condylar position. The present study aimed to investigate a standardized method for mandibular reconstruction in cases of obsolete mandibular defects, using a 3-dimensional (3D)-printed surgical template enhanced by computer-aided design. We collected computed tomography data preoperatively to computerize the physiologic positions of the mandibular condyle and ramus on the sagittal, axial, and coronal planes. Surgical simulation and 3D-printed template preparation were then conducted to assist in the implementation of actual surgery. Postoperative review was performed to assess the repositioning of the condyle, where patients were found to regain a satisfactory condyle position. Reconstruction error was ±0.56 mm, fulfilling the preoperative design. No complications and discomfort were reported. Overall, the combined use of computer-aided design and 3D-printed surgical templates can standardize mandibular reconstruction in cases of obsolete mandibular body defects.
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Affiliation(s)
- Yipeng Ren
- Department of Stomatology, Chinese PLA General Hospital, Beijing, China
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McCann AC, Shnayder Y, Przylecki WH, Kakarala K, Nazir N, Girod DA, Andrews BT. Comparison of Modern Rigid Fixation Plating Outcomes for Segmental Mandibular Microvascular Reconstruction. Laryngoscope 2018; 129:1081-1086. [PMID: 30284278 DOI: 10.1002/lary.27406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS New advances in osseous microvascular mandibular rigid fixation are being employed at many institutions. These include standardized prebent/preformed reconstruction plates as well as computer-aided design/computer-aided manufacturing (CAD/CAM) custom plates that are patient specific. Our goal was to assess and compare the outcomes of both of these new technologies when utilized for mandibular microvascular reconstruction. STUDY DESIGN Retrospective chart review. METHODS Subjects were categorized into two groups according to their mandibular rigid fixation technique: group 1 = prebent/preformed plates and group 2 = CAD/CAM custom plates. Primary outcome measures were 1) perioperative complications (defined as deep tissue infection, wound dehiscence resulting in bone exposure, and/or plate exposure) and 2) reoperation rates for mandibular hardware failure/explantation. Statistical analysis consisted of χ2 , Fisher exact test, and multivariable regression models. RESULTS A total of 142 subjects underwent microvascular mandibular reconstruction in a 6-year period. Eighty-nine subjects utilized prebent/preformed plates, and 53 employed CAD/CAM custom plates. Perioperative complications occurred in 32 of 89 (35.9%) subjects with prebent/preformed plates and 11 of 53 (20.7%) subjects using CAD/CAM custom plates. Reoperation requiring hardware explantation occurred in 18 of 89 (20.2%) subjects and three of 53 (5.6%) using CAD/CAM custom plates. Statistical comparison of perioperative complications between the two groups approached significance (P = .0556), and the rate of reoperation was significant favoring CAD/CAM implants (P = .0180). CONCLUSIONS In our experience, CAD/CAM custom plates utilized for rigid fixation during microvascular mandibular reconstruction demonstrated fewer complications and statistically lower reoperation rates when compared with prebent/preformed plates. LEVEL OF EVIDENCE 2c Laryngoscope, 129:1081-1086, 2019.
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Affiliation(s)
- Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Wojciech H Przylecki
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Douglas A Girod
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Brian T Andrews
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.,Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
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van Baar GJC, Forouzanfar T, Liberton NPTJ, Winters HAH, Leusink FKJ. Accuracy of computer-assisted surgery in mandibular reconstruction: A systematic review. Oral Oncol 2018; 84:52-60. [PMID: 30115476 DOI: 10.1016/j.oraloncology.2018.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 11/18/2022]
Abstract
Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software programs have entered the market, offering numerous approaches for preoperative planning and postoperative evaluation of the CAS process of mandibular reconstruction. In this systematic review, we reviewed planning and evaluation methods in studies that quantitatively assessed accuracy of mandibular reconstruction performed with CAS. We included 42 studies describing 413 mandibular reconstructions planned and evaluated using CAS. The commonest software was Proplan/Surgicase CMF (55%). In most cases, the postoperative virtual 3-dimensional model was compared to the preoperative 3-dimensional model, revised to the virtual plan (64%). The commonest landmark for accuracy measurements was the condyle (54%). Accuracy deviations ranged between 0 mm and 12.5 mm and between 0.9° and 17.5°. Because of a lack of uniformity in planning (e.g., image acquisition, mandibular resection size) and evaluation methodologies, the ability to compare postoperative outcomes was limited; meta-analysis was not performed. A practical and simple guideline for standardizing planning and evaluation methods needs to be considered to allow valid comparisons of postoperative results and facilitate meta-analysis in the future.
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Affiliation(s)
- Gustaaf J C van Baar
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Niels P T J Liberton
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Henri A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Frank K J Leusink
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Numajiri T, Morita D, Nakamura H, Yamochi R, Tsujiko S, Sowa Y. Designing CAD/CAM Surgical Guides for Maxillary Reconstruction Using an In-house Approach. J Vis Exp 2018:58015. [PMID: 30199014 PMCID: PMC6231809 DOI: 10.3791/58015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Computer-aided design/computer-assisted manufacturing (CAD/CAM) is now being evaluated as a preparative technique for maxillofacial surgery. Because this technique is expensive and available in only limited areas of the world, we developed a novel CAD/CAM surgical guide using an in-house approach. By using the CAD software, the maxillary resection area and cutting planes and the fibular cutting planes and angles are determined. Once the resection area is decided, the necessary faces are extracted using a Boolean modifier. These superficial faces are united to fit the surface of the bones and thickened to stabilize the solids. Not only the cutting guides for the fibula and maxilla but also the location arrangement of the transferred bone segments is defined by thickening the superficial faces. The CAD design is recorded as .stl files and three-dimensionally (3-D) printed as actual surgical guides. To check the accuracy of the guides, model surgery using 3-D-printed facial and fibular models is performed. These methods may be used to assist surgeons where commercial guides are not available.
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Affiliation(s)
- Toshiaki Numajiri
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine;
| | - Daiki Morita
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital
| | - Hiroko Nakamura
- Department of Plastic and Reconstructive Surgery, Fukuchiyama City Hospital
| | - Ryo Yamochi
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine
| | - Shoko Tsujiko
- Department of Plastic and Reconstructive Surgery, Saiseikai Shiga Hospital
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine
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Bouchet B, Raoul G, Julieron B, Wojcik T. Functional and morphologic outcomes of CAD/CAM-assisted versus conventional microvascular fibular free flap reconstruction of the mandible: A retrospective study of 25 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:455-460. [PMID: 30098447 DOI: 10.1016/j.jormas.2018.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/26/2018] [Accepted: 07/29/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Mandibular reconstruction using fibula free flap has been improved in the last decade with computer-aided design and computer-aided manufacturing (CAD/CAM) but any functional and aesthetic evaluation of their reattempts has been realized. Aim of this retrospective study is to compare functional and morphologic outcomes after mandibular reconstruction with fibula free flap using CAD/CAM or conventional peroperative shaping for mandible reconstruction. Moreover, we compared quality of life, patient and surgery characteristics in the two groups. PATIENTS AND METHODS We realized a monocentric retrospective analyzed of 25 cases of unilateral mandibular reconstruction divided in two groups, using CAD/CAM (12 patient) or conventional approach (13 patients) between April 2012 and March. Functional and aesthetic measurements were performed postoperatively. RESULTS Mouth opening, laterotrusion and protrusion of the mandible seemed to be improved in CAD/CAM group compared with conventional group but did not differ significantly. Quality of life, bite force, masticatory ability, eating and chewing satisfaction, appearance and social activity satisfaction did not differ significantly in the two groups. CONCLUSION Even if no superiority has been established for CAD/CAM group regarding functional and aesthetic outcomes, a prospective design of future studies and transdisciplinary approach should improve our data and their interpretations. Thus, the integration of virtual planning and guided surgery is definitely of significant value and must be considered in complex maxillofacial reconstructions.
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Affiliation(s)
- B Bouchet
- Department of Oral and Maxillofacial Surgery, Lille Teaching Hospital, Roger-Salengro Hospital, Lille Teaching Hospital, 59000 Lille, France.
| | - G Raoul
- Department of Oral and Maxillofacial Surgery, Lille Teaching Hospital, Roger-Salengro Hospital, Lille Teaching Hospital, 59000 Lille, France.
| | - B Julieron
- Head and Neck Department, Oncologic Center Oscar-Lambret, 59000 Lille, France.
| | - T Wojcik
- Head and Neck Department, Oncologic Center Oscar-Lambret, 59000 Lille, France.
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50
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Ren W, Gao L, Li S, Chen C, Li F, Wang Q, Zhi Y, Song J, Dou Z, Xue L, Zhi K. Virtual Planning and 3D printing modeling for mandibular reconstruction with fibula free flap. Med Oral Patol Oral Cir Bucal 2018; 23:e359-e366. [PMID: 29680849 PMCID: PMC5945234 DOI: 10.4317/medoral.22295] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background This study was to evaluate the use of virtual planning and 3D printing modeling in mandibular reconstruction and compare the operation time and surgical outcome of this technique with conventional method. Material and Methods Between 2014 and 2017, 15 patients underwent vascularized fibula flap mandibular reconstruction using virtual planning and 3D printing modeling. Titanium plates were pre-bent using the models and cutting guides were used for osteotomies. 15 patients who underwent mandibular reconstruction using fibula flap without aid of virtual planning and 3D printing models were selected as control group. The operation time was recorded and compared in two groups. Accuracy of reconstruction was measured by superimposing the preoperative image onto the postoperative image of mandible. The selected bony landmark, distance and angle were measured. Results The mean total operation time and reconstruction time were 1.60±0.37 and 5.54±0.50 hours in computer-assisted group, respectively; These were 2.58±0.45 and 6.54±0.70 hours in conventional group, respectively. Both operation time and reconstruction time were shorter in computer-assisted group. The difference between the preoperative and postoperative intercondylar distances, intergonial angle distances, anteroposterior distances and gonial angles were 2.92±1.15 and 4.48±1.41mm, 2.93±1.19 and 4.79±1.48mm, 4.31±1.24 and 5.61±1.41mm, 3.85±1.68° and 5.88±2.12° in the computer-assisted and conventional group, respectively. The differences between the preoperative and postoperative mandible is smaller in the computer-assisted group. Conclusions Virtual planning and 3D printing modeling have the potential to increase mandibular reconstruction accuracy and reduce operation time. we believe that this technology for mandibular reconstruction in selected patients will become a used method and improve the quality of reconstruction. Key words:Mandibular reconstruction, fibula flap, virtual planning, computer-assisted design, 3D printing.
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Affiliation(s)
- W Ren
- Department of Oral and Maxillofacial Surgery, The affiliated hospital of Qingdao University, No.1677, Wutai mountain Road, Qingdao, Shandong, P. R. China. 255666
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