Post-traumatic maxillofacial reconstruction with vascularized flaps and digital techniques: 10-year experience

Prelamination of Anterolateral Thigh Osseocutaneous Flap With Fibula for the Reconstruction of Zygomatic Arch Defects After Facial Trauma

Complex facial trauma usually results in significant physical, esthetical, functional, and psychological damage. Nowadays, tissue flap transfer is the most effective and common treatment for the reconstruction of facial defects. Among them, the prelaminated flap has a bigger role in reconstructing massive facial defects. In this report, the authors have described a case of a 48-year-old man who presented a complex defect of tissue and deformity in the oral and maxillofacial region because of traffic accident trauma. Given the complexity of this case, it was impossible to complete the reconstruction in a single operation. The authors used a vascularized fibula-free flap (VFFF) to reconstruct the right mandible during the first operation and implanted a segment of fibula into the subcutaneous tissue of the right anterolateral thigh, which was used during the second operation for the reconstruction of zygomatic arch. This individualized treatment plan achieved a final satisfactory surgical outcome.

Needle Removal in the Deep Maxillofacial Region Assisted by Computerized Navigation Technique and Digital Guiding Plate

Retention of foreign bodies frequently happened in the region of oral and maxillofacial. In very rare cases, the positions of the foreign objects moved with the movement of muscles in the oral and maxillofacial regions. Precise locations of moving objects and minimally invasive surgeries pose a great challenge to surgeons. The case of a 44-year-old female patient diagnosed with retention of the fractured needle is reported in this study. A digital guide plate was manufactured to locate the precise position of the fractured needle and preoperatively mimic the surgery processes. The computerized navigation system guided us to make an incision and precisely target the fractured needle during the surgery. Combing the technologies of the digital guiding plate and navigation system, removing the moving foreign bodies becomes objective, time-saving, and minimally invasive.

Analysis of intraoral microvascular anastomosis in maxillofacial defects reconstruction

This review summarizes the research progress in the field of intraoral microvascular anastomosis techniques (IAT) and attempts to investigate the indications for procedures in which IAT can be applied, the surgical procedure and the difficulties involved, technical assessments, result evaluation and the perspective. Currently, microvascular anastomosis technique is widely used in maxillofacial defects reconstruction from various causes including cutaneous injury or congenital deformity which usually required extensive flap reconstruction and therefore a vascular free flap is routinely used. Conventional microvascular anastomosis reconstruction techniques cannot avoid new incisions, which will affect the postoperative aesthetic situation. Surgeons have therefore attempted to improve this technique to effectively eliminate scars caused by surgery: some patients can be chosen to undergo microvascular anastomosis of the free flap intraorally, thus reducing the extraoral incision caused by the anastomosis located in neck or maxillofacial improving the postoperative appearance of the patients. In addition to preserving the external appearance, intraoral anastomosis technique (IAT) can also solve some other problems of maxillofacial vascular anastomosis, such as insufficient vessel pedicle length and high risk of facial nerve injury.

Computer-assisted preoperative planning of bone fracture fixation surgery: A state-of-the-art review

Background: Bone fracture fixation surgery is one of the most commonly performed surgical procedures in the orthopedic field. However, fracture healing complications occur frequently, and the choice of the most optimal surgical approach often remains challenging. In the last years, computational tools have been developed with the aim to assist preoperative planning procedures of bone fracture fixation surgery. Objectives: The aims of this review are 1) to provide a comprehensive overview of the state-of-the-art in computer-assisted preoperative planning of bone fracture fixation surgery, 2) to assess the clinical feasibility of the existing virtual planning approaches, and 3) to assess their clinical efficacy in terms of clinical outcomes as compared to conventional planning methods. Methods: A literature search was performed in the MEDLINE-PubMed, Ovid-EMBASE, Ovid-EMCARE, Web of Science, and Cochrane libraries to identify articles reporting on the clinical use of computer-assisted preoperative planning of bone fracture fixation. Results: 79 articles were included to provide an overview of the state-of-the art in virtual planning. While patient-specific geometrical model construction, virtual bone fracture reduction, and virtual fixation planning are routinely applied in virtual planning, biomechanical analysis is rarely included in the planning framework. 21 of the included studies were used to assess the feasibility and efficacy of computer-assisted planning methods. The reported total mean planning duration ranged from 22 to 258 min in different studies. Computer-assisted planning resulted in reduced operation time (Standardized Mean Difference (SMD): -2.19; 95% Confidence Interval (CI): -2.87, -1.50), less blood loss (SMD: -1.99; 95% CI: -2.75, -1.24), decreased frequency of fluoroscopy (SMD: -2.18; 95% CI: -2.74, -1.61), shortened fracture healing times (SMD: -0.51; 95% CI: -0.97, -0.05) and less postoperative complications (Risk Ratio (RR): 0.64, 95% CI: 0.46, 0.90). No significant differences were found in hospitalization duration. Some studies reported improvements in reduction quality and functional outcomes but these results were not pooled for meta-analysis, since the reported outcome measures were too heterogeneous. Conclusion: Current computer-assisted planning approaches are feasible to be used in clinical practice and have been shown to improve clinical outcomes. Including biomechanical analysis into the framework has the potential to further improve clinical outcome.

Accurate Reconstruction of Mandibular Defects With Vascularized Bone Flaps Through Utilization of Mandible Space-Retention Guides

PURPOSE

Comprehensive evaluation of the effects of using computer-aided design and space retention guide technology to reconstruct mandibular defects using vascularized autogenous bone flaps.

METHOD

This study included 8 patients who received autogenous bone flaps (2 cases of vascularized fibula flaps and 6 cases of vascularized iliac flaps) for mandibular defect reconstruction at Peking University School and Hospital of Stomatology, from July 2018 to May 2021. All patients received digital surgery planning, CAD/CAM, surgical guide technique for the removal of diseased bone segments, as well as vascularized fibular flap/iliac flap reconstruction. Three-dimensional deviations were analyzed after the operation.

RESULT

The mandibular defects of all 8 patients were successfully reconstructed using the vascularized fibular flap/iliac bone flap. There were no serious complications at either the donor site or recipient site during our follow-up. The average three-dimensional deviation of all 8 patients was 1.92 mm, based on comparisons of preoperative design and actual postoperative computed tomography.

CONCLUSION

Utilizing CAD/CAM, we designed a new mandibular space-retention guide, which can accurately translate the preoperative digital design plan to real-time surgery with satisfactory accuracy and efficacy.

Orthodontic treatment combined with 3D printing guide plate implant restoration for edentulism and its influence on mastication and phonic function

BACKGROUND

Dentition defect, a common clinical oral disease developed in humans, not only causes masticatory dysfunction and articulation difficulties but also affects facial appearance and increases the burden on the intestinal tract. Restorative treatment is the primary option for this disease. However, traditional restorations have many drawbacks, such as mismatch with the body, low reliability, and incomplete occlusal function recovery.

AIM

to analyze the efficacy of orthodontics combined with 3D printing guide plate implant restoration in treating patients with dentition defects and its influence on masticatory and phonic functions.

METHODS

A prospective study was carried out in 86 patients with dentition defects who received implant prosthesis after orthodontic treatment in our hospital between January 2018 and January 2019. Those patients were divided into a control group and an intervention group with 43 patients in each group using a random number table. The control group received traditional implant restoration, whereas the intervention group received 3D printing guide plate implant restoration. Treatment outcomes, cosmetic appearance, dental function, implant deviation, and quality of life were compared between the two groups.

RESULTS

The overall response rate in the intervention group was significantly higher than that in the control group (95.35% vs 81.40%, χ² = 4.071, P = 0.044). The number of cases with neatly trimmed cosmetic appearance (χ² = 4.497, P = 0.034), complete coverage (χ² = 4.170, P = 0.041), and normal occlusion (χ² = 5.512, P = 0.019) in the intervention group was higher than that in the control group. After treatment, mastication, swallowing, and articulation were significantly improved in both groups. Masticatory (t = 2.980, P = 0.004), swallowing (t = 2.199, P = 0.031), and phonic functions (t = 3.950, P = 0.004) were better in the intervention group than those in the control group. The deviation value and the deviation angle (t = 5.440, P = 0.000) at the top (t = 6.320, P = 0.000) and middle parts of the implants (t = 22.295, P = 0.000) in the intervention group were lower than those in the control group after treatment. Functional limitations, psychosocial and physical pain and discomfort, and total scores decreased in both groups. The functional limitation (t = 2.379, P = 0.020), psychosocial (t = 2.420, P = 0.000), physical pain and discomfort (t = 6.581, P = 0.000), and total scores (t = 2.140, P = 0.035) were lower in the intervention group than those in the control group.

CONCLUSION

Orthodontic treatment combined with 3D printing guide plate implant restoration can significantly improve the masticatory and phonic functions, quality of life, and psychological health of patients with dentition defects. Therefore, it is highly recommended in clinic application.

Digitally reconstructed severe trauma-induced oro-maxillofacial defects with free vascularised composite tissue flaps

The aim of this study was to outline the characteristics of severe trauma-induced oro-maxillofacial defects and explore the application of microsurgical reconstruction of these defects by selecting appropriate free vascularised composite tissue flaps. A retrospective analysis was performed in 11 cases with severe trauma-induced oro-maxillofacial defects from 2005 to 2018, All cases were reconstructed with free vascularised composite flaps using a supermicro-surgical/micro-surgical and digital technology. This study consisted of 11 patients (8 men, 3 women) with a median age (range) of 28 (6-64) years. Patients with long-standing trauma experienced severe scars and displacements. The trauma-induced oro-maxillofacial defects ranged in size from 4.0 × 5.0 cm² to 7 × 15 cm². Six radial forearm flaps, three fibular osteocutaneous flaps, a lateral thoracic flap, and an anterolateral thigh flap were harvested individually. All patients were treated effectively and followed up for over two years, with a 100% survival rate of these free vascularised composite tissue flaps. No uncontrollable complications occurred, and all patients were satisfied with the postoperative shape and function. The trauma-induced oro-maxillofacial defects display unique features, and microsurgical techniques play an important role in the reconstruction of shapes and function. In addition, some patients may need multi-stage surgeries to attain aesthetic refinement.

Automatic virtual reconstruction of maxillofacial bone defects assisted by ICP (iterative closest point) algorithm and normal people database

OBJECTIVES

The aim of this study was to propose and validate an automatic approach based on iterative closest point algorithm for virtual complement and reconstruction for maxillofacial bone defects.

MATERIALS AND METHODS

A 3D craniomaxillofacial database of normal Chinese people including 500 skull models was established. Modified iterative closest point (ICP) algorithm was developed to complete bone defects automatically. The performances were evaluated by two approaches: (1) model experiment, virtual bony defects were created on 30 intact normal skull models not included in the database. For each defect model, the algorithm was applied to select the reference skull model from the database. 3-Dimensional and 2-dimensional comparison were conducted to evaluate the error between reference skull model with original intact model. Root mean square error (RMSE) and processing time were calculated. (2) Clinical application, the algorithm was utilized to assist reconstruction of 5 patients with maxillofacial bone defects. The symmetry of post-operative skull model was evaluated by comparing with its mirrored model.

RESULTS

The algorithm was tested on an CPU with 1.80 GHz and average processing time was 493.5 s. (1) Model experiment, the average root-mean-square deviation of defect area was less than 2 mm. (2) Clinical application, the RMSE of post-operative skull and its mirrored model was 1.72 mm.

CONCLUSION

It is feasible using iterative closest point algorithm based on normal people database to automatically predict the reference data of missing maxillofacial bone.

CLINICAL RELEVANCE

An automated approach based on ICP algorithm and normal people database for maxillofacial bone defect reconstruction has been proposed and validated.