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Hurczulack MV, Guebur MI, Albrecht Ramos GH, Duarte da Silva AB, Sassi LM. Results of a Novel Technique for Increasing Bone Contact and Stability in Mandibular Reconstruction with Micro-vascularized Fibula Flap. J Maxillofac Oral Surg 2024; 23:235-241. [PMID: 38601240 PMCID: PMC11001831 DOI: 10.1007/s12663-021-01536-x] [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: 06/19/2020] [Accepted: 02/23/2021] [Indexed: 10/21/2022] Open
Abstract
Background Reconstruction of large mandibular defects requires reestablishment of mandibular continuity with bone and soft tissue. The microvascularized fibula flap (MFF) has the advantage of providing both, with adequate length, low resorption rate, low infection risk and possibility of dental implant insertion. It can be adapted to mandibular defects in many different ways. Purpose This retrospective study will present and evaluate the results of the male-female joint technique for flap positioning and fixation. Methods The technique consists of designing osteotomies on the binding edge of the MFF and recipient jaw, increasing bone contact from one to five faces. Patients submitted to mandibular reconstruction through this technique were included and evaluated regarding systemic compromise, complication occurrence as well as primary and long-term stability. Results Ten patients underwent mandibular reconstruction with the male-female joint technique. Sixteen joints were applied, and excluding an early loss due to vascular failure, all remaining 14 joints healed uneventfully. None showed signs of early or late mobility. Conclusion Fitting the MFF through a male-female joint that provides greater bone contact may improve stability and reduce screw loosening and mini-plate removal rates.
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Affiliation(s)
- Marcio Vinícius Hurczulack
- Oral and Maxillofacial Surgery Department, Erasto Gaertner Hospital, R. Dr. Ovande do Amaral, 201-Jardim das Americas, Curitiba, PR 81520-060 Brazil
| | - Maria Isabela Guebur
- Oral and Maxillofacial Surgery Department, Erasto Gaertner Hospital, R. Dr. Ovande do Amaral, 201-Jardim das Americas, Curitiba, PR 81520-060 Brazil
| | | | | | - Laurindo Moacir Sassi
- Oral and Maxillofacial Surgery Department, Erasto Gaertner Hospital, R. Dr. Ovande do Amaral, 201-Jardim das Americas, Curitiba, PR 81520-060 Brazil
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Ritschl LM, Singer H, Clasen FC, Haller B, Fichter AM, Deppe H, Wolff KD, Weitz J. Oral rehabilitation and associated quality of life following mandibular reconstruction with free fibula flap: a cross-sectional study. Front Oncol 2024; 14:1371405. [PMID: 38562168 PMCID: PMC10982308 DOI: 10.3389/fonc.2024.1371405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Mandibular reconstruction with the free fibula flap (FFF) has become a standardized procedure. The situation is different with oral rehabilitation, so the purpose of this study was to investigate the frequency of implant placement and prosthetic restoration. Additionally, the patients' situation, motivation, and treatment course were structurally assessed. Materials and methods All cases between January 2013 and December 2018 that underwent mandibular reconstruction in our department with a free fibula flap and gave written informed consent to participate were interviewed with two structured questionnaires about their restoration and quality of life. Additionally, medical records, general information, status of implants and therapy, and metric analyses of the inserted implants were performed. Results In total 59 patients were enrolled and analyzed in this monocentric study. Overall, oral rehabilitation was achieved in 23.7% at the time of investigation. In detail, implants were inserted in 37.3% of patients and showed an 83.3% survival of dental implants. Of these implanted patients, dental implants were successfully restored with a prosthetic restoration in 63.6. Within this subgroup, satisfaction with the postoperative aesthetic and functional result was 79.9% and with the oral rehabilitation process was 68.2%. Satisfaction with the implant-borne prosthesis was 87.5%, with non-oral-squamous-cell-carcinoma patients being statistically significantly more content with the handling (p=0.046) and care (p=0.031) of the prosthesis. Discussion Despite the well-reconstructed bony structures, there is a need to increase the effort of achieving oral rehabilitation, especially looking at the patient's persistent motivation for the procedure.
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Affiliation(s)
- Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Hannes Singer
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Franz-Carl Clasen
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Andreas M. Fichter
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
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Graf-Alexiou L, Qiu Y, Aalto D, Westover L. An Investigation of the Effect of Irradiation on the Biomechanical Properties of Fibular Grafts. J Oral Maxillofac Surg 2021; 80:784.e1-784.e5. [PMID: 34942151 DOI: 10.1016/j.joms.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Irradiation of fibular grafts for jaw reconstruction following mandibulectomy can be associated with increased graft failure and implant instability. The objective of this study is to investigate the effect of isolated irradiation on the biomechanical properties of ex-vivo porcine fibula grafts. It was hypothesized that the isolated irradiation (without biological response) will not significantly influence the biomechanical properties of the fibular grafts. METHODS Forty porcine fibular grafts (n = 20 irradiated and n = 20 nonirradiated) were obtained. The irradiated group was subjected to a single dose of 60 Gy of irradiation with cesium 137. Both groups underwent 3-point bending tests with cyclic loading for 1500 cycles (50 to 500 N at 2 Hz) followed by push to failure. Rate of damage (mm/s), stiffness (N/mm), modulus of elasticity (MPa), maximum load (N), maximum displacement (mm), and maximum stress (MPa) were compared between the 2 groups using independent t tests (P < .05). RESULTS No significant differences were found between the irradiated and nonirradiated groups for any of the biomechanical parameters (all P values > 0.05). CONCLUSIONS The results of this study support our hypothesis that even high levels of isolated irradiation do not significantly affect the biomechanical properties of fibular bone grafts. This work allows us to exclude acute structural changes in the bone due to irradiation as a possible factor leading to bone/implant instability following jaw reconstruction with fibular grafts. Further studies need to be conducted to better understand the range of factors that may lead to implant instability, including the biological response after radiation therapy.
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Affiliation(s)
- Lucas Graf-Alexiou
- Student, Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - Yuelin Qiu
- Student, Department of Civil Engineering, University of Alberta, Edmonton, Canada
| | - Daniel Aalto
- Assistant Professor, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada; Assistant Professor, Institute for Reconstructive Sciences in Medicine (iRSM), Edmonton, Canada
| | - Lindsey Westover
- Student, Department of Mechanical Engineering, University of Alberta, Edmonton, Canada.
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Ritschl LM, Kilbertus P, Grill FD, Schwarz M, Weitz J, Nieberler M, Wolff KD, Fichter AM. In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis. Front Oncol 2021; 11:731336. [PMID: 34631563 PMCID: PMC8498593 DOI: 10.3389/fonc.2021.731336] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Mandibular reconstruction is conventionally performed freehand, CAD/CAM-assisted, or by using partially adjustable resection aids. CAD/CAM-assisted reconstructions are usually done in cooperation with osteosynthesis manufacturers, which entails additional costs and longer lead time. The purpose of this study is to analyze an in-house, open-source software-based solution for virtual planning. Methods and Materials All consecutive cases between January 2019 and April 2021 that underwent in-house, software-based (Blender) mandibular reconstruction with a free fibula flap (FFF) were included in this cross-sectional study. The pre- and postoperative Digital Imaging and Com munications in Medicine (DICOM) data were converted to standard tessellation language (STL) files. In addition to documenting general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time), conventional measurements and three-dimensional analysis methods (root mean square error [RMSE], mean surface distance [MSD], and Hausdorff distance [HD]) were used. Results Twenty consecutive cases were enrolled. Three-dimensional analysis of preoperative and virtually planned neomandibula models was associated with a median RMSE of 1.4 (0.4–7.2), MSD of 0.3 (-0.1–2.9), and HD of 0.7 (0.1–3.1). Three-dimensional comparison of preoperative and postoperative models showed a median RMSE of 2.2 (1.5–11.1), MSD of 0.5 (-0.6–6.1), and HD of 1.5 (1.1–6.5) and the differences were significantly different for RMSE (p < 0.001) and HD (p < 0.001). The difference was not significantly different for MSD (p = 0.554). Three-dimensional analysis of virtual and postoperative models had a median RMSE of 2.3 (1.3–10.7), MSD of -0.1 (-1.0–5.6), and HD of 1.7 (0.1–5.9). Conclusions Open-source software-based in-house planning is a feasible, inexpensive, and fast method that enables accurate reconstructions. Additionally, it is excellent for teaching purposes.
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Affiliation(s)
- Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Paul Kilbertus
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Florian D Grill
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Schwarz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
| | - Markus Nieberler
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Andreas M Fichter
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
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Computer-Aided Design and Manufacturing versus Conventional Surgical Planning for Head and Neck Reconstruction: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2021; 148:183-192. [PMID: 34076623 DOI: 10.1097/prs.0000000000008085] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Virtual surgical planning and computer-aided design/computer-aided manufacturing (CAD/CAM) for complex head and neck reconstruction has a number of cited advantages over conventional surgical planning, such as increased operative efficiency, fewer complications, improved osseous flap union, immediate osseointegrated dental implant placement, and superior functional and aesthetic outcomes. The authors performed a systematic review and meta-analysis of the available evidence on CAD/CAM maxillofacial reconstruction with the primary purpose of determining which approach is more efficacious. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a PubMed and Embase database search was performed to identify English-language, human-subject studies of CAD/CAM-assisted head and neck reconstruction. All comparative studies were included in a meta-analysis to identify differences in operative time, ischemia time, surgical-site occurrence, microvascular complication, and partial or total flap loss between the two groups. All included studies (comparative and noncomparative) were used in the systematic review, summarizing the various flap characteristics, technical nuances, and functional and aesthetic outcomes. RESULTS Twelve articles were included in the meta-analysis, representing 277 patients in the CAD/CAM group and 419 patients in the conventional group. CAD/CAM was associated with 65.3 fewer minutes of operating room time (95 percent CI, -72.7 to -57.9 minutes; p < 0.0001) and 34.8 fewer minutes of ischemia time (95 percent CI, -38 to -31.5 minutes; p < 0.0001). There were no significant differences in surgical-site occurrence, nonunion, flap loss, microvascular complications, or hardware-related complications. CONCLUSIONS CAD/CAM is associated with shorter operating room and ischemia times. There are no significant differences in flap or hardware-related complications between CAD/CAM and conventional surgical planning.
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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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Bone volume change following vascularized free bone flap reconstruction of the mandible. J Craniomaxillofac Surg 2020; 48:859-867. [DOI: 10.1016/j.jcms.2020.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/03/2020] [Accepted: 07/19/2020] [Indexed: 01/18/2023] Open
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Harrison P, Patel A, Cheng A, Bell RB. Three-Dimensional Computer-Assisted Surgical Planning, Manufacturing, and Intraoperative Navigation in Oncologic Surgery. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:129-144. [PMID: 32741510 DOI: 10.1016/j.cxom.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Phillip Harrison
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney, Suite 300, Portland, OR 97209, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA.
| | - Ashish Patel
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney, Suite 300, Portland, OR 97209, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA. https://twitter.com/patelmddds
| | - Allen Cheng
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA. https://twitter.com/allenchengddsmd
| | - R Bryan Bell
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; Earle A. Chiles Research Institute in the Robert W. Franz Cancer Center, Providence Cancer Institute, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA. https://twitter.com/rbryanbell
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Virtual Surgical Planning for Mandibular Reconstruction With the Fibula Free Flap. Ann Plast Surg 2019; 84:117-122. [DOI: 10.1097/sap.0000000000002006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rendenbach C, Steffen C, Hanken H, Schluermann K, Henningsen A, Beck-Broichsitter B, Kreutzer K, Heiland M, Precht C. Complication rates and clinical outcomes of osseous free flaps: a retrospective comparison of CAD/CAM versus conventional fixation in 128 patients. Int J Oral Maxillofac Surg 2019; 48:1156-1162. [PMID: 30792087 DOI: 10.1016/j.ijom.2019.01.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 02/02/2023]
Abstract
Studies evaluating plate-related complications in patient-specific versus conventional fixation systems in free flap surgery are lacking. This was a retrospective study of 128 osseous free flaps with a minimum follow-up of 12 months. Wound healing disorders, plate exposure, fixation failure, and subtotal osseous union were recorded and evaluated statistically by univariate and regression analysis. Complication rates were as follows: wound healing disorders 33.6% (computer-aided design and computer-aided manufacturing (CAD/CAM) vs. conventional: 35.1% vs. 33.0%); plate exposure 21.9% (29.7% vs. 18.7%); fixation failure 7.0% (8.1% vs. 6.6%); subtotal osseous union 36.7% (45.9% vs. 33.0%). Radiotherapy (P<0.001) and more than two segments (P=0.026) were independent variables for the overall complication rate and were negatively correlated with the dental implantation rate. The time between diagnosis and ablative surgery was increased by 11.0days in the CAD/CAM group (34.2±16.2days vs. 23.2±12.0 days; P=0.002). Rates of dental rehabilitation were not significantly different (35.1% vs. 44.0%, P=0.358). On average, 3.2±1.7 dental implants were placed into flap segments. Plate-related complications were increased with radiotherapy and multisegment flaps. There was a non-significant trend towards increased complications with patient-specific plates in comparison to conventional reconstruction plates.
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Affiliation(s)
- C Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate Member Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
| | - C Steffen
- Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate Member Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - H Hanken
- Department of Oral and Maxillofacial Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - K Schluermann
- Department of Oral and Maxillofacial Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A Henningsen
- Department of Oral and Maxillofacial Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - B Beck-Broichsitter
- Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate Member Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - K Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate Member Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate Member Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - C Precht
- Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate Member Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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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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