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Zhao B, Wang H, Liu C, Liu H, Zhao X, Sun Z, Hu M. A preliminary study of the mechanical properties of 3D-printed personalized mesh titanium alloy prostheses and repair of hemi-mandibular defect in dogs. J Biomed Mater Res B Appl Biomater 2024; 112:e35466. [PMID: 39223742 DOI: 10.1002/jbm.b.35466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 07/10/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
This study is a preliminary investigation exploring the mechanical properties of three-dimensional (3D)-printed personalized mesh titanium alloy prostheses and the feasibility of repairing hemi-mandibular defects. The ANSYS 14.0 software and selective laser melting (SLM) were used to produce personalized mesh titanium alloy scaffolds. Scaffolds printed using different parameters underwent fatigue property tests and scanning electron microscopy (SEM) of the fracture points. Models of hemi-mandibular defects (encompassing the temporomandibular joint) were created using beagle dogs. Freeze-dried allogeneic mandibles or 3D-printed personalized mesh titanium alloy prostheses were used for repair. Gross observation, computed tomography (CT), SEM, and histological examinations were used to compare the two repair methods. The prostheses with filament diameters of 0.5 and 0.7 mm could withstand 14,000 times and >600,000 cycles of alternating stresses, respectively. The truss-structure scaffold with a large aperture and large aperture ratio could withstand roughly 250,000 cycles of alternating forces. The allogeneic mandible graft required intraoperative shaping, while the 3D-printed mesh titanium alloy prostheses were personalized and did not require intraoperative shaping. The articular disc on the non-operated sides experienced degenerative changes. No liver and kidney toxicity was observed in the two groups of animals. The 3D-printed mesh titanium alloy prostheses could effectively restore the shape of the mandibular defect region and reconstruct the temporomandibular joint.
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Affiliation(s)
- Bingjing Zhao
- Department of Stomatology, The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, Guangdong, China
- Scientific Research Platform, The Second Clinical Medical College, Guangdong Medical University, Dongguan, Guangdong, China
| | - Hong Wang
- Department of Stomatology, The Second Affiliated Stomatological Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Changkui Liu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Xi'an Medical University, Shanxi, Xi'an, China
| | - Huawei Liu
- Department of Stomatology, General Hospital of the PLA, Beijing, China
| | - Xiaowen Zhao
- Shenzhen Excellent Technology Research Institute, Shenzhen, Guangdong, China
| | - Zenghui Sun
- Zhong An Tai Hua Medical Academy, Beijing, China
| | - Min Hu
- Department of Stomatology, General Hospital of the PLA, Beijing, China
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Aftabi H, Sagl B, Lloyd JE, Prisman E, Hodgson A, Fels S. To what extent can mastication functionality be restored following mandibular reconstruction surgery? A computer modeling approach. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108174. [PMID: 38640839 DOI: 10.1016/j.cmpb.2024.108174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/26/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
STATEMENT OF PROBLEM Advanced cases of head and neck cancer involving the mandible often require surgical removal of diseased sections and subsequent replacement with donor bone. During the procedure, the surgeon must make decisions regarding which bones or tissues to resect. This requires balancing tradeoffs related to issues such as surgical access and post-operative function; however, the latter is often difficult to predict, especially given that long-term functionality also depends on the impact of post-operative rehabilitation programs. PURPOSE To assist in surgical decision-making, we present an approach for estimating the effects of reconstruction on key aspects of post-operative mandible function. MATERIAL AND METHODS We develop dynamic biomechanical models of the reconstructed mandible considering different defect types and validate them using literature data. We use these models to estimate the degree of functionality that might be achieved following post-operative rehabilitation. RESULTS We find significant potential for restoring mandibular functionality, even in cases involving large defects. This entails an average trajectory error below 2 mm, bite force comparable to a healthy individual, improved condyle mobility, and a muscle activation change capped at a maximum of 20%. CONCLUSION These results suggest significant potential for adaptability in the masticatory system and improved post-operative rehabilitation, leading to greater restoration of jaw function.
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Affiliation(s)
- Hamidreza Aftabi
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada.
| | - Benedikt Sagl
- Center for Clinical Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, 1090, Austria
| | - John E Lloyd
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, 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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Wang Y, Li B, Liao J, Wang Y. Comparison of condylar position after free fibular flap mandibular reconstruction using computer-assisted and traditional techniques. BMC Oral Health 2024; 24:452. [PMID: 38622579 PMCID: PMC11017485 DOI: 10.1186/s12903-024-04203-y] [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: 01/17/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVES To compare the changes in condylar position after mandibular reconstruction with free fibular flap(FFF) and the differences between computer-assisted techniques and traditional methods on CT images. METHODS Thirty-four patients who underwent mandibular reconstruction with free fibular flap were selected according to the inclusion and exclusion criteria. In the 3D group, virtual surgical planning (VSP) with osteotomy cutting plate and placement guiding plate were used, while the traditional group underwent freehand reconstruction. The CT data of 68 temporomandibular joints (TMJs) were recorded before and immediately after surgery. The condylar position was evaluated by measuring the anterior space (AS), posterior space (PS) and superior space (SS), and the ln (PS/AS) was calculated according to the method proposed by Pullinger and Hollender. RESULTS In the patients included in the 3D group, the condyle on the ipsilateral side moved slightly backward; however, in the patients in the traditional group, the ipsilateral side moved considerably anteroinferior. No obvious changes on the contralateral side were noted. In the 3D group, 33% of ipsilateral condyles were in the posterior position postoperatively when compared with the preoperative position (13%). In the traditional group, the number of ipsilateral condyles in the anterior position increased from 4 to 10, accounting for 53% postoperatively. Contrary to the traditional group, the 3D group presented less condylar displacement on the ipsilateral side postoperatively. CONCLUSIONS This study showed a decreased percentage of change in condylar position postoperatively when VSP was used. Virtual surgical planning improved the accuracy of FFF mandibular reconstruction and made the condylar position more stable.
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Affiliation(s)
- Yu Wang
- Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong, 510120, China
| | - Bowen Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Juankun Liao
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Yan Wang
- Department of Stomatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China.
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Wang Y, Chen G, Zhou N, Huang X. A new classification of mandible defects and condyle changed after mandible reconstruction with FFF. Heliyon 2024; 10:e25831. [PMID: 38384523 PMCID: PMC10878914 DOI: 10.1016/j.heliyon.2024.e25831] [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: 09/23/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives To explore a new classification of mandibular defects and changes in the preserved condyle after mandibular reconstruction with free fibular flap(FFF). Study design We reviewed patients who underwent mandibular reconstruction with FFF from 2015 to 2021 and classified the mandibular defects into five categories: classⅠ(unilateral-mandibular excluding condyle), classⅡ(unilateral-mandibular including condyle), classⅢ(bilateral-mandibular excluding condyle), classⅣ(bilateral-mandibular including one condyle), and classⅤ(bilateral-mandibular including both condyles). Cone Beam Computed Tomography (CBCT) data were collected preoperatively(T0), at 7-10 postoperative days(T1), 6 postoperative months(T2), and 1 postoperative year(T3). We calculated the condylar surface area, volume, and displacement. Results 62 cases were collected. The condylar surface areas and volumes in T2 and T3 values were lower than those of T0 and T1(P < 0.01) The condylar displacement was the lowest in ClassI and the largest in ClassⅣ(P < 0.01), while no significant differences in classesⅠ-Ⅲ(P < 0.05). Displacement during T1-T0 was greater than that during T2-T0 and T3-T0(P < 0.05). Conclusion Mandibular reconstruction with FFF results in displacement and alteration of the condyle within a time interval, and this alteration stabilizes after 6 months. Mandibular defects that do not reach the midline, surgical alteration to preserve the condyle are not required. However, when the defects cross the midline, the condyle should be preserved as much as possible.
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Affiliation(s)
- Yaxi Wang
- Guangxi Medical University, Nanning, 530021, PR China
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Guangxi Medical University, Nanning, 530021, PR China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, 530021, PR China
| | - Guosheng Chen
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Guangxi Medical University, Nanning, 530021, PR China
| | - Nuo Zhou
- Guangxi Medical University, Nanning, 530021, PR China
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Guangxi Medical University, Nanning, 530021, PR China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, 530021, PR China
| | - Xuanping Huang
- Guangxi Medical University, Nanning, 530021, PR China
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Guangxi Medical University, Nanning, 530021, PR China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, 530021, PR China
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Chen H, Li Y, Sun Y, Chen X, Pu Y, Sun G. Changes in condylar position and morphology after mandibular reconstruction by vascularized fibular free flap with condyle preservation. Clin Oral Investig 2023; 27:6097-6109. [PMID: 37632578 DOI: 10.1007/s00784-023-05225-6] [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: 04/25/2022] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
OBJECTS Changes in condylar position and morphology after mandibular reconstruction are important to aesthetic and functional rehabilitation. We evaluated changes in condylar position and morphology at different stages after mandibular reconstruction using vascularized fibular free flap with condyle preservation. MATERIALS AND METHODS A total of 23 patients who underwent mandibular reconstruction with fibular flap were included in this retrospective study. CT data of all patients were recorded before surgery (T0), 7 to 14 days after surgery (T1), and at least 6 months after surgery (T2). Five parameters describing the condylar position and 4 parameters describing the morphology were measured in sagittal and coronal views of CT images. The association between clinical characteristics and changes in condylar position and morphology was analyzed. A finite element model was established to investigate the stress distribution and to predict the spatial movement tendency of the condyle after reconstruction surgery. RESULTS The condylar position changed over time after mandibular reconstruction. The ipsilateral condyles moved inferiorly after surgery (T0 to T1) and continually move anteriorly, inferiorly, and laterally during long-term follow-up (T1 to T2). Contrary changes were noted in the contralateral condyles with no statistical significance. No morphological changes were detected. The relationship between clinical characteristics and changes in condylar position and morphology was not statistically significant. A consistent result was observed in the finite element analysis. CONCLUSION Condylar positions showed obvious changes over time after mandibular reconstruction with condylar preservation. Nevertheless, further studies should be conducted to evaluate the clinical function outcomes and condylar position. CLINICAL RELEVANCE These findings can form the basis for the evaluation of short-term and long-term changes in condylar position and morphology among patients who have previously undergone mandibular reconstruction by FFF with condyle preservation.
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Affiliation(s)
- Haoliang Chen
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, People's Republic of China
| | - Yongheng Li
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Yawei Sun
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, People's Republic of China
| | - Xin Chen
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, People's Republic of China
| | - Yumei Pu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, People's Republic of China
| | - Guowen Sun
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing, 210008, People's Republic of China.
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Weitz J, Grabenhorst A, Singer H, Niu M, Grill FD, Kamreh D, Claßen CAS, Wolff KD, Ritschl LM. Mandibular reconstructions with free fibula flap using standardized partially adjustable cutting guides or CAD/CAM technique: a three- and two-dimensional comparison. Front Oncol 2023; 13:1167071. [PMID: 37228490 PMCID: PMC10203950 DOI: 10.3389/fonc.2023.1167071] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Background Mandibular reconstruction with the fibula free flap (FFF) is performed freehand, CAD/CAM-assisted, or by using partially adjustable resection/reconstruction aids. The two latter options represent the contemporary reconstructive solutions of the recent decade. The purpose of this study was to compare both auxiliary techniques with regard to feasibility, accuracy, and operative parameters. Methods and materials The first twenty consecutively operated patients requiring a mandibular reconstruction (within angle-to-angle) with the FFF using the partially adjustable resection aids between January 2017 and December 2019 at our department were included. Additionally, matching CAD/CAM FFF cases were used as control group in this cross-sectional study. Medical records and general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time) were analyzed. In addition, the pre- and postoperative Digital Imaging and Communications in Medicine data of the mandibles were converted to standard tessellation language (.stl) files. Conventional measurements - six horizontal distances (A-F) and temporo-mandibular joint (TMJ) spaces - and the root mean square error (RMSE) for three-dimensional analysis were measured and calculated. Results In total, 40 patients were enrolled (20:20). Overall operation time, ischemia time, and the interval between ischemia time start until end of operation showed no significant differences. No significant difference between the two groups were revealed in conventional measurements of distances (A-D) and TMJ spaces. The Δ differences for the distance F (between the mandibular foramina) and the right medial joint space were significantly lower in the ReconGuide group. The RMSE analysis of the two groups showed no significant difference (p=0.925), with an overall median RMSE of 3.1 mm (2.2-3.7) in the CAD/CAM and 2.9 mm (2.2-3.8) in the ReconGuide groups. Conclusions The reconstructive surgeon can achieve comparable postoperative results regardless of technique, which may favor the ReconGuide use in mandibular angle-to-angle reconstruction over the CAD/CAM technique because of less preoperative planning time and lower costs per case.
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Affiliation(s)
- Jochen Weitz
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alex Grabenhorst
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hannes Singer
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Minli Niu
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian D. Grill
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Kamreh
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Carolina A. S. Claßen
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Oral and Maxillofacial Surgery, School of Medicine, University of Saarland, Homburg, Saar, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Munich, Germany
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Al-Wesabi SN, Abotaleb B, Al-Shujaa EA, Mohamed AA, Alkebsi K, Telha W, Jian S, Fuqiang X. Three dimensional condylar positional and morphological changes following mandibular reconstruction based on CBCT analysis: a prospective study. Head Face Med 2023; 19:3. [PMID: 36747208 PMCID: PMC9903492 DOI: 10.1186/s13005-023-00347-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the condylar positional changes following mandibular reconstruction with preservation of the condylar head using Cone-Beam Computed Tomography (CBCT). Also, to assess joint space changes and the overall volumetric space compared to the preoperative status. METHODOLOGY This prospective study included 30 patients (60 joints) subjected to unilateral mandibular resection and reconstruction with preservation of the condylar head. The Helkimo index and preoperative (T1), two weeks postoperative (T2), and follow-up CBCTs (T3) after at least six months were gathered and processed to evaluate the condylar position and TMJ joint space using Anatomage Invivo 6. A student's t-test and repeated-measures ANOVA statistics were used. A P value of less than 0.05 was considered statistically significant. RESULTS Thirty patients (14 males, 16 females) with a mean age of 40.01 ± 12.7 years (a range of 18.1-62.9 years) were included. On the tumor side, there were significant variances in the vertical and mediolateral condylar positions between the three-time points (T1, T2, T3). Immediately after the operation, the condyles were significantly displaced in a downward direction at T2, which became larger after the last follow-up period (T3) (p = 0.007). The condylar positions at the anteroposterior direction were relatively stable without significant differences between the three times points (p = 0.915). On the non-tumor side, the condylar positions were relatively stable in the mediolateral and anteroposterior positions. In the tumor side, all of the TMJ spaces were significantly increased in size following the mandibular reconstructions (T2 and T3). However, on the non-tumor side, the anterior, posterior, and medial joint spaces were significantly changed postoperatively. CONCLUSION After mandibular reconstruction with condylar preservation, the condylar position and volumetric measurement immediately changed noticeably and continued to be a permanent change over time compared to relatively stable condyles on the non-tumor side. According to Helkimo index, patients become adapted to the postoperative changes without significant differences between the two sides.
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Affiliation(s)
- Saddam Noman Al-Wesabi
- Lanzhou University, Second Hospital, Oral and Maxillofacial Surgery Department, Lanzhou, Gansu Province, China. .,State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, Department of Oral implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China. .,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
| | - Bassam Abotaleb
- grid.444909.4Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Eissa Abdo Al-Shujaa
- grid.32566.340000 0000 8571 0482Lanzhou University, Second Hospital, Oral and Maxillofacial Surgery Department, Lanzhou, Gansu Province China ,grid.444909.4Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Abdo Ahmed Mohamed
- grid.412536.70000 0004 1791 7851Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Khaled Alkebsi
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan China
| | - Wael Telha
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan China
| | - Sun Jian
- grid.32566.340000 0000 8571 0482Lanzhou University, Second Hospital, Oral and Maxillofacial Surgery Department, Lanzhou, Gansu Province China
| | - Xie Fuqiang
- Lanzhou University, Second Hospital, Oral and Maxillofacial Surgery Department, Lanzhou, Gansu Province, China.
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Schulz KL, Kesting MR, Nobis CP, Matta R, Lutz R. Three-dimensional evaluation of condylar position after mandibular reconstruction with a fibula free flap—comparison of different surgical techniques. Int J Oral Maxillofac Surg 2022; 52:648-655. [PMID: 36274023 DOI: 10.1016/j.ijom.2022.10.003] [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: 05/06/2022] [Revised: 07/18/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
Three-dimensional positional changes of the temporomandibular joint after mandible reconstruction using microvascular fibula flaps were investigated in 58 patients. The results of preoperative virtually planned surgery, intraoperative resection- and cutting-guided surgery, and non-guided surgery were compared. Pre- and postoperative computed tomography data of each patient were processed and superimposed digitally. The condyle deviations and rotations along the axes and planes of the skull, as well as Euclidean distances, were determined. Reliability analyses, descriptive statistics, and non-parametric tests were performed with the alpha level set at P = 0.05. Reliability proved to be excellent for all variables. The median Euclidean distance was 2.07 mm for the left condyle and 2.11 mm for the right condyle. Deviations of ≥ 10 mm occurred in nine (16%) cases. The maximum deviation occurred in the horizontal plane and the least deviation in the sagittal plane. Median rotation was ≤ 1.4° around all axes. The condylar displacements did not differ significantly between the different surgical techniques investigated. The three-dimensional measurement method applied is highly reliable for evaluating the three-dimensional condylar position after mandibular reconstruction.
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Affiliation(s)
- K L Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M R Kesting
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C-P Nobis
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - R Matta
- Department of Prosthodontics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - R Lutz
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.
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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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Nicot R, Raoul G, Ferri J, Schlund M. Temporomandibular disorders in head and neck cancers: Overview of specific mechanisms and management. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:563-568. [PMID: 32151696 DOI: 10.1016/j.jormas.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
Diagnosis classification system of Temporomandibular disorders (TMD) is based on the biopsychosocial model of pain. The pathogenesis is poorly understood, leading to difficulties in treating these multifactorial conditions. The predisposing factors are pathophysiological, psychological or structural processes that alter the masticatory system and lead to an increase in the risk of development of TMD. The purpose of this integrative review was then to point out the specific mechanisms of TMD in the oral oncologic context to optimize the TMJ functional results in the management of patients with oral oncologic conditions. We explored in this paper the role of Axis II assessment of the biopsychosocial model of pain, the involvement of mechanical concepts such as dental occlusion, mandibular condyle positioning and related-structures reconstruction, and the stomatognathic changes induced by radiation.
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Affiliation(s)
- R Nicot
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France.
| | - G Raoul
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France
| | - J Ferri
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France
| | - M Schlund
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, Boulevard du Prof Emile Laine, 59000 Lille, France
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