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Shahzad F. Computer-Assisted Surgery in Mandible Reconstruction. Semin Plast Surg 2024; 38:198-208. [PMID: 39118858 PMCID: PMC11305827 DOI: 10.1055/s-0044-1786805] [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: 08/10/2024]
Abstract
Computer-assisted surgery is the most significant recent advancement in osseous head and neck reconstruction. Computer-aided design (CAD) software allows computerized planning of resection and reconstruction. Computer-aided manufacturing (CAM) can be used to create models, cutting guides, and patient-specific plates. Several studies have shown that these techniques are more accurate and result in decreased flap ischemia times compared with conventional techniques. CAD also facilitates the immediate placement of dental implants. The most useful application of computer-assisted surgery is delayed reconstruction, in which soft tissue contraction and the absence of a specimen as a reference make accurate estimation of the defect challenging. The drawbacks of CAD/CAM are lack of intraoperative flexibility and cost. Some centers have created in-house CAD/CAM processes using open-source software and commercially available three-dimensional printers.
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Affiliation(s)
- Farooq Shahzad
- Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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Guruprasad Y, Laskar S, Patadiya MMM, Gowdar IM, Parihar AS, Singh K, Makkad RS. Exploring the use of Virtual Surgical Planning (VSP) in Maxillofacial Reconstructions. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S2312-S2314. [PMID: 39346367 PMCID: PMC11426835 DOI: 10.4103/jpbs.jpbs_229_24] [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: 03/17/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 10/01/2024] Open
Abstract
Background Virtual surgical planning (VSG), also known as computer-assisted reconstruction, has started to become the norm for more complex patients in many centers in recent times. Aim This study was conducted to evaluate the VSG in maxillofacial reconstruction surgery. Methods and Materials This study included 20 patients who underwent surgery for maxillofacial reconstruction. The study participants were divided into two main categories: Category 1: Conventional surgical planning (CSG). Category 2: VSG. The surgical planning in both categories, including the evaluation of volume of defect, length, width, and height of graft, to be placed. Results The gap between defect to be reconstructed and graft placed was greater in CSG as compared to VSG. The distance of graft from actual location was lesser in VSG as compared to CSG. The findings were significant statistically. Frequency of success was 93.21% and 97.47%, respectively. The frequency of success was greater in VSG as compared to CSG. Conclusion Virtual surgical planning is more effective in maxillofacial reconstruction surgery.
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Affiliation(s)
- Yadavalli Guruprasad
- Department of Oral and Maxillofacial Surgery, Government Dental College and Research Institute, VIMS Campus, Cantonment, Ballari, Karnataka, India
| | - Shyamalendu Laskar
- Department of Oral and Maxillofacial Surgery, Index Institute of Dental Sciences, Indore, Madhya Pradesh, India
| | | | - Inderjit Murugendrappa Gowdar
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdul Aziz University, Alkharj, KSA
| | - Anuj Singh Parihar
- Department of Periodontology, People's Dental Academy, Bhopal, Madhya Pradesh, India
| | - Karandeep Singh
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Budhera, Gurugram-Badli Road, Gurugram, Haryana, India
| | - Ramanpal Singh Makkad
- Department of Oral Medicine And Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
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Chen T, Chan HHL, de Almeida J, Goldstein DP, Gilbert RW, Yao CMKL, Irish JC, Davies JC. A 3D Analysis of Plating Strategies in Mandibular Reconstruction: A Randomized Control Pilot Study. Laryngoscope 2024; 134:2182-2186. [PMID: 37962081 DOI: 10.1002/lary.31171] [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: 01/17/2023] [Revised: 06/03/2023] [Accepted: 09/22/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE(S) The purpose of this study was to compare computer-assisted mandibular plating to conventional plating using quantitative metrics. METHODS Patients scheduled to undergo mandibular reconstruction were randomized to three-dimensional modelling for preoperative plate bending or intraoperative freehand bending. Preoperative and postoperative head and neck computed tomography scans were obtained to generate computer models of the reconstruction. The overall plate surface contact area, mean plate-to-bone distance, degree of conformance, and position of the condylar head within the glenoid fossa between pre- and post-operative scans were calculated. RESULTS Twenty patients were included with a mean age of 57.8 years (standard deviation [SD] = 13.6). The mean follow-up time was 9.8 months (range = 1.6-22.3). Reconstruction was performed with fibular (25%) or scapular free flaps (75%). The percentage of surface contact between the reconstructive plate and mandible was improved with three-dimensional models compared to freehand bending (93.9 ± 7.7% vs. 78.0 ± 19.9%, p = 0.04). There was improved overall plate-to-bone distance (3D model: 0.7 ± 0.31 mm vs. conventional: 1.3 ± 0.8 mm, p = 0.06). Total intraoperative time was non-significantly decreased with the use of a model (3D model: 726.5 ± 89.1 min vs. conventional: 757.3 ± 84.1 min, p = 0.44). There were no differences in condylar head position or postoperative complications. CONCLUSION Computer-assisted mandibular plating can be used to improve the accuracy of plate contouring. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2182-2186, 2024.
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Affiliation(s)
- Tanya Chen
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - John de Almeida
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joel C Davies
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, 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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Recker MJ, Barber JC, Xia JJ, Markiewicz MR, Kuang T, Deng HH, Singh T, Reynolds RM. Accuracy of Surgical Outcome Using Computer-Aided Surgical Simulation in Fronto-Orbital Advancement for Craniosynostosis: A Pilot Study. Oper Neurosurg (Hagerstown) 2024; 26:46-53. [PMID: 37811925 DOI: 10.1227/ons.0000000000000925] [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: 05/08/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Computer-aided surgical simulation (CASS) can be used to virtually plan ideal outcomes of craniosynostosis surgery. Our purpose was to create a workflow analyzing the accuracy of surgical outcomes relative to virtually planned fronto-orbital advancement (FOA). METHODS Patients who underwent FOA using CASS between October 1, 2017, and February 28, 2022, at our center and had postoperative computed tomography within 6 months of surgery were included. Virtual 3-dimensional (3D) models were created and coregistered using each patient's preoperative and postoperative computed tomography data. Three points on each bony segment were used to define the object in 3D space. Each planned bony segment was manipulated to match the actual postoperative outcome. The change in position of the 3D object was measured in translational (X, Y, Z) and rotational (roll, pitch, yaw) aspects to represent differences between planned and actual postoperative positions. The difference in the translational position of several bony landmarks was also recorded. Wilcoxon signed-rank tests were performed to measure significance of these differences from the ideal value of 0, which would indicate no difference between preoperative plan and postoperative outcome. RESULTS Data for 63 bony segments were analyzed from 8 patients who met the inclusion criteria. Median differences between planned and actual outcomes of the segment groups ranged from -0.3 to -1.3 mm in the X plane; 1.4 to 5.6 mm in the Y plane; 0.9 to 2.7 mm in the Z plane; -1.2° to -4.5° in pitch; -0.1° to 1.0° in roll; and -2.8° to 1.0° in yaw. No significant difference from 0 was found in 21 of 24 segment region/side combinations. Translational differences of bony landmarks ranged from -2.7 to 3.6 mm. CONCLUSION A high degree of accuracy was observed relative to the CASS plan. Virtual analysis of surgical accuracy in FOA using CASS was feasible.
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Affiliation(s)
- Matthew J Recker
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo , New York , USA
| | - Joshua C Barber
- Department of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Research Institute and Hospital, Houston , Texas , USA
| | - James J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Research Institute and Hospital, Houston , Texas , USA
- Department of Surgery (Oral and Maxillofacial Surgery), Weill-Cornell Medical College, New York , New York , USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, Buffalo , New York , USA
| | - Tianshu Kuang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Research Institute and Hospital, Houston , Texas , USA
| | - Hannah H Deng
- Department of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Research Institute and Hospital, Houston , Texas , USA
| | - Tanya Singh
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo , New York , USA
| | - Renée M Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo , New York , USA
- Department of Pediatric Neurosurgery, John R. Oishei Children's Hospital, Buffalo , New York , USA
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Hirase T, McChesney GR, Garvin L, Tappa K, Satcher RL, Mericli AF, Rhines LD, Bird JE. Advances in Virtual Cutting Guide and Stereotactic Navigation for Complex Tumor Resections of the Sacrum and Pelvis: Case Series with Short-Term Follow-Up. Bioengineering (Basel) 2023; 10:1342. [PMID: 38135933 PMCID: PMC10740571 DOI: 10.3390/bioengineering10121342] [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: 08/31/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Primary malignancies of the sacrum and pelvis are aggressive in nature, and achieving negative margins is essential for preventing recurrence and improving survival after en bloc resections. However, these are particularly challenging interventions due to the complex anatomy and proximity to vital structures. Using virtual cutting guides to perform navigated osteotomies may be a reliable method for safely obtaining negative margins in complex tumor resections of the sacrum and pelvis. This study details the technique and presents short-term outcomes. Patients who underwent an en bloc tumor resection of the sacrum and/or pelvis using virtual cutting guides with a minimum follow-up of two years were retrospectively analyzed and included in this study. Preoperative computer-assisted design (CAD) was used to design osteotomies in each case. Segmentation, delineating the tumor from normal tissue, was performed by the senior author using preoperative CT scans and MRI. Working with a team of biomedical engineers, virtual surgical planning was performed to create osteotomy lines on the preoperative CT and overlaid onto the intraoperative CT. The pre-planned osteotomy lines were visualized as "virtual cutting guides" providing real-time stereotactic navigation. A precision ultrasound-powered cutting tool was then integrated into the navigation system and used to perform the osteotomies in each case. Six patients (mean age 52.2 ± 17.7 years, 2 males, 4 females) were included in this study. Negative margins were achieved in all patients with no intraoperative complications. Mean follow-up was 38.0 ± 6.5 months (range, 24.8-42.2). Mean operative time was 1229 min (range, 522-2063). Mean length of stay (LOS) was 18.7 ± 14.5 days. There were no cases of 30-day readmissions, 30-day reoperations, or 2-year mortality. One patient was complicated by flap necrosis, which was successfully treated with irrigation and debridement and primary closure. One patient had local tumor recurrence at final follow-up and two patients are currently undergoing treatment for metastatic disease. Using virtual cutting guides to perform navigated osteotomies is a safe technique that can facilitate complex tumor resections of the sacrum and pelvis.
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Affiliation(s)
- Takashi Hirase
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
| | - Grant R. McChesney
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
| | - Lawrence Garvin
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
| | - Karthik Tappa
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Robert L. Satcher
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
| | - Alexander F. Mericli
- Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Laurence D. Rhines
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Justin E. Bird
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
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Sun Q, Zhu Z, Meng F, Zhao R, Li X, Long X, Li Y, Dong H, Zhang T. Application of a modified osteotomy and positioning integrative template system (MOPITS) based on a truncatable reconstruction model in the precise mandibular reconstruction with fibula free flap: a pilot clinical study. BMC Oral Health 2023; 23:842. [PMID: 37940900 PMCID: PMC10630995 DOI: 10.1186/s12903-023-03596-6] [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: 07/20/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Mandibular defects can greatly affect patients' appearance and functionality. The preferred method to address this issue is reconstructive surgery using a fibular flap. The current personalized guide plate can improve the accuracy of osteotomy and reconstruction, but there are still some problems such as complex design process and time-consuming. Therefore, we modified the conventional template to serve the dual purpose of guiding the mandible and fibula osteotomy and facilitating the placement of the pre-bent titanium. METHODS The surgery was simulated preoperatively using Computer-Aided Design (CAD) technology. The template and truncatable reconstruction model were produced in the laboratory using 3D printing. After pre-bending the titanium plate according to the contour, the reconstruction model was truncated and the screw trajectory was transferred to form a modified osteotomy and positioning integrative template system (MOPITS). Next, the patient underwent a composite template-guided vascularized fibula flap reconstruction of the mandible. All cases were reviewed for the total operative time and accuracy of surgery. RESULTS The procedures involved 2-4 fibular segments in 15 patients, averaging 3 fibular segments per procedure. The osteotomy error is 1.01 ± 1.02 mm, while the reconstruction angular error is 1.85 ± 1.69°. The preoperative and postoperative data were compared, and both p > 0.05. During the same operation, implant placement was performed on four patients, with an average operative time of 487.25 ± 60.84 min. The remaining malignant tumor patients had an average operative time of 397.18 ± 73.09 min. The average postoperative hospital stay was 12.95 ± 3.29 days. CONCLUSIONS This study demonstrates the effectiveness of MOPITS in facilitating precise preoperative planning and intraoperative execution of fibula flap reconstruction. MOPITS represents a promising and reliable tool for reconstructive surgery, particularly for inexperienced surgeons navigating the challenges of mandible defect reconstruction.
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Affiliation(s)
- Qing Sun
- Department of Plastic Surgery, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Zhihui Zhu
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Fanhao Meng
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ruiqi Zhao
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Xing Li
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Yansheng Li
- Beijing University of Technology, Beijing, China
| | - Haitao Dong
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China
| | - Tao Zhang
- Department of Stomatology, Peking Union Medical College &, Chinese Academy of Medical Science, Beijing, China.
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Xu Y, Li Y, Xiao W, Yue J, Xue L, Li L, Xu Z, Sun J. Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series. Front Bioeng Biotechnol 2023; 11:1273318. [PMID: 38026888 PMCID: PMC10656737 DOI: 10.3389/fbioe.2023.1273318] [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: 08/05/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Oromandibular tumors or osteoradionecrosis often lead to extensive composite defects encompassing intraoral, bone and extraoral tissues. A single flap cannot simultaneously offer sufficient bone and soft tissue. The combination of free flaps could be a prospective approach to overcome the challenge. The study aims to assess the efficacy of virtual surgical planning (VSP) and 3D printing assisted fibula osteoseptocutaneous flap (FOSCF) combined with anterolateral thigh flaps (ALT) in reconstructing extensive composite defects in the oromandibular region. A retrospective analysis was conducted on 8 patients who underwent reconstruction using FOSCFs combined with ALTs. Post-surgical excision of the lesions, we obtained mean values for the defects of intraoral soft tissue, bone, extraoral soft tissue, namely, being 42.7 cm2, 96 mm, and 68.9 cm2. The mean surgical procedures took 712.5 min. A total of 16 flaps were harvested and transplanted for the 8 patients, with all successfully surviving. Postoperatively, complications manifested as localized intraoral infections in 2 cases, intermuscular vein thrombosis in another 2 cases, and pulmonary infections in 2 patients. Two patients unfortunately experienced tumor recurrence, at 12 and 3 months post-operation respectively. For the surviving 6 patients, the average follow-up period was 12.2 months. Regarding patient satisfaction, one expressed dissatisfaction with the contour of the mandible, and two exhibited moderate trismus. Objective assessments identified 1 case of oral incontinence and 2 cases where external flap contractures were observed. All 8 patients experienced restoration of masticatory function and were able to consume a soft diet within a month post-surgery. VSP/3D printing assisted FOSCFs combined with ALTs can be performed safely to reconstruct the extensive composite tissue defects in our study, with desirable esthetic and functional results, and it is a reliable option in selecting patients with defects involving multiple tissue types. However, the benefits of this method needed more cases to validate.
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Affiliation(s)
- Yaoxiang Xu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
| | - Yali Li
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenlin Xiao
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Jin Yue
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Lingfa Xue
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Li Li
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
| | - Zexian Xu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
| | - Jian Sun
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
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Riordan E, Yung A, Cheng K, Lim L, Clark J, Rtshiladze M, Ch'ng S. Modeling Methods in Craniofacial Virtual Surgical Planning. J Craniofac Surg 2023; 34:1191-1198. [PMID: 36806300 DOI: 10.1097/scs.0000000000009187] [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: 06/18/2022] [Accepted: 10/09/2022] [Indexed: 02/22/2023] Open
Abstract
Despite the widespread use of virtual surgical planning (VSP), few papers describe the modeling methods used to generate the digital simulations that underpin VSP. This paper aims to review the modeling methods that are currently available for use in VSP and the implications of their use in clinical practice. A literature review was undertaken of the two broad categories of modeling techniques; contour-based planning-namely mirroring from the contralateral side, templating from a normative database, and extrapolation from surrounding landmarks-and occlusal-based planning (OBP). The indications for each modeling method were discussed, including mandibular/maxillary reconstruction, pediatric craniofacial surgery, and orthognathic, as well as the limitations to the accuracy of modeling types. Unilateral defects of the upper/midface, wherein contour accuracy is paramount, are best reconstructed using mirroring methods, whereas bilateral defects-or cases with asymmetry due to craniofacial dysmorphology-are most suited to normative-data-based methods. Cases involving resection of the alveolar margin, in which functional occlusion is the primary outcome are best managed with OBP. Similarly, orthognathic surgery typically uses OBP, although complex cases involving asymmetry, such as clefts, may benefit from a combination of OBP and normative data methods. The choice of modeling methods is, therefore, largely driven by the defect type and the goals of reconstruction.
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Affiliation(s)
- Edward Riordan
- Department of Plastic Surgery, St George Hospital
- Melanoma Institute Australia, The University of Sydney
| | - Amanda Yung
- Melanoma Institute Australia, The University of Sydney
- Sydney Medical School, University of Sydney
| | - Kai Cheng
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
| | - Lydia Lim
- Department of Maxillofacial Surgery, Westmead Hospital
| | - Jonathan Clark
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
- Faculty of Medicine and Health, The University of Sydney
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre
| | - Michael Rtshiladze
- Melanoma Institute Australia, The University of Sydney
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital Randwick
- Department of Plastic Surgery, Prince of Wales Hospital
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
- Faculty of Medicine and Health, The University of Sydney
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Krishnadas A, Iyer S, Balasubramaniam D, Subash P, Subramaniam N, Kapahtia R, Pullan S, Ramu J. Simplified Virtual Surgical Planning Method for Reconstruction of Secondary Maxilla and Mandibular Defects Using Free Bone Flap. J Maxillofac Oral Surg 2023; 22:105-109. [PMID: 37041941 PMCID: PMC10082867 DOI: 10.1007/s12663-023-01906-7] [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: 01/29/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Objective Free fibula flap is the commonly used microvascular free tissue transfer for maxillary and mandibular reconstruction to restore form and function after ablative procedures. Bony reconstruction is an important aspect of reconstruction. This paper describes our technique in using virtual surgical planning for secondary reconstruction of the maxilla and mandible using only stereolithographic models. Discussion In the recent past, virtual surgical planning has become a game changer in planning complex reconstruction of maxilla and mandible. This becomes even more important in the cases of secondary reconstruction. Virtual surgical planning requires close interaction between the surgeon and the design and manufacturing team. The latter is often done remotely making the process cumbersome and less user friendly. We have been using a simplified version of the virtual surgical planning at a low cost set up with effective outcomes. This report consists of 22 cases in which secondary reconstruction using osteo-cutaneous free fibula flap was carried out using virtual surgical planning. Mock surgery was performed on stereolithographic (STL) models (face and fibula), pre-bending of plates and fabrication of occlusal splints helped in precise translation of the treatment plan to the operating room which in turn helped in reducing the surgical time and attaining more predictable results. Conclusion Secondary reconstruction of maxilla and mandible is complex and requires meticulous planning to achieve optimal and predictable results which directly improves the quality of life of the patients.
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Affiliation(s)
- Arjun Krishnadas
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Subramania Iyer
- Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Deepak Balasubramaniam
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Pramod Subash
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Narayana Subramaniam
- Department of Head and Neck Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, Karnataka India
| | - Radhika Kapahtia
- Department of Plastic Reconstructive Surgery, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, Karnataka India
| | - Sony Pullan
- Department of Oral and Maxillofacial Surgery, Barnet and Chase Farm Hospitals Wellhouse Lane, Royal Free NHS Foundation Trust, Barnet, UK
| | - Janarthanan Ramu
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
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11
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Wiesmueller M, Meixner CR, Weber M, Kesting M, Nagel AM, Wuest W, May MS, Roemer FW, Uder M, Heiss R. Time-of-Flight Angiography in Ultra-High-Field 7 T MRI for the Evaluation of Peroneal Perforator Arteries Before Osseomyocutaneous Flap Surgery. Invest Radiol 2023; 58:216-222. [PMID: 36165876 PMCID: PMC9914154 DOI: 10.1097/rli.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Presurgical identification and morphologic characterization of the peroneal perforator arteries (PPAs) are essential for osseomyocutaneous flap surgery. The aim of this study was to evaluate PPAs using time-of-flight (TOF) angiography in 7 T magnetic resonance imaging in comparison with dual-energy computed tomographic angiography (CTA). MATERIALS AND METHODS In this prospective study, TOF angiography and CTA of both lower legs were acquired before flap surgery from 07/2019 to 02/2020. Magnetic resonance imaging was performed using a dedicated 28-channel knee coil with an acquisition time of 9:55 minutes (voxel size: 0.4 × 0.4 × 0.8 mm). Computed tomographic angiography was acquired with a third-generation dual-source computed tomography on the same day. Virtual monoenergetic reconstructions at 40 keV photon energy served as the standard of reference for PPA identification and subtyping. Two independent readers assessed the image quality, quantity, length assessment, and classification according to surgical considerations of PPAs for TOF angiography and CTA. Both TOF angiography and CTA were used for presurgical flap design and were evaluated by an orofacial surgeon. RESULTS Ten patients (mean age, 59.9 ± 14.9 years; 7 men) were included. Time-of-flight angiography and CTA identified 53 and 51 PPAs in total, respectively. Time-of-flight angiography showed superior image quality (both readers, P < 0.05). Time-of-flight angiography enabled specific classification of PPA subtypes more often (53 vs 39; P < 0.05), and both readers reported higher diagnostic confidence for TOF angiography than CTA in all patients (interrater agreement κ = 0.8; P < 0.05). Regarding length assessment, PPAs were significantly more conspicuous with TOF angiography (TOF mean , 50 ± 11 mm; CTA mean , 40 ± 9 mm; P = 0.001). In comparison with CTA, TOF angiography prospectively changed the orofacial surgeon's final decision on the presurgical selected PPAs in 60% of cases. CONCLUSIONS Presurgical assessment of PPAs is feasible using TOF in 7 T magnetic resonance imaging. Moreover, TOF angiography was superior to CTA for classifying and identifying PPAs, which may facilitate the planning of reconstructive surgery.
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Affiliation(s)
| | | | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Armin M. Nagel
- From the Institute of Radiology, University Hospital Erlangen
- Division of Medical Physics in Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Wolfgang Wuest
- From the Institute of Radiology, University Hospital Erlangen
| | - Matthias S. May
- From the Institute of Radiology, University Hospital Erlangen
| | - Frank W. Roemer
- From the Institute of Radiology, University Hospital Erlangen
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Massachusetts
| | - Michael Uder
- From the Institute of Radiology, University Hospital Erlangen
| | - Rafael Heiss
- From the Institute of Radiology, University Hospital Erlangen
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12
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An Analysis of Volume, Length and Segmentation of Free Fibula Flap in Reconstruction of the Jaws: Investigation of Their Role on Flap Failure. REPORTS 2023. [DOI: 10.3390/reports6010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Reconstruction of defects of the jaws is mainly performed via free fibula flap. An incidence of 2–21% of overall flap failure is still described. We investigated the roles of volume, length and number of fibula flap segments on flap survival using novel three-dimensional segmentation tools. We also analyzed the role of other possible risk factors. Seventy-one consecutive patients with a follow up of at least three months and who underwent free fibula flap reconstruction in a single center between 2002 and 2022 have been evaluated. A total of 166 fibula segments were analyzed. Malignancies were the main reason of resection (45.1%). In 69% of the cases a reconstruction of the mandible was performed. The flaps were mainly divided in two segments (39%) (range 1–4), with a mean length of 2.52 cm and a mean volume was 3.37 cm3. Total flap failure (TFF) occurred in 12 cases, (16.9%), while partial flap failure (PFF) appeared in 3 patients (4.2%). Volume, length and number of fibula flap segments did not seem to influence flap failure incidence in uni- and multivariate analysis. Reconstruction of the maxilla and use of a recipient vessel different from the facial artery seemed to significantly impact on flap failure. Smoking and previous surgeries showed a higher trend to flap failure, but they did not reach statistical significance. Prospective and multicentric analysis on a wider population should be assessed.
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13
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Idris S, Logan H, Tabet P, Osswald M, Nayar S, Seikaly H. The Accuracy of 3D Surgical Design and Simulation in Prefabricated Fibula Free Flaps for Jaw Reconstruction. J Pers Med 2022; 12:jpm12111766. [PMID: 36579487 PMCID: PMC9698275 DOI: 10.3390/jpm12111766] [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: 08/30/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 01/01/2023] Open
Abstract
The ideal jaw reconstruction involves the restoration and maintenance of jaw continuity, jaw relations, joint alignment, and facial contour, and, most importantly, dental occlusal reconstruction. One of the essential requirements of achieving a consistent functional outcome is to place the bony reconstruction in the correct three-dimensional position as it relates to the other jaw segments and dentition. A protocol of occlusion-driven reconstruction of prefabricated fibular free flaps that are customized to the patient with surgical design and simulation (SDS)-planned osseointegrated implant installation was developed by our institution. This innovation introduced significant flexibility and efficiency to jaw reconstructions, but functional and cosmetic outcomes were dependent on the accuracy of the final reconstructions when compared to the SDS plan. The purpose of this study was to examine the accuracy of the SDS-planned fibular flap prefabrication in a cohort of patients undergoing jaw reconstruction. All patients that had undergone primary jaw reconstruction with prefabricated fibular free flaps were reviewed. The primary outcome of this study was the accuracy of the postoperative implant positions as compared to the SDS plan. A total of 23 implants were included in the analysis. All flaps survived, there was no implant loss postoperatively, and all the patients underwent all stages of the reconstruction. SDS planning of fibular flap prefabrication resulted in better than 2 mm accuracy of osteointegrated implant placement in a cohort of patients undergoing jaw reconstruction. This accuracy could potentially result in improved functional and cosmetic outcomes.
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Affiliation(s)
- Sherif Idris
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Heather Logan
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, AB T5R 4H5, Canada
| | - Paul Tabet
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Université de Montréal, Montreal, PQ H1T 2M4, Canada
| | - Martin Osswald
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, AB T5R 4H5, Canada
| | - Suresh Nayar
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, AB T5R 4H5, Canada
| | - Hadi Seikaly
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, AB T5R 4H5, Canada
- Correspondence: ; Tel.: +1-(780)-407-3691
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14
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Wang Z, Miao D, Wan J, Ding X, Song X, Wu H, Yuan H, Du Y, Wang Y. Intraoral versus transcervical approaches in mandibular reconstruction with free flaps: A retrospective study. J Craniomaxillofac Surg 2022; 50:S1010-5182(22)00130-5. [PMID: 36210272 DOI: 10.1016/j.jcms.2022.09.003] [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: 07/03/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
This study aims to investigate the clinical and functional differences between intraoral and transcervical approaches for segmental mandible resection and reconstruction with free flaps. Patients diagnosed as benign and low-grade mandibular malignant tumors without neck dissections were retrospectively reviewed and divided into intraoral and transcervical groups. Patients of intraoral group underwent intraoral mandibulectomy and vascular anastomosis was performed through a 2-cm submandibular incision, while traditional submandibular approach was used in transcervical group. Clinical characteristics of two groups were assessed including body mass index (BMI), defect types and number of fibular segments, as well as perioperative variables such as operation time, blood loss, drainage volume. The score of appearance, swallowing and speech using the University of Washington Quality of Life Questionnaire (UW-QOL) was recorded and analyzed 6-month postoperatively. A total of 14 patients in intraoral group and 21 patients in transcervical group was collected, respectively. In intraoral group, intraoperative blood loss and postoperative drainage volume were significantly reduced in comparison with transcervical group (p = 0.0146, p = 0.0017; respectively). The score of appearance was 87.50 ± 12.97 in intraoral group, which was significantly higher than 64.29 ± 12.68 in transcervical group (p < 0.0001). Similar results were found in patients of subtype Class II mandibular defect between two groups. However, patients of intraoral group had a significant increase in operative time and a comparable amount of intraoperative blood loss (p = 0.0472, p = 0.1434; respectively). Within the limitations of the study it seems that an intraoral approach combined with a 2-cm submandibular incision should be preferred over a transcervical approach for segmental mandibulectomy and free flap reconstruction whenever appropriate.
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Affiliation(s)
- Zhuo Wang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, People's Republic of China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Dongqing Miao
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, People's Republic of China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Jinbo Wan
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, People's Republic of China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Xu Ding
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, People's Republic of China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Xiaomeng Song
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, People's Republic of China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Heming Wu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, People's Republic of China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Hua Yuan
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, People's Republic of China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Yifei Du
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, People's Republic of China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029, People's Republic of China.
| | - Yuli Wang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, People's Republic of China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029, People's Republic of China.
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15
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Nyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, Agrawal A, Old MO, Seim NB, Carrau RL, Rocco JW, VanKoevering KK. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol 2022; 132:105976. [PMID: 35809506 DOI: 10.1016/j.oraloncology.2022.105976] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 01/12/2023]
Abstract
Microvascular free flap reconstruction has remained the standard of care in reconstruction of large tissue defects following ablative head and neck oncologic surgery, especially for bony structures. Computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensionally (3D) printed models and devices offer novel solutions for reconstruction of bony defects. Conventional free hand techniques have been enhanced using 3D printed anatomic models for reference and pre-bending of titanium reconstructive plates, which has dramatically improved intraoperative and microvascular ischemia times. Improvements led to current state of the art uses which include full virtual planning (VP), 3D printed osteotomy guides, and patient specific reconstructive plates, with advanced options incorporating dental rehabilitation and titanium bone replacements into the primary surgical plan through use of these tools. Limitations such as high costs and delays in device manufacturing may be mitigated with in house software and workflows. Future innovations still in development include printing custom prosthetics, 'bioprinting' of tissue engineered scaffolds, integration of therapeutic implants, and other possibilities as this technology continues to rapidly advance. This review summarizes the literature and serves as a summary guide to the historic, current, advanced, and future possibilities of 3D printing within head and neck oncologic surgery and bony reconstruction. This review serves as a summary guide to the historic, current, advanced, and future roles of CAD/CAM and 3D printing within the field of head and neck oncologic surgery and bony reconstruction.
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Affiliation(s)
- Sarah C Nyirjesy
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Margaret Heller
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Natalia von Windheim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amelia Gingras
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Stephen Y Kang
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Enver Ozer
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amit Agrawal
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Matthew O Old
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Nolan B Seim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Ricardo L Carrau
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - James W Rocco
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Kyle K VanKoevering
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States.
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16
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Pamias-Romero J, Masnou-Pratdesaba J, Sáez-Barba M, de-Pablo-García-Cuenca A, Siurana-Montilva S, Sala-Cunill A, Valls-Comamala V, Pujol-Pina R, Bescós-Atín C. Personalized Surgery Service in a Tertiary Hospital: A Method to Increase Effectiveness, Precision, Safety and Quality in Maxillofacial Surgery Using Custom-Made 3D Prostheses and Implants. J Clin Med 2022; 11:jcm11164791. [PMID: 36013033 PMCID: PMC9410390 DOI: 10.3390/jcm11164791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 01/11/2023] Open
Abstract
Personalized surgery (PS) involves virtual planning (VP) and the use of 3D printing technology to design and manufacture custom-made elements to be used during surgery. The widespread use of PS has fostered a paradigm shift in the surgical process. A recent analysis performed in our hospital—along with several studies published in the literature—showed that the extensive use of PS does not preclude the lack of standardization in the process. This means that despite the widely accepted use of this technology, standard individual roles and responsibilities have not been properly defined, and this could hinder the logistics and cost savings in the PS process. The aim of our study was to describe the method followed and the outcomes obtained for the creation of a PS service for the Oral and Maxillofacial Surgery Unit that resolves the current absence of internal structure, allows for the integration of all professionals involved and improves the efficiency and quality of the PS process. We performed a literature search on the implementation of PS techniques in tertiary hospitals and observed a lack of studies on the creation of PS units or services in such hospitals. Therefore, we believe that our work is innovative and has the potential to contribute to the implementation of PS units in other hospitals.
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Affiliation(s)
- Jorge Pamias-Romero
- Oral and Maxillofacial Surgery Service, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- New Technologies and Craniofacial Microsurgery, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Joan Masnou-Pratdesaba
- Radiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Manel Sáez-Barba
- Oral and Maxillofacial Surgery Service, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- New Technologies and Craniofacial Microsurgery, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Alba de-Pablo-García-Cuenca
- Oral and Maxillofacial Surgery Service, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- New Technologies and Craniofacial Microsurgery, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Sahyly Siurana-Montilva
- MRI Unit, Radiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Anna Sala-Cunill
- Innovation, Quality and Processes Management, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Victòria Valls-Comamala
- Innovation, Quality and Processes Management, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Rosa Pujol-Pina
- New Technologies and Craniofacial Microsurgery, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Coro Bescós-Atín
- Oral and Maxillofacial Surgery Service, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- New Technologies and Craniofacial Microsurgery, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-746-179
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17
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Secondary Mandible Reconstruction with Computer-Assisted-Surgical Simulation and Patient-Specific Pre-Bent Plates: The Algorithm of Virtual Planning and Limitations Revisited. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Despite the known advantages of virtual surgical planning and three-dimensional (3D) printing, translation of virtual planning to actual operation is a challenge, especially in secondary mandibular reconstruction. Patients who underwent secondary microvascular mandibular reconstruction were retrospectively reviewed and categorized into three categories as follows: (i) defect not crossing the midline (category I); (ii) defects crossing the midline with availability of previous imaging data (category II) and; (iii) defects crossing the midline with unavailability of previous imaging data (category III). The resulting 3D printed models were used as an effective guide for plate bending during secondary reconstruction surgery. Accuracy of the reconstruction was evaluated by superimposing post-operative images over virtual plan. Out of eleven patients, five were category I, three were category II, and three were category III. The mean linear discrepancy between the planned and post-operative position was measured. A Mann-Whitney U test was conducted to compare mean discrepancy among the groups showed no significant difference between group I and group II (p > 0.05) whereas comparison of groups I and II with group III showed a significant difference (p < 0.01). The proposed algorithm for the generation of defect template for manual plate bending during secondary reconstruction of mandibular defects is valid with acceptable accuracy in various defect configurations.
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18
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Vyas K, Gibreel W, Mardini S. Virtual Surgical Planning (VSP) in Craniomaxillofacial Reconstruction. Facial Plast Surg Clin North Am 2022; 30:239-253. [DOI: 10.1016/j.fsc.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Sharaf B, Kuruoglu D, Cantwell SR, Alexander AE, Dickens HJ, Morris JM. EPPOCRATIS: Expedited Preoperative Point-of-Care Reduction of Fractures to Normalized Anatomy and Three-Dimensional Printing to Improve Surgical Outcomes. Plast Reconstr Surg 2022; 149:695-699. [PMID: 35196689 DOI: 10.1097/prs.0000000000008871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY Virtual surgical planning and three-dimensional printing have been invaluable tools in craniomaxillofacial surgery. From planning head and neck reconstruction to orthognathic surgery and secondary reconstruction of maxillofacial trauma, virtual surgical planning and three-dimensional printing allow the surgeon to rehearse the surgical plan and use patient-specific surgical guides for carrying out the plan accurately. However, the process of virtual surgical planning and three-dimensional printing requires time and coordination between the surgeon on one hand and the biomedical engineers and designers on the other hand. Outsourcing to third-party companies contributes to inefficiencies in this process. Advances in surgical planning software and three-dimensional printing technology have enabled the integration of virtual surgical planning and three-dimensional printing at the treating hospital, the point of care. This allows for expedited use of this process in semiurgent surgical cases and acute facial trauma cases by bringing the surgeon, radiologist, biomedical engineers, and designers to the point of care. In this article, the authors present the utility of EPPOCRATIS, expedited preoperative point of care reduction of fractures to normalized anatomy and three-dimensional printing to improve surgical outcomes, in the management of acute facial trauma.
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Affiliation(s)
- Basel Sharaf
- From the Division of Plastic Surgery, Department of Surgery; Anatomic Modeling Laboratory; and Department of Radiology, Mayo Clinic
| | - Doga Kuruoglu
- From the Division of Plastic Surgery, Department of Surgery; Anatomic Modeling Laboratory; and Department of Radiology, Mayo Clinic
| | - Sean R Cantwell
- From the Division of Plastic Surgery, Department of Surgery; Anatomic Modeling Laboratory; and Department of Radiology, Mayo Clinic
| | - Amy E Alexander
- From the Division of Plastic Surgery, Department of Surgery; Anatomic Modeling Laboratory; and Department of Radiology, Mayo Clinic
| | - Hunter J Dickens
- From the Division of Plastic Surgery, Department of Surgery; Anatomic Modeling Laboratory; and Department of Radiology, Mayo Clinic
| | - Jonathan M Morris
- From the Division of Plastic Surgery, Department of Surgery; Anatomic Modeling Laboratory; and Department of Radiology, Mayo Clinic
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Knitschke M, Baumgart AK, Bäcker C, Adelung C, Roller F, Schmermund D, Böttger S, Streckbein P, Howaldt HP, Attia S. Impact of Periosteal Branches and Septo-Cutaneous Perforators on Free Fibula Flap Outcome: A Retrospective Analysis of Computed Tomography Angiography Scans in Virtual Surgical Planning. Front Oncol 2022; 11:821851. [PMID: 35127535 PMCID: PMC8807634 DOI: 10.3389/fonc.2021.821851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Virtual surgical planning (VSP) for jaw reconstruction with free fibula flap (FFF) became a routine procedure and requires computed tomography angiography (CTA) for preoperative evaluation of the lower limbs vascular system and the bone. The aim of the study was to assess whether the distribution and density of periosteal branches (PB) and septo-cutaneous perforators (SCP) of the fibular artery have an impact on flap success. METHOD This retrospective clinical study assessed preoperative CTA of the infra-popliteal vasculature and the small vessel system of 72 patients who underwent FFF surgery. Surgical outcome of flap transfer includes wound healing, subtotal, and total flap loss were matched with the segmental vascular supply. RESULT A total of 72 patients (28 females, 38.9 %; 44 males, 61.1 %) fulfilled the study inclusion criteria. The mean age was 58.5 (± 15.3 years). Stenoses of the lower limbs' vessel (n = 14) were mostly detected in the fibular artery (n = 11). Flap success was recorded in n = 59 (82.0%), partial flap failure in n = 4 (5.5%) and total flap loss in n = 9 (12.5%). The study found a mean number (± SD) of 2.53 ± 1.60 PBs and 1.39 ± 1.03 SCPs of the FA at the donor-site. The proximal FFF segment of poly-segmental jaw reconstruction showed a higher rate of PB per flap segment than in the distal segments. Based on the total number of prepared segments (n = 121), 46.7% (n = 7) of mono-, 40.4% (n = 21) of bi-, and 31.5 % (n = 17) of tri-segmental fibula flaps were at least supplied by one PB in the success group. Overall, this corresponds to 37.2% (45 out of 121) of all successful FFF. For total flap loss (n = 14), a relative number of 42.9% (n = 6) of distinct supplied segments was recorded. Wound healing disorder of the donor site was not statistically significant influenced by the detected rate of SCP. CONCLUSION In general, a correlation between higher rates of PB and SCP and the flap success could not be statistically proved by the study sample. We conclude, that preoperative PB and SCP mapping based on routine CTA imaging is not suitable for prediction of flap outcome.
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Affiliation(s)
- Michael Knitschke
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Anna Katrin Baumgart
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Christina Bäcker
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Christian Adelung
- Department of Diagnostic and Interventional Radiology and Pediatric Radiology, Justus-Liebig-University, Giessen, Germany
| | - Fritz Roller
- Department of Diagnostic and Interventional Radiology and Pediatric Radiology, Justus-Liebig-University, Giessen, Germany
| | - Daniel Schmermund
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Sebastian Böttger
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Philipp Streckbein
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
| | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Giessen, Germany
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Blesnyuk ZV, Likhitskyi OO, Glushanets VA. A CLINICAL CASE OF MANDIBULAR FIBROUS DYSPLASIA TREATMENT USING SURGICAL TEMPLATES AND INDIVIDUALIZED TITANIUM CONSTRUCTION WITH PRELIMINARY VIRTUAL SURGICAL PLANNING. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2022. [DOI: 10.29254/2077-4214-2022-3-166-137-147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Zh. V. Blesnyuk
- Communal non-profit enterprise "Podilskyi oncology center" of the Vinnytsya Regional Council
| | | | - V. A. Glushanets
- Communal non-profit enterprise "Podilskyi oncology center" of the Vinnytsya Regional Council
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Gao N, Fu K, Cai J, Chen H, He W. The role of folded fibular flap in patients' reconstruction of mandibular defects: a retrospective clinical study. Sci Rep 2021; 11:23853. [PMID: 34903811 PMCID: PMC8668899 DOI: 10.1038/s41598-021-03331-7] [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: 02/19/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022] Open
Abstract
This study has analyzed 41 patients with mandibular ameloblastoma who underwent a partial mandibulectomy and reconstruction by folding the free fibular flap. In the preoperative and postoperative (6 months and 24 months after surgery), the Quality of Life (QOL) of these patients was assessed by using the University of Washington Quality of Life Questionnaire (UW-QOL) and the medical outcome study short form-36 (SF-36) questionnaires. SPSS 20.0 statistical software was used to conduct statistical analysis on the base data of the two groups of patients. Independent sample t test was conducted for sf-36 and UW-QOL scores at two time points in each group. The SF-36 survey showed that body pain (54.54 ± 8.10), general health (55.27 ± 7.54), and health changes (58.29 ± 9.60) decreased significantly at 6 months after surgery, but the mean score at 24 months after surgery all exceeded the preoperational level. At 24 months after the surgery, the vitality (80.41 ± 3.74), social function (81.61 ± 4.07), emotional role (82.39 ± 4.07), psychological health (81.66 ± 4.37) and total score (704.00 ± 31.53) all returned to the preoperative level, which was statistically significant compared with 6 months after surgery. However, there was no significant difference compared with the preoperative level. The UW-QOL survey showed that chewing (56.68 ± 7.23), speech (54.54 ± 7.7) and taste (62.29 ± 10.15) have significantly changed at 6 months after the surgery, and the difference was statistically significant at 24 months after surgery. Saliva generation decreased slightly (80.76 ± 3.35) at 6 months after surgery, but quickly returned to the preoperative level (81.59 ± 4.06). The total score of the patients almost recovered to the preoperative level at 24 months after surgery. The folded the fibular flap can not only repair the defects of soft tissue and bone tissue, but also restore the height of the alveolar ridge to, avoid the imbalance of crown and root ratio after implantation and reduce the occurrence of peri-implant inflammation, so that a true functional reconstruction can be realized.
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Affiliation(s)
- Ning Gao
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Kun Fu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jinghua Cai
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Hao Chen
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wei He
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Institutional-based and commercial virtual surgical planning in maxillomandibular reconstruction - Comparing the digital plan and postoperative scan. J Plast Reconstr Aesthet Surg 2021; 75:1399-1407. [PMID: 34952809 DOI: 10.1016/j.bjps.2021.11.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Virtual surgical planning (VSP) is increasingly used in maxillomandibular osseous free flap reconstruction. Non-commercial ('in-house') VSP may offer the same level of accuracy and other benefits, without the inflated costs and time delays inherent in using commercial providers. Comparisons between commercial and in-house methods are lacking. This study aims to determine the accuracy of VSP, compare in-house and commercially planned cases, and explore predictors of the reconstruction error. METHODS Seventy-six patients who had a virtually planned maxillomandibular reconstruction between January 2012 and July 2020 were retrospectively identified. The preoperative digital plan was compared to the postoperative CT scan in terms of length of bone segments, angle between adjacent segments and intercondylar, and intergonial angle distances (mandibular reconstructions only). RESULTS Forty-four patients fulfilled the inclusion criteria. The mean intergonial and intercondylar distances error was 1.7 ± 1.01 mm, mean segment length error was 1.3 ± 1.40 mm, and mean angles error was 1.9 ± 2.32°. The difference in error of in-house VSP compared to commercial VSP was not statistically significant for intercondylar and intergonial distance (p = 0.76), segment length (p = 0.15), or angle between segments (p = 0.92). The increased error was associated with osteoradionecrosis as the indication for surgery, greater number of segments, and secondary reconstructions. CONCLUSION VSP is an accurate method of maxillary and mandibular reconstruction. In-house VSP may be similar in accuracy to commercial VSP options. Higher levels of inaccuracy are likely to occur in more complex reconstructions, particularly secondary reconstructions, and in the setting of osteoradionecrosis.
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Sharaf BA, Morris JM, Kuruoglu D. EPPOCRATIS: A Point-of-Care Utilization of Virtual Surgical Planning and Three-Dimensional Printing for the Management of Acute Craniomaxillofacial Trauma. J Clin Med 2021; 10:5640. [PMID: 34884342 PMCID: PMC8658368 DOI: 10.3390/jcm10235640] [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: 11/04/2021] [Revised: 11/28/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022] Open
Abstract
While virtual surgical planning (VSP) and three-dimensional planning (3DP) have become important tools in acute craniomaxillofacial surgery, the incorporation of point of care VSP and 3DP is crucial to allow for acute facial trauma care. In this article, we review our approach to acute craniomaxillofacial trauma management, EPPOCRATIS, and discuss current challenges and future directions in acute facial trauma management.
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Affiliation(s)
- Basel A. Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55902, USA;
| | - Jonathan M. Morris
- Anatomic Modeling Lab, Department of Radiology, Mayo Clinic, Rochester, MN 55902, USA;
- Department of Radiology, Mayo Clinic, Rochester, MN 55902, USA
| | - Doga Kuruoglu
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55902, USA;
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Osseous Genioplasty: Prevention of Witch's Chin Deformity with No-Degloving Technique. Plast Reconstr Surg 2021; 148:720e-726e. [PMID: 34529592 DOI: 10.1097/prs.0000000000008478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Osseous genioplasty is a powerful procedure that can correct chin dysmorphology; however, traditional techniques may result in chin ptosis or a "witch's chin" deformity. Iatrogenic chin ptosis is thought to be caused by excessive degloving of soft tissue with a failure to reattach the mentalis muscle. In the authors' study, they compared the "no-degloving" technique (using a 90-degree plate with lag-screw fixation) to the "traditional" technique, for minimization of chin ptosis. METHODS The authors compared genioplasty techniques for consecutive patients: group 1 (traditional) underwent degloving for fixation of a stair-step plate, whereas group 2 (no-degloving) underwent lag-screw fixation (n = 50; 25 patients per group). The authors compared operating room time, advancement, complications, preoperative-to-postoperative vertical height change of the pogonion and menton (obtained through cone beam computed tomographic scans), surgeons' assessment of witch's chin, and FACE-Q surveys. RESULTS No-degloving versus traditional groups had similar age and sex distributions, horizontal/vertical change (5 mm/2 mm versus 6 mm/2 mm), length of surgery, and complication rate (5 percent). The traditional group had more deviation from expected position for both the pogonion (3.4 mm versus 1.2 mm; p ≤ 0.05) and menton (2.9 mm versus 0.8 mm; p ≤ 0.05), and more occurrences of witch's chin (six versus zero). No-degloving was superior for several FACE-Q scales, including Chin Appearance, Quality of Life, Satisfaction with Decision to Undergo Procedure, and Satisfaction with Outcome. CONCLUSION No-degloving osseous genioplasty is a safe, reproducible technique that results in decreased soft-tissue ptosis and increased patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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González-Alonso M, Hermida-Sánchez M, Martínez-Seijas P, Ruano-Ravina A. Application of 3D printing in the treatment of appendicular skeleton fractures: Systematic review and meta-analysis. J Orthop Res 2021; 39:2083-2092. [PMID: 33280162 DOI: 10.1002/jor.24939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
The objective of this study is to evaluate, through a systematic review of the scientific literature and meta-analysis, the applications of three-dimensional (3D) printing in the surgical treatment of complex fractures of the appendicular skeleton, mainly in terms of effectiveness and safety. A systematic review of the scientific literature was conducted in MEDLINE (PubMed) and the Cochrane Library combining different keywords. A specific methodological assessment scale was developed and applied to included papers. Ten studies were included; all of them were controlled trials, except for one retrospective observational cohort study. We observed statistically significant differences between the group that used 3D printing and the control group in terms of reduction in surgical time, reduction in the volume of blood lost during surgery and reduction in the number of intraoperative fluoroscopies, in favor of the 3D printing group. No statistically significant differences were observed in terms of fracture healing time, postoperative joint function, or postoperative complications. Meta-analysis revealed more favorable results for 3D-printing compared with conventional surgery, with the greatest difference observed for the number of intraoperative fluoroscopies. 3D printing might be considered effective and safe in the surgical treatment of anatomically complex appendicular skeleton fractures, in terms of reducing surgical time, lost blood volume, and radiation exposure of surgeons and patients.
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Affiliation(s)
- María González-Alonso
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Miguel Hermida-Sánchez
- Orthopaedic Surgery and Traumatology Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Pedro Martínez-Seijas
- Oral and Maxillofacial Surgery Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER de EpidemiologíaySaludPública (CIBERESP), Santiago de Compostela, Galicia, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
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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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Navigation-Assisted Resection and Fibula Free-Flap Reconstruction of an Extensive Maxillary Tumor. J Craniofac Surg 2021; 32:e450-e452. [PMID: 33278254 DOI: 10.1097/scs.0000000000007304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Tumor resection and reconstruction as a one-step procedure requires accurate definition of the intended safety margins, precise location of osteotomy lines and reliable individual rehabilitation.In recent years, the role of image-guided surgery in the maxillofacial region has increased significantly. As this technology allows the surgeon to track the actual position of each instrument during the operation in real-time, it makes it possible to perform extensive bone structure resections and reconstructions in anatomically distorted or complex areas, such as the head and neck region, without unnecessarily damaging vital structures.The authors described a case of a 26-year-old woman presented to our Clinic with an extensive maxillary squamous cell carcinoma involving the infratemporal fossa. The patient underwent single-step navigation-guided en bloc resection of the tumor and defect reconstruction.The aim of this study is describe and discuss the unusual surgical planning and the challenging operative technique adding a new case to the currently limited scientific literature on the computer-assisted head and neck oncologic surgery.
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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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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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Sethi RKV, Spector ME, Chinn SB. New Technologies in Bony Reconstruction of Complex Head and Neck Defects. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00290-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ma H, Shujaat S, Bila M, Sun Y, Vranckx J, Politis C, Jacobs R. Computer-assisted versus traditional freehand technique for mandibular reconstruction with free vascularized fibular flap: A matched-pair study. J Plast Reconstr Aesthet Surg 2021; 74:3031-3039. [PMID: 34020903 DOI: 10.1016/j.bjps.2021.03.121] [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] [Received: 11/16/2020] [Revised: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to perform a surgery-related and patient-related outcome analysis of a case-matched series of patients treated with computer-assisted surgery (CAS) and traditional freehand surgery. METHODS A total of 153 patients who underwent mandibular reconstruction by VFF were included from Jan 1999 to Dec 2019. The mandibular resection and reconstruction were performed by four experienced oral and maxillofacial surgeons. Reasons for reconstruction were oncologic, osteoradionecrosis, trauma, and osteoporosis. All the patients were followed up postoperatively for at least 1 year. Eighteen pairs were formed with the matched cohort consisting of a total of 36 patients who underwent primary mandibular reconstruction without additional combined flaps. The surgery-related and patient-related continuous and categorical parameters were assessed in both groups. RESULTS The average operation time and bleeding volume in the CAS group were less than those in the non-CAS group. Additionally, both hospitalization and ICU days were lower in the CAS group without any significant difference. The only significant finding related to surgical parameters was observed for the ischemia time, which was lower in the CAS group. CONCLUSIONS Computer-assisted surgery indicated improved efficiency considering reduced ischemia time, operation time, and length of hospital stay with lower early complications than that of conventional surgical procedures. It can thus be considered as an optimized alternative to the freehand approach.
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Affiliation(s)
- Hongyang Ma
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michel Bila
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Yi Sun
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Vranckx
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
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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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Knitschke M, Sonnabend S, Bäcker C, Schmermund D, Böttger S, Howaldt HP, Attia S. Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years. Cancers (Basel) 2021; 13:cancers13040865. [PMID: 33670721 PMCID: PMC7922890 DOI: 10.3390/cancers13040865] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022] Open
Abstract
Fibula free flap (FFF) is widely used in head and neck reconstructive surgery and is considered as a standard and therapy of choice after ablative cancer surgery. The aim of this retrospective monocenter study was to determine the success rates of fibula free flaps for jaw reconstruction after ablative tumor surgery. The disease course of patients who underwent jaw reconstructive surgery with FFF from January 2002 to June 2020 was evaluated regarding the flap success rate. Flap failure was analyzed in detail and categorized into two groups: partial flap failure (PFF) and total flap failure (TFF). A total of 180 free fibular flaps were performed over the last 19 years and a total of 36 flap failures were recorded. TFF occurred in n = 20 (56.6%) and PFF in n = 16 cases (44.4%) cases. No statistically significant differences were found concerning patients' age at flap transfer, sex, BMI, ASA-Score, preoperative non-virtual or virtual surgical planning (non-VSP vs. VSP), and time of reconstruction (immediately vs. delayed). Duration of hospitalization shows statistically significant differences between both groups (p = 0.038), but no differences concerning operating time and duration on Intensive Care Unit (ICU). Partial flap failure appears to be underreported in literature. Sub- and complete failure of the skin paddle leads to clinical complaints like uncovered bone segments and plate exposure. Partial or complete FFF failure lead to infections on the recipient site and prolonged wound healing and therefore may cause a delay of the beginning of adjuvant radiation therapy (RT). PFF of hard tissue can be induced by RT.
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Bacteriological and mechanical impact of the Sterrad sterilization method on personalized 3D printed guides for mandibular reconstruction. Sci Rep 2021; 11:581. [PMID: 33436705 PMCID: PMC7804113 DOI: 10.1038/s41598-020-79752-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 12/10/2020] [Indexed: 01/28/2023] Open
Abstract
Surgical cutting guides are increasingly used for maxillofacial reconstruction. They are usually provided by laboratories. In recent years, surgical teams have published studies on the possibility of manufacturing their own cutting guides thanks to 3D printers. The object of this study is to analyze the impact of the sterilization on the surface of those personalized models and to assess the effectiveness of sterilization. Using the data from high-resolution CT scan of patient, 3D models were generated through computerized assisted design and fabricated with a 3D printer using Acrylonitrile Butadiene Styrene (ABS). For the sterilization, a Sterrad method was used. In order to evaluate the effectiveness of sterilization, 3D models were artificially contaminated with several bacterial reference strains, sterilized and finally cultured. The surfaces and mechanical modifications were analyzed before and after sterilization with infrared spectrometry, surface contact angle, extensometer, scanning electron microscopy and atomic force microscopy. Ten models of different shapes and 24 samples were fabricated, sterilized and analyzed. The 3D models were designed in 48 h, printed in an average of 122 min and underwent a 47 min cycle of sterilization. All experimentally contaminated 3D models were negative in culture, with at least, a six log reduction of the initial inoculum. The hydrophobicity and roughness of the surface suffered few changes. The reproducibility of this procedure was proved by identical results in the three sterilization rounds. Using Sterrad process for the sterilization of ABS printed material doesn’t represent a bacterial risk for the patient. It is a feasible and safe innovative reconstructive method that can save time particularly for oncological cases.
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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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Barry CP, MacDhabheid C, Tobin K, Stassen LF, Lennon P, Toner M, O'Regan E, Clark JR. 'Out of house' virtual surgical planning for mandible reconstruction after cancer resection: is it oncologically safe? Int J Oral Maxillofac Surg 2020; 50:999-1002. [PMID: 33317906 DOI: 10.1016/j.ijom.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/14/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate whether the time delay between 'out of house' proprietary virtual surgical planning (OH-VSP) of the mandibular resection for oral cancer and the actual surgery results in compromised margins and oncological disadvantage for the patient. Outcomes of patients who had OH-VSP of their mandibular resection and reconstruction were compared with those of patients who had the same surgery using a conventional non-VSP approach. The groups were similar in patient demographics, tumour stage and size, nodal status, and reconstruction complexity. VSP resulted in a significant reduction in operating time (P<0.01). VSP did not affect bony (P=0.49) or soft tissue (P=0.22) margin status. In summary, VSP reduced the operating theatre time, and despite the time interval between bony resection planning and surgery, there was no compromise to the oncological safety of the operation.
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Affiliation(s)
- C P Barry
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland; School of Dental Science, Trinity College, Dublin, Ireland.
| | - C MacDhabheid
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland
| | - K Tobin
- School of Medicine, Trinity College, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland
| | - L F Stassen
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - P Lennon
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - M Toner
- School of Dental Science, Trinity College, Dublin, Ireland; Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - E O'Regan
- School of Medicine, Trinity College, Dublin, Ireland; Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - J R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
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The use of medical modeling in microvascular free tissue transfer reconstruction with osseointegrated implantation in complex midface defects. Oral Oncol 2020; 110:104982. [DOI: 10.1016/j.oraloncology.2020.104982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022]
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Discussion: The Latest Evolution in Virtual Surgical Planning: Customized Reconstruction Plates in Free Fibula Flap Mandibular Reconstruction. Plast Reconstr Surg 2020; 146:880-881. [PMID: 32970010 DOI: 10.1097/prs.0000000000007164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vimawala S, Gao T, Goldfarb J, Gadaleta D, Ku B, Jean-Gilles P, Luginbuhl A, Pugliese R, Weed D, Curry JM. Initial Experience Using 3-Dimensional Printed Models for Head and Neck Reconstruction in Haiti. EAR, NOSE & THROAT JOURNAL 2020; 101:NP89-NP91. [PMID: 32776836 DOI: 10.1177/0145561320938920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This report describes the first use of a novel workflow for in-house computer-aided design (CAD) for application in a resource-limited surgical outreach setting. Preoperative computed tomography imaging obtained locally in Haiti was used to produce rapid-prototyped 3-dimensional (3D) mandibular models for 2 patients with large ameloblastomas. Models were used for patient consent, surgical education, and surgical planning. Computer-aided design and 3D models have the potential to significantly aid the process of complex surgery in the outreach setting by aiding in surgical consent and education, in addition to expected surgical applications of improved anatomic reconstruction.
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Affiliation(s)
- Swar Vimawala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Terry Gao
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jared Goldfarb
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Dominick Gadaleta
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Bon Ku
- Thomas Jefferson University Hospital, The Health Design Lab, Philadelphia, PA, USA
| | | | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert Pugliese
- Thomas Jefferson University Hospital, The Health Design Lab, Philadelphia, PA, USA
| | - Donald Weed
- Department of Otolaryngology, Miller School of Medicine, University of Miami, FL, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Krakowczyk Ł, Piotrowska-Seweryn A, Szymczyk C, Wierzgoń J, Oleś K, Ulczok R, Donocik K, Dowgierd K, Maciejewski A. Virtual surgical planning and cone beam computed tomography in reconstruction of head and neck tumors - pilot study. Otolaryngol Pol 2020; 75:28-33. [PMID: 33949315 DOI: 10.5604/01.3001.0014.3450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> The aim of the study was to prove that a combination of visual surgical planning (VSP) and cone beam computed tomography (CBCT) is an optimal technique in fibular free flap reconstructions after complex tumor resections in the head and neck region and that it leads to better functional and aesthetic outcomes. <br><b>Material and method:</b> Six patients (3 females, 3 males) with head and neck tumors were included in the study. The region concerned midface in 2 cases and mandible in 4 patients. On the basis of computed tomography of the head, fibular free flap (FFF) reconstruction was planned with the VSP technique. The 3D-printed models were prepared. At the beginning of the operation and a few minutes after the reconstruction, an xCAT CBCT by XORAN was performed. Minor corrections of the angles of the reconstructed bony parts were made where needed. The time of the operation was assessed for each case. Functional and cosmetic results were evaluated in a 1-year follow-up. <br><b>Results:</b> The mean time of operation was 6 hours and 48 minutes, which was approximately 1hour and 40 minutes less than standard reconstructive surgery. Functional recovery was achieved in all patients. Aesthetic result was unsatisfactory for 2 patients due to insufficient soft tissue masses of FFF. <br><b>Conclusions:</b> The authors claim that intraoperative CBCT imaging, regardless of the cost, improves the accuracy of aesthetic outcome of reconstructive surgeries based on VSP, especially in the region of the midface and the mandible. Further studies on a higher number of subjects are required.
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Affiliation(s)
- Łukasz Krakowczyk
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Agnieszka Piotrowska-Seweryn
- Department of Oncological and Reconstructive Surgery, National Institute of Oncology Maria Skłodowskiej-Curie National Research Institute, Gliwice Branch, Poland
| | - Cezary Szymczyk
- Department of Oncological and Reconstructive Surgery, National Institute of Oncology Maria Skłodowskiej-Curie National Research Institute, Gliwice Branch, Poland
| | - Janusz Wierzgoń
- Department of Oncological and Reconstructive Surgery, National Institute of Oncology Maria Skłodowskiej-Curie National Research Institute, Gliwice Branch, Poland
| | - Krzysztof Oleś
- Department of Oncological and Reconstructive Surgery, National Institute of Oncology Maria Skłodowskiej-Curie National Research Institute, Gliwice Branch, Poland
| | - Rafał Ulczok
- Department of Oncological and Reconstructive Surgery, National Institute of Oncology Maria Skłodowskiej-Curie National Research Institute, Gliwice Branch, Poland
| | - Karolina Donocik
- Department of Oncological and Reconstructive Surgery, National Institute of Oncology Maria Skłodowskiej-Curie National Research Institute, Gliwice Branch, Poland
| | - Krzysztof Dowgierd
- Maxillofacial and Reconstructive Surgery Department, Children's Hospital in Olsztyn, Poland
| | - Adam Maciejewski
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
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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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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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Bartier S, Mazzaschi O, Benichou L, Sauvaget E. Computer-assisted versus traditional technique in fibular free-flap mandibular reconstruction: A CT symmetry study. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:23-27. [PMID: 32620425 DOI: 10.1016/j.anorl.2020.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In the past few years, virtual planning has been increasingly used for mandibular reconstruction. The objective of our study was to evaluate and compare symmetry and the accuracy of morphologic reconstruction in patients undergoing mandibular reconstruction by fibular free flap between traditional freehand technique and computer-aided surgical cutting guides. MATERIAL AND METHODS A single-center retrospective study included all cases of mandibular reconstruction using fibular free flap. In the three-dimensional (3D) group, virtual surgery planning with cut guides was used (Materialise ®), while the Control group underwent traditional freehand reconstruction. Morphometric comparisons were made to evaluate reconstruction accuracy between pre- and post-operative CT scans (mean deviations of 3 angles and 3 lengths). Mandible symmetry was calculated by comparing each angle and length in the affected and non-affected sides of the mandible. RESULTS Thirty-three patients treated between January 2015 and June 2018 were included: 25 patients in the 3D group and 8 in the control group. The average number of mandibular segments was 2.16±0.55 in the 3D group and 1.75±1.16 in the control group (p=0.005). Mean deviations between pre- and post-operative values of the coronal mandibular angle (angle formed by the line through the two condyles and the ramus), mandibular body height and mandibular ramus length on the affected side were significantly lower in the 3D group than in the control group. Sagittal mandibular angle symmetry was better in the 3D group than, in the control group (ratios of affected over non-affected sides: 1.07±0.04 vs 1.12±0.1; p=0.034). CONCLUSION Virtual surgical planning for fibula free-flap reconstruction helps to improve reconstruction accuracy and maintains a significantly greater symmetry than the traditional freehand technique, and should improve functional and esthetic outcome in mandibular reconstruction.
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Affiliation(s)
- S Bartier
- Head and Neck Surgery Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond-Losserand, 75014 Paris, France.
| | - O Mazzaschi
- Head and Neck Surgery Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond-Losserand, 75014 Paris, France
| | - L Benichou
- Maxillo-Facial Surgery Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond-Losserand, 75014 Paris, France; University Paris Descartes, School of Medicine, 75005 Paris, France
| | - E Sauvaget
- Head and Neck Surgery Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond-Losserand, 75014 Paris, France; University Paris Descartes, School of Medicine, 75005 Paris, France
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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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Agrawal N, DeFazio MV, Bird JE, Mericli AF. Computer-Aided Design and Computer-Aided Manufacturing for Pelvic Tumor Resection and Free Fibula Flap Reconstruction. Plast Reconstr Surg 2020; 145:889e-890e. [PMID: 32221265 DOI: 10.1097/prs.0000000000006689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nikhil Agrawal
- Division of Plastic Surgery, Department of General Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Justin E Bird
- Department of Orthopedic Oncology, Division of Surgery
| | - Alexander F Mericli
- Division of Plastic Surgery, Department of General Surgery, Baylor College of Medicine, Houston, Texas
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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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Accuracy of Computer-Aided Design/Computer-Aided Manufacturing-Assisted Mandibular Reconstruction With a Fibula Free Flap. J Craniofac Surg 2020; 30:2319-2323. [PMID: 31261320 DOI: 10.1097/scs.0000000000005704] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The recent increase in computer-aided design and computer-aided manufacturing (CAD/CAM)-assisted surgery has warranted a thorough evaluation of the accuracy of virtual plan execution. Mandibular reconstructions with a fibula free flap were evaluated by comparing the fibular segments postoperatively with the virtual surgical plans. METHODS This study included computed tomography data for 20 patients (11 males; mean age 61.3 years, range 47-74) that received a mandibular reconstruction with a fibula free flap. Linear distances (superior and inferior borders) of 41 fibula segments and intercoronoid distances were measured. RESULTS The mean difference was 3.11 ± 2.80 mm for superior borders (range 0.02-12.20 mm), and 2.75 ± 2.61 mm for inferior borders (range 0.22-13.58 mm). The mean intercoronoid difference was 3.57 ± 1.80 mm (range 0.91-6.11 mm). CONCLUSION This study confirmed the presumed accuracy regarding the use of fibular and mandibular cutting guides. CAD/CAM is an attractive technique which enhances efficiency and assurance during surgery and preoperative planning.
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Computer-Assisted Design and Manufacturing Assists Less Experienced Surgeons in Achieving Equivalent Outcomes in Cranial Vault Reconstruction. J Craniofac Surg 2019; 30:2034-2038. [PMID: 31306375 DOI: 10.1097/scs.0000000000005748] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The purpose of this study was to assess whether long-term outcomes were equivalent between computer-assisted design and manufacturing (CAD/CAM) -assisted cranial vault reconstruction performed by an inexperienced surgeon, with fewer years of surgical experience, and traditional reconstruction performed by senior surgeons with many decades of experience. METHODS An Institutional Review Board-approved retrospective cohort study was performed for all patients with nonsyndromic craniosynostosis between the ages of 1 month to 18 years who received primary, open calvarial vault reconstruction at the Johns Hopkins Hospital between 1990 and 2017. The primary outcome variable was the Whitaker category (I-IV) for level of required revision at the 2-year follow-up visit. Secondary outcomes included estimated blood loss, length of stay, operative time, and postoperative complications. CAD/CAM-assisted surgery was considered noninferior if the proportion of cases requiring any revision (Whitaker II, III, or IV) was no more than 10% greater than the proportion in the traditional surgery group with multivariate logistic regression analysis. t tests and fisher exact tests were used for secondary outcomes. RESULTS A total of 335 patients were included, with 35 CAD/CAM-assisted reconstructions. CAD/CAM-assisted reconstruction was noninferior to traditional after accounting for patient demographics, type of surgery, and experience level of the plastic surgeon. The traditional group required revision more frequently at 29.0% compared to CAD/CAM at 14.3%. Secondary outcomes were not significantly different between groups, but CAD/CAM had significantly longer average operative times (5.7 hours for CAD/CAM, 4.3 hours for traditional, P < 0.01). CONCLUSION CAD/CAM technology may lower the learning curve and assist less experienced plastic surgeons in achieving equivalent long-term outcomes in craniofacial reconstruction.
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