1
|
Pu JJ, Su YX. Response to comments to "Long-term stability of jaw reconstruction with microvascular bone flaps: A prospective longitudinal study". Oral Oncol 2024; 157:106962. [PMID: 39032345 DOI: 10.1016/j.oraloncology.2024.106962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Jingya Jane Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China.
| |
Collapse
|
2
|
Pu JJ, Choi WS, Wong MCM, Wu S, Leung PH, Yang WF, Su YX. Long-term stability of jaw reconstruction with microvascular bone flaps: A prospective longitudinal study. Oral Oncol 2024; 152:106780. [PMID: 38555752 DOI: 10.1016/j.oraloncology.2024.106780] [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: 12/30/2023] [Revised: 03/01/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Microvascular bone flap jaw reconstruction has achieved satisfactory clinical outcomes. However, little is known about the long-term stability of the reconstructed jaw. This prospective longitudinal study aimed to investigate the long-term stability of jaw reconstruction and factors that were associated with it. METHODS Patients with successful computer-assisted osseous free-flap jaw reconstruction in the Department of Oral and Maxillofacial Surgery, Queen Mary Hospital, Hong Kong were recruited for this prospective longitudinal study. The three-dimensional jaw models at the pre-operative plan, post-operative 1-month, and 2 years were aligned and compared. RESULTS A total of 69 patients were recruited, among which 48 patients were available for the long-term analysis. Compared to 1-month after surgery, further deviation from the pre-operative plan was observed at post-operative 2 years. Lack of accuracy in surgery, segmental mandible resection especially with the involvement of mandible angles, and post-operative radiation therapy were identified as the significant factors affecting the positional stability of the reconstructed jaw (p < 0.05). Stable reconstruction was observed in the subgroup analysis of patients without post-operative radiation therapy. CONCLUSION Up to the best of our knowledge, this is the first prospective longitudinal study reporting the long-term stability of jaw reconstruction and its affecting factors. Our data demonstrated that the reconstructed jaw position lacked stability over the postoperative period. How to improve long-term stability of reconstructed jaw thus optimize the functional outcomes warrants further studies.
Collapse
Affiliation(s)
- Jingya Jane Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| | - Wing Shan Choi
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - May C M Wong
- Division of Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Songying Wu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Pui Hang Leung
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Wei-Fa Yang
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
3
|
Pu JJ, Lo AWI, Wong MCM, Choi WS, Ho G, Yang WF, Su YX. A quantitative comparison of bone resection margin distances in virtual surgical planning versus histopathology: a prospective study. Int J Surg 2024; 110:111-118. [PMID: 37737999 PMCID: PMC10793803 DOI: 10.1097/js9.0000000000000780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Positive bone margins have been shown to be associated with worse locoregional control and survival performance in oral oncology patients. With the application of computer-assisted surgery and patient-specific surgical guides, the authors can accurately execute the preoperative osteotomy plan. However, how well the authors can predict the margin distance in the final histopathology with a preoperative computed tomography (CT) scan, the factors associated with it, and how much leeway CT should spare when designing the osteotomy planes during virtual surgical planning (VSP) remain to be investigated. MATERIALS AND METHODS Patients from January 2021 to December 2022 with benign or malignant jaw tumors and with signs of bone marrow involvement in the preoperative CT scan in our center were prospectively recruited to the study. VSP and measurement of the closest margin distance in the CT scan were performed by the single team of surgeons. The resection specimen was processed, and the margin distances were measured by a dedicated senior pathologist with the knowledge of orientation of the osteotomy planes. RESULTS A total of 35 patients were recruited, with 21 malignant and 14 benign cases. Sixty-eight bone margins were quantitatively analyzed. No significant difference in margin distances measured from the CT scan and final histopathology was detected ( P =0.19), and there was a strong correlation between the two (r s =0.74, P <0.01). A considerable amount of variance was detected in the level of discrepancy between margin distances measured in the CT scan and final histopathology (overall SD=6.26 mm, malignancy SD=7.44 mm, benign SD=4.40 mm). No significant correlation existed between the two margin distances when only maxilla tumor margins were assessed ( P =0.16). CONCLUSION The bone margin distance in VSP is reliably correlated to the final pathological margin distance. A leeway distance of 15mm and 9mm should be considered when designing the osteotomy planes for malignancy and benign cases, respectively. Extra attention should be paid to maxilla cases when predetermining the osteotomy planes during VSP.
Collapse
Affiliation(s)
- Jane J. Pu
- Division of Oral and Maxillofacial Surgery
| | | | - May C. M. Wong
- Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong
| | | | - Grace Ho
- Department of Radiology, Queen Mary Hospital, Hong Kong Special Administrative Region, People’s Republic of China
| | | | | |
Collapse
|
4
|
Su YXR, Ganry L, Ozturk C, Lohman R, Al Afif A, McSpadden R, Frias V, Pu JJ. Fibula Flap Reconstruction for the Mandible: Why It Is Still the Workhorse? Atlas Oral Maxillofac Surg Clin North Am 2023; 31:121-127. [PMID: 37500195 DOI: 10.1016/j.cxom.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Yu-Xiong Richard Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China.
| | - Laurent Ganry
- Department of Head and Neck Surgery, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Can Ozturk
- Department of Head & Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Rob Lohman
- Department of Head & Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ayham Al Afif
- Department of Head & Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ryan McSpadden
- Department of Dentistry, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA; Department of Maxillofacial Prosthetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Vladimir Frias
- Department of Dentistry, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA; Department of Maxillofacial Prosthetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jane Jingya Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
| |
Collapse
|
5
|
Liu R, Su Y, Pu J, Zhang C, Yang W. Cutting-edge patient-specific surgical plates for computer-assisted mandibular reconstruction: The art of matching structures and holes in precise surgery. Front Surg 2023; 10:1132669. [PMID: 36969756 PMCID: PMC10033664 DOI: 10.3389/fsurg.2023.1132669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesCutting-edge patient-specific surgical plates (PSSPs) are supposed to improve the efficiency, precision, and functional outcomes of mandibular reconstruction. This study characterized the premium role of PSSPs in precise surgery and explored their working principles in computer-assisted mandibular reconstruction (CAMR).MethodsThe PSSPs-enhanced surgical precision was investigated through the model surgery and representative cases. Spatial deviations of reconstruction were characterized by comparing the reconstructed mandible with the virtually designed mandible. Working principles of PSSPs were distinguished by a review of evolving surgical techniques in CAMR.ResultsIn the model surgery, spatial deviations between the virtually planned mandible and the reconstructed mandible were 1.03 ± 0.43 mm in absolute distance deviation, 1.70 ± 1.26 mm in intercondylar length, and 1.86 ± 0.91 mm in intergonial length in the study group of PSSPs, significantly smaller than in the control group of conventional prebent surgical plates. Meanwhile, in the study group, distance deviations were 0.51 ± 0.19 mm in bone-plate distance and 0.56 ± 0.28 mm in drilled screw holes, indicating the art of matching structures and holes. The PSSPs-enhanced CAMR was further demonstrated in three representative cases of mandibular reconstruction. Finally, four primary techniques of CAMR were summarized based on a review of 8,672 articles. The premium role of PSSPs was distinguished by the benefits of matching structures and holes.ConclusionsThe PSSPs-enhanced surgical precision was verified through the model surgery and demonstrated in human surgery. Compared to other surgical techniques of CAMR, PSSPs contributed to the precise surgery by the art of matching structures and holes.
Collapse
Affiliation(s)
- Renshun Liu
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
| | - Yuxiong Su
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | - Jingya Pu
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | - Chunyu Zhang
- Guangzhou Janus Biotechnology Co., Ltd, Guangzhou, China
| | - Weifa Yang
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
- Correspondence: Weifa Yang
| |
Collapse
|
6
|
Pu JJ, Hakim SG, Melville JC, Su YX. Current Trends in the Reconstruction and Rehabilitation of Jaw following Ablative Surgery. Cancers (Basel) 2022; 14:cancers14143308. [PMID: 35884369 PMCID: PMC9320033 DOI: 10.3390/cancers14143308] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary The Maxilla and mandible provide skeletal support for of the middle and lower third of our faces, allowing for the normal functioning of breathing, chewing, swallowing, and speech. The ablative surgery of jaws in the past often led to serious disfigurement and disruption in form and function. However, with recent strides made in computer-assisted surgery and patient-specific implants, the individual functional reconstruction of the jaw is evolving rapidly and the prompt rehabilitation of both the masticatory function and aesthetics after jaw resection has been made possible. In the present review, the recent advancements in jaw reconstruction technology and future perspectives will be discussed. Abstract The reconstruction and rehabilitation of jaws following ablative surgery have been transformed in recent years by the development of computer-assisted surgery and virtual surgical planning. In this narrative literature review, we aim to discuss the current state-of-the-art jaw reconstruction, and to preview the potential future developments. The application of patient-specific implants and the “jaw-in-a-day technique” have made the fast restoration of jaws’ function and aesthetics possible. The improved efficiency of primary reconstructive surgery allows for the rehabilitation of neurosensory function following ablative surgery. Currently, a great deal of research has been conducted on augmented/mixed reality, artificial intelligence, virtual surgical planning for soft tissue reconstruction, and the rehabilitation of the stomatognathic system. This will lead to an even more exciting future for the functional reconstruction and rehabilitation of the jaw following ablative surgery.
Collapse
Affiliation(s)
- Jane J. Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong;
| | - Samer G. Hakim
- Department Oral and Maxillofacial Surgery, University Hospital of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany;
| | - James C. Melville
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong;
- Correspondence:
| |
Collapse
|