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Villarmé A, Pace-Loscos T, Schiappa R, Poissonnet G, Dassonville O, Chamorey E, Bozec A, Culié D. Impact of virtual surgical planning and three-dimensional modeling on time to surgery in mandibular reconstruction by free fibula flap. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108008. [PMID: 38359724 DOI: 10.1016/j.ejso.2024.108008] [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: 11/07/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Mandible reconstruction using a free fibula flap (FFF) is preferably performed with virtual surgical planning (VSP) to potentially improve functional and aesthetic outcomes. However, VSP is time-consuming. This study aims to assess the impact of VSP on time to surgery (TS). MATERIALS AND METHODS All patients who underwent FFF for oral cavity cancer between 2007 and 2020 were included. Time to surgery (from the date of the first consultation to the surgery date) was compared between patients without VSP and with VSP. In our department, VSP and 3D modeling were performed by an external engineering laboratory. RESULTS One hundred sixty-five patients were included retrospectively. VSP was utilized for 90 patients (55%). The mean time to surgery was 31 ± 16 days for patients undergoing conventional surgery without VSP and 44 ± 19 days for patients with VSP (p < 0.001). No clinical or tumoral characteristic were associated with a TS extended, except for the utilization of VSP (p < 0.001). By constituting groups of 25 consecutive patients, there is no difference in TS between the groups. CONCLUSION The use of VSP significantly increased the time to surgery in our study, unrelated to clinical differences or year of surgery. This delay may have an impact on oncologic outcomes, so it should be considered in the care organization for each patient. Implementing new procedures to reduce this difference is warranted.
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Affiliation(s)
- A Villarmé
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France.
| | - Tanguy Pace-Loscos
- Epidemiology and Biostatistic Unit, Centre Antoine Lacassagne, Nice, France
| | - Renaud Schiappa
- Epidemiology and Biostatistic Unit, Centre Antoine Lacassagne, Nice, France
| | - Gilles Poissonnet
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France
| | - Olivier Dassonville
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France
| | - Emmanuel Chamorey
- Epidemiology and Biostatistic Unit, Centre Antoine Lacassagne, Nice, France
| | - Alexandre Bozec
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France
| | - Dorian Culié
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France
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Suhaym O, Moles L, Callahan N. Cutting guides in mandibular tumor ablation: Are we as accurate as we think? Saudi Dent J 2024; 36:340-346. [PMID: 38420006 PMCID: PMC10897611 DOI: 10.1016/j.sdentj.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 03/02/2024] Open
Abstract
Purpose Tumor margin status is critical in local tumor recurrence and is a significant prognostic factor in head and neck cancer survival. With the introduction of computer-assisted surgical planning, one of the main challenges is the accurate positioning of the surgical cutting guide but there is limited evidence of the accuracy of the 3D cutting guides in mimicking virtually planned osteotomy. This study evaluates the accuracy of osteotomy lines produced by 3D-printed cutting guides and assesses the overall accuracy of mandibular reconstruction. Material and Methods The pre and postoperative 3D models were aligned using an automated surface registration feature based on the iterative closest point algorithm. The differences in osteotomy line deviation, linear and angle measurements, and 3D volume quantification of the pre and post models were measured. Results We included 14 patients (8 men and 6 women with ages ranging from 13 to 75 years) with a segmental mandibular resection who met all of the inclusion criteria. The smallest defect size was 4.4 cm, the largest defect was 12.2 cm, and the average was 7.30 cm +/- 2.80 cm. The average deviation between virtually planned osteotomy and actual surgical osteotomy was 1.52 +/-1.02 mm. No covariates were associated with increased inaccuracy of the 3D-printed cutting guides. Conclusion The finding of this study suggests that virtual surgical planning is an unambiguous paradigm shift in the predictability of the surgical plan and achievement of the reconstruction goals. The 3D-printed cutting guides are a very accurate and reliable tool in translating virtual ablation plans to an actual surgical resection margin.
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Affiliation(s)
- Omar Suhaym
- Maxillofacial Surgery and Diagnostic Sciences, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), Prince Mutib Ibn Abdullah Ibn Abdulaziz Rd, Ar Rimayah, 14611 Riyadh, Saudi Arabia
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Velarde K, Cafino R, Isla A, Ty KM, Palmer XL, Potter L, Nadorra L, Pueblos LV, Velasco LC. Virtual surgical planning in craniomaxillofacial surgery: a structured review. Comput Assist Surg (Abingdon) 2023; 28:2271160. [PMID: 37862041 DOI: 10.1080/24699322.2023.2271160] [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] [Indexed: 10/21/2023] Open
Abstract
Craniomaxillofacial (CMF) surgery is a challenging and very demanding field that involves the treatment of congenital and acquired conditions of the face and head. Due to the complexity of the head and facial region, various tools and techniques were developed and utilized to aid surgical procedures and optimize results. Virtual Surgical Planning (VSP) has revolutionized the way craniomaxillofacial surgeries are planned and executed. It uses 3D imaging computer software to visualize and simulate a surgical procedure. Numerous studies were published on the usage of VSP in craniomaxillofacial surgery. However, the researchers found inconsistency in the previous literature which prompted the development of this review. This paper aims to provide a comprehensive review of the findings of the studies by conducting an integrated approach to synthesize the literature related to the use of VSP in craniomaxillofacial surgery. Twenty-nine related articles were selected as a sample and synthesized thoroughly. These papers were grouped assigning to the four subdisciplines of craniomaxillofacial surgery: orthognathic surgery, reconstructive surgery, trauma surgery and implant surgery. The following variables - treatment time, the accuracy of VSP, clinical outcome, cost, and cost-effectiveness - were also examined. Results revealed that VSP offers advantages in craniomaxillofacial surgery over the traditional method in terms of duration, predictability and clinical outcomes. However, the cost aspect was not discussed in most papers. This structured literature review will thus provide current findings and trends and recommendations for future research on the usage of VSP in craniomaxillofacial surgery.
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Affiliation(s)
- Kaye Velarde
- Mindanao State University-Iligan Institute of Technology, Iligan City, The Philippines
| | - Rentor Cafino
- Zamboanga City Medical Center, Zamboanga City, The Philippines
| | - Armando Isla
- Mercy Community Hospital, Iligan City, The Philippines
| | - Karen Mae Ty
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, The Philippines
| | | | | | - Larry Nadorra
- Department of Health - Center for Health Development, Cagayan de Oro City, The Philippines
| | | | - Lemuel Clark Velasco
- Mindanao State University-Iligan Institute of Technology, Iligan City, The Philippines
- Premiere Research Institute of Science and Mathematics - Center for Computational Analytics and Modelling
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Jelovac D, Micic M, Hajdarevic S, Kuzmanovic C, Cukic B, Stefanovic B, Zelic K, Bonfante E, Ewers R, Petrovic M. Immediate placement of extra-short implants in refined scapula tip microvascular free flaps: In house virtual planning and surgical technique - Proof of concept. Heliyon 2023; 9:e18021. [PMID: 37496908 PMCID: PMC10366439 DOI: 10.1016/j.heliyon.2023.e18021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/24/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023] Open
Abstract
Scapula tip flaps have been introduced in the literature as an ideal surgical treatment option for large defects in the horizontal plane of the maxilla. This article aims to present a unique step by step protocol for a near total maxillectomy with a pterygoid bone resection and consecutive microvascular reconstruction with a harvested scapula tip flap. The protocol includes immediate placement of extra-short implants in donor bone with the aid of Virtual Surgical Planning (VSP), and an in-house 3D printing of medical 3D models and surgical guides. So far, there has been no presented surgical technique combining immediate implant placement in the scapula region with simultaneous microvascular repair. This technique allows: tumour resection; flap harvesting; extra-short implant placements and reconstruction to be performed in one simultaneous procedure. The technique is presented with illustrations, VSP (presented on videos), radiographs, and surgical findings. We discovered that this refinement of the scapula tip surgery has enabled reconstructive procedures to be performed at the same time as implant placements, providing expedited functional and aesthetic outcomes in selected cases. Moreover, modification of the surgical technique could enhance the competence of the oropharyngeal edge. In conclusion, this new surgical protocol utilizing VSP, 3D models and simultaneous extra-short implant placement provides indispensable advantages for such a complicated surgical procedures, while significantly shortening the duration of surgery.
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Affiliation(s)
- Drago Jelovac
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Milutin Micic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Sanela Hajdarevic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - Cedomir Kuzmanovic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | | | | | - Ksenija Zelic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
- School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
| | - E.A. Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo – Bauru School of Dentistry, Bauru, SP, Brazil
| | - Rolf Ewers
- University Hospital for Cranio Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18 - 20, 1090, Vienna, Austria
| | - Milan Petrovic
- Clinic for Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 1100, Belgrade, Serbia
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Jones EA, Huang AT. Virtual Surgical Planning in Head and Neck Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00070-1. [PMID: 37221116 DOI: 10.1016/j.otc.2023.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Virtual surgical planning is a revolutionary tool for the head and neck reconstructive surgeon. As with any tool, there are strengths and weaknesses. The strengths include shorter operative time, shorter ischemic time, streamlined dental rehabilitation, facilitation of complex reconstruction, non-inferior and possibly superior accuracy, and increased durability. The weaknesses are increased up-front costs, potential delays to operative management, limited flexibility on the day of surgery, and loss of familiarity with conventionally planned surgery.
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Affiliation(s)
- Evan A Jones
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, 1977 Butler Boulevard, Suite E5.200, Houston, TX 77030, USA
| | - Andrew T Huang
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, 1977 Butler Boulevard, Suite E5.200, Houston, TX 77030, USA.
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Chitosan-based therapeutic systems and their potentials in treatment of oral diseases. Int J Biol Macromol 2022; 222:3178-3194. [DOI: 10.1016/j.ijbiomac.2022.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/09/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
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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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高 廷, 王 栋, 陈 默, 展 昭, 彭 笑, 张 凯. [Application of personalized guide plate combined with real-time navigation in repairing mandibular defect using fibula muscle flap]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:691-697. [PMID: 35712925 PMCID: PMC9240846 DOI: 10.7507/1002-1892.202202090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the application of personalized guide plate combined with intraoperative real-time navigation in repairing of mandibular defect using fibula muscle flap, providing the basis for the precise repair and reconstruction of mandible. METHODS The clinical data of 12 patients (9 males and 3 females) aged from 23 to 71 years (mean, 55.5 years) between July 2019 and December 2021 were recorded. These patients were diagnosed as benign or malignant mandibular tumors, including 2 cases of ameloblastoma, 6 cases of squamous cell carcinoma, 2 cases of osteosarcoma, 1 case of adenoid cystic carcinoma, and 1 case of squamous carcinoma. All patients were treated with mandibular amputation, and then repaired by double-stacked three-segment fibula muscle flap. Preoperative virtual design scheme and guide plate were performed. During the operation, personalized guide plate combined with real-time navigation was used for fibular osteotomy and shaping. Thin-slice CT examination was performed at 2-3 weeks after operation, and was fitted with the preoperative virtual design scheme. The difference between the distance of bilateral mandibular angles relative to the reference plane in three-dimensional directions (left-right, vertical, and anterior-posterior) and the difference of the medial angle of the lower edge of the mandible reconstructed by fibula were measured, and the mean error of chromatographic fitting degree was calculated. RESULTS The guide plate and navigation were applied well, and the fibula shaping and positioning were accurate. The fibula muscle flap survived, the incision healed well, and the occlusal relationship was good. All 12 patients were followed up 1-29 months, with an average of 17 months. There was no significant difference on the distance of bilateral mandibular angles relative to the reference plane in the left-right [(-0.24±1.35) mm; t=-0.618, P=0.549], vertical [-0.85 (-1.35, 1.40) mm; Z=-0.079, P=0.937], and anterior-posterior [(-0.46±0.78) mm; t=-2.036, P=0.067] directions. The difference of the medial angle of the lower edge of the mandible reconstructed by fibula was also not significant [(-1.35±4.34)°; t=-1.081, P=0.303)]. Postoperative CT and preoperative virtual design fitting verified that there was no significant difference in the change of the mandibular angle on both sides, and the average error was (0.47±1.39) mm. CONCLUSION The personalized guide combined with intraoperative real-time navigation improves the accuracy of peroneal muscle flap reconstruction of the mandible, reduces the complications, and provides a preliminary basis for the application of visual intraoperative navigation in fibula muscle flap reconstruction of the mandible.
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Affiliation(s)
- 廷益 高
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 栋 王
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 默 陈
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 昭均 展
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 笑 彭
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 凯 张
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
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Rodríguez-Arias JP, Tapia B, Pampín MM, Morán MJ, Gonzalez J, Barajas M, Del Castillo JL, Navarro Cuéllar C, Cebrian JL. Clinical Outcomes and Cost Analysis of Fibula Free Flaps: A Retrospective Comparison of CAD/CAM versus Conventional Technique. J Pers Med 2022; 12:jpm12060930. [PMID: 35743715 PMCID: PMC9224908 DOI: 10.3390/jpm12060930] [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: 04/26/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: A decrease in operative time can not only improve patient outcomes through a reduction in the risk of developing complications but can also result in cost savings. The aim of this study is to determine whether there an intraoperative time gain can be achieved by using the preoperative virtual planning of mandibular reconstruction using a free fibula flap compared with freehand plate bending and osteotomies. (2) Methods: A retrospective comparative study was carried out in the Oral and Maxillofacial Department of La Paz University Hospital, Madrid, Spain. The study compared 18 patients in the CAD/CAM group with 19 patients in the conventional freehand group. A comparison was made between the total surgical time, the comorbidities, and the hospital stay. The resource consumption was estimated using a cost analysis. (3) Results: Although CAD/CAM was a statistically more expensive procedure in the perioperative phase, no significant differences were observed in total health care costs between the two groups. There was a non-significant trend towards an increase in complications with conventional reconstruction plates compared to patient-specific plates (PSI). (4) Conclusions: CAD/CAM technology and a 3D printed cutting guide offer a significantly shorter surgical time, which is associated with a reduction in hospital days, PACU days, and complications. The cost of CAD/CAM technology is comparable to that of the conventional freehand technique.
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Affiliation(s)
- Juan Pablo Rodríguez-Arias
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (M.M.P.); (M.J.M.); (J.G.); (M.B.); (J.L.D.C.); (J.L.C.)
- Correspondence: ; Tel.: +34-659-464-730
| | - Blanca Tapia
- Anesthesia and Intensive Care Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain;
| | - Marta María Pampín
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (M.M.P.); (M.J.M.); (J.G.); (M.B.); (J.L.D.C.); (J.L.C.)
| | - Maria José Morán
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (M.M.P.); (M.J.M.); (J.G.); (M.B.); (J.L.D.C.); (J.L.C.)
| | - Javier Gonzalez
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (M.M.P.); (M.J.M.); (J.G.); (M.B.); (J.L.D.C.); (J.L.C.)
| | - Maria Barajas
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (M.M.P.); (M.J.M.); (J.G.); (M.B.); (J.L.D.C.); (J.L.C.)
| | - Jose Luis Del Castillo
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (M.M.P.); (M.J.M.); (J.G.); (M.B.); (J.L.D.C.); (J.L.C.)
| | - Carlos Navarro Cuéllar
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Jose Luis Cebrian
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (M.M.P.); (M.J.M.); (J.G.); (M.B.); (J.L.D.C.); (J.L.C.)
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Osseous Union after Mandible Reconstruction with Fibula Free Flap Using Manually Bent Plates vs. Patient-Specific Implants: A Retrospective Analysis of 89 Patients. Curr Oncol 2022; 29:3375-3392. [PMID: 35621664 PMCID: PMC9139377 DOI: 10.3390/curroncol29050274] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 12/01/2022] Open
Abstract
The aim of this monocentric, retrospective clinical study was to evaluate the status of osseous union in uni- and poly-segmental mandible reconstructions regarding conventional angle-stable manually bent osteosynthesis plates (Unilock 2.0 mm) versus titan laser-melted PSI patient-specific implant’s (PSI). The clinical impact of PSI’s high stiffness fixation methods on bone healing and regeneration is still not well addressed. The special interest was in evaluating the ossification of junctions between mandible and fibula and between osteotomized fibula free flap (FFF) segments. Panoramic radiograph (OPT), computed tomography (CT) scans, or cone-beam CTs (CBCT) of patients who underwent successful FFF for mandible reconstruction from January 2005 to December 2020 were analyzed. A total number of 89 cases (28 females (31.5%), 61 males (68.5%), mean age 58.2 ± 11.3 years, range: 22.8–82.7 years) fulfilled the chosen inclusion criteria for analysis (conventional: n = 44 vs. PSI: n = 45). The present study found an overall incomplete ossification (IOU) rate of 24.7% (conventional: 13.6% vs. PSI: 35.6%; p = 0.017) for mandible to fibula and intersegmental junctions. Between osteotomized FFF segments, an IOU rate of 16% was found in the PSI-group, while no IOU was recorded in the conventional group (p = 0.015). Significant differences were registered for IOU rates in poly-segmental (p = 0.041), and lateral (p = 0.016) mandibular reconstructions when PSI was used. Multivariate logistic regression analysis identified plate exposure and type of plate used as independent risk factors for IOU. Previous or adjuvant radiotherapy did not impact incomplete osseous union in the evaluated study sample. PSI is more rigid than bent mini-plates and shields functional mechanical stimuli, and is the main reason for increasing the rate of incomplete ossification. To enhance the functional stimulus for ossification it has to be discussed if patient-specific implants can be designed to be thinner, and should be divided into segmental plates. This directs chewing forces through the bone and improves physiological bone remodeling.
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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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12
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Crosetti E, Succo G, Battiston B, D'Addabbo F, Tascone M, Maldi E, Bertotto I, Berrone M. Surgical Margins After Computer-Assisted Mandibular Reconstruction: A Retrospective Study. FRONTIERS IN ORAL HEALTH 2022; 2:806477. [PMID: 35098211 PMCID: PMC8793010 DOI: 10.3389/froh.2021.806477] [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: 10/31/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: The use of virtual surgical planning in head and neck surgery is growing strongly. In the literature, its validity, accuracy and clinical utility for mandibular reconstruction are widely documented. Virtual planning of surgical bone resection and reconstruction takes place several days before surgery and its very sensitive nature can negatively affect an intervention aimed at maximum precision in term of oncological safety. Methods: The study focuses on a retrospective evaluation of the surgical margins in 26 consecutive cases with oral cavity malignancy and who underwent computer-assisted mandibular resection/reconstruction guided by the different types of bone, periosteal and peri-mandibular tissue involvement. The goal was to analyze the strategic and technical aspects useful to minimize the risk of positive or close margins and to vary the reconstructive strategy in the case of intraoperative findings of a non-radical planned resection. Results: No intraoperative or perioperative complications occurred. In 20 patients, virtual surgical planning permitted mandibular reconstruction to be performed using composite fibular free flaps, characterized by high accuracy and negative bone margins. In the remaining 6 patients, also virtually planned but otherwise reconstructed due to poor general condition (advanced age, severe comorbidity), negative bone margins were obtained. Intraoperative enlargement of the resection was carried out in one case and positive soft tissue margins were observed in another case. Conclusion: The results were satisfactory in terms of oncological radicality and precision. The functional benefits and reduction in operating times, previously demonstrated in other articles also by the authors, seem to justify the side effects related to the risk of modifying the planned surgery. During virtual planning, the surgeons must bear in mind that an unexpected progression of the tumor or a limited planned resection will entail modifying the extent of the resection intraoperatively and nullifying the virtual planning on which the reconstruction was based. Further investigations are necessary to clarify all aspects of virtual surgical planning in this setting.
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Affiliation(s)
- Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Giovanni Succo
- Head Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology, Hand and Microsurgery Unit, Orthopedic and Trauma Centre, Azienda Ospedaliero Universitaria (AOU) Città Della Salute e Della Scienza, Turin, Italy
| | | | - Martina Tascone
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Elena Maldi
- Pathology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Mattia Berrone
- Head Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
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13
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Knitschke M, Baumgart AK, Bäcker C, Adelung C, Roller F, Schmermund D, Böttger S, Howaldt HP, Attia S. Computed Tomography Angiography (CTA) before Reconstructive Jaw Surgery Using Fibula Free Flap: Retrospective Analysis of Vascular Architecture. Diagnostics (Basel) 2021; 11:1865. [PMID: 34679563 PMCID: PMC8534841 DOI: 10.3390/diagnostics11101865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Computed tomography angiography (CTA) is widely used in preoperative evaluation of the lower limbs' vascular system for virtual surgical planning (VSP) of fibula free flap (FFF) for jaw reconstruction. The present retrospective clinical study analysed n = 72 computed tomography angiographies (CTA) of lower limbs for virtual surgical planning (VSP) for jaw reconstruction. The purpose of the investigation was to evaluate the morphology of the fibular bone and its vascular supply in CTA imaging, and further, the amount and distribution of periosteal branches (PB) and septo-cutaneous perforators (SCPs) of the fibular artery. A total of 144 lower limbs was assessed (mean age: 58.5 ± 15.3 years; 28 females, 38.9%; 44 males, 61.1%). The vascular system was categorized as regular (type I-A to II-C) in 140 cases (97.2%) regarding the classification by Kim. Absent anterior tibial artery (type III-A, n = 2) and posterior tibial artery (type III-B, n = 2) were detected in the left leg. Stenoses were observed mostly in the fibular artery (n = 11), once in the anterior tibial artery, and twice in the posterior tibial artery. In total, n = 361 periosteal branches (PBs) and n = 231 septo-cutaneous perforators (SCPs) were recorded. While a distribution pattern for PBs was separated into two clusters, a more tripartite distribution pattern for SCPs was found. We conclude that conventional CTA for VSP of free fibula flap (FFF) is capable of imaging and distinguishing SCPs and PBs.
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Affiliation(s)
- Michael Knitschke
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Anna Katrin Baumgart
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Christina Bäcker
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Christian Adelung
- Department of Radiology, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (C.A.); (F.R.)
| | - Fritz Roller
- Department of Radiology, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (C.A.); (F.R.)
| | - Daniel Schmermund
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Sebastian Böttger
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
| | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany; (A.K.B.); (C.B.); (D.S.); (S.B.); (H.-P.H.); (S.A.)
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14
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Ma H, Shujaat S, Van Dessel J, Sun Y, Bila M, Vranckx J, Politis C, Jacobs R. Adherence to Computer-Assisted Surgical Planning in 136 Maxillofacial Reconstructions. Front Oncol 2021; 11:713606. [PMID: 34336702 PMCID: PMC8322949 DOI: 10.3389/fonc.2021.713606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the adherence to initially planned maxillofacial reconstructions using computer-assisted surgery (CAS) and to identify the influential factors affecting its compliance for maxillofacial reconstruction. Patients and Methods A retrospective analysis of 136 computer-assisted maxillofacial reconstructive surgeries was conducted from January 2014 to June 2020. The categorical parameters involved age, gender, disease etiology, disease site, defect size, bone flap segments, and flap type. Apart from descriptive data reporting, categorical data were related by applying the Fisher-exact test, and a p-value below 5% was considered statistically significant (P < 0.05). Results The main reasons for partial or non-adherence included unfitness, patient health condition, and other subjective reasons. Out of the total patient population, 118 patients who underwent mandibular reconstruction showed higher CAS compliance (83.9%) compared to the 18 midface reconstruction (72.2%) without any statistically significant difference (p = 0.361). Based on the size of the defect, a significantly higher CAS compliance (p = 0.031) was observed with a minor defect (80.6%) compared to the large-sized ones (74.1%). The bone flaps with two or more segments were significantly (p = 0.003) prone to observe a partial (15.4%) or complete (12.8%) discard of the planned CAS compared to the bone flaps with less than two segments. The malignant tumors showed the lowest CAS compliance when compared to other disorders without any significant difference (p = 0.1). Conclusion The maxillofacial reconstructive surgical procedures offered optimal compliance to the initially planned CAS. However, large-sized defects and multiple bone flap segments demonstrated a higher risk of partial or complete abandonment of the CAS.
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Affiliation(s)
- Hongyang Ma
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,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, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Van Dessel
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,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, Leuven, Belgium.,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, Leuven, Belgium.,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, Leuven, Belgium.,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, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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