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de Boutray M, Cuau L, Ohayon M, Garrel R, Poignet P, Zemiti N. Robot-guided osteotomy in fibula free flap mandibular reconstruction: a preclinical study. Int J Oral Maxillofac Surg 2024; 53:343-346. [PMID: 37604757 DOI: 10.1016/j.ijom.2023.07.010] [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: 02/22/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023]
Abstract
Various methods currently exist to guide fibular osteotomy positioning in fibula free flap mandibular reconstruction, but patient-specific navigation methods and cutting guides require experience, and may be time-consuming and/or expensive. This study describes a robot-guided osteotomy technique for mandible reconstruction using a fibula free flap according to virtual preoperative planning. The method was assessed on five 3D-printed models and a cadaveric model. The precision of the robot-guided osteotomy was evaluated by measuring the deviations between the lengths and angles of the fragments obtained and those of the virtual planning. The average deviation of the anterior and posterior crest lengths was 0.42 ± 0.29 mm for the 3D-printed models and 1.00 ± 0.53 mm for the cadaveric model. The average angle deviation was 1.90 ± 1.22° and 1.94 ± 0.69° for the 3D-printed and cadaveric models, respectively. The results of this preclinical study revealed that fibular osteotomy positioning guidance using a robot-positioned cutting guide may be a precise, easy-to-use technique that could be tailored for fibula free flap mandibular reconstruction.
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Affiliation(s)
- M de Boutray
- ENT Department, Neck Surgery and Maxillofacial Surgery, Gui de Chauliac University Hospital, Montpellier University School of Medicine, Montpellier, France; LIRMM, University of Montpellier, CNRS, Montpellier, France.
| | - L Cuau
- LIRMM, University of Montpellier, CNRS, Montpellier, France
| | - M Ohayon
- LIRMM, University of Montpellier, CNRS, Montpellier, France
| | - R Garrel
- ENT Department, Neck Surgery and Maxillofacial Surgery, Gui de Chauliac University Hospital, Montpellier University School of Medicine, Montpellier, France
| | - P Poignet
- LIRMM, University of Montpellier, CNRS, Montpellier, France
| | - N Zemiti
- LIRMM, University of Montpellier, CNRS, Montpellier, France
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2
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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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Cuau L, De Boutray M, Cavalcanti Santos J, Zemiti N, Poignet P. Contactless surface registration of featureless anatomy using structured light camera: application to fibula navigation in mandible reconstruction. Int J Comput Assist Radiol Surg 2023; 18:2073-2082. [PMID: 37270743 DOI: 10.1007/s11548-023-02966-3] [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: 01/10/2023] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Mandibular reconstruction using fibula free flap is a challenging surgical procedure. To assist osteotomies, computer-assisted surgery (CAS) can be used. Nevertheless, precise registration is required and often necessitates anchored markers that disturb the patient and clinical flow. This work proposes a new contactless surface-based method adapted to featureless anatomies such as fibula to achieve a fast, precise, and reproducible registration. METHODS Preoperatively, a CT-scan of the patient is realized and osteotomies are virtually planned. During surgery, a structured light camera digitizes the fibula. The obtained intraoperative point cloud is coarsely registered with the preoperative model using 3 points defined in the CT-scan and located on the patient's bone with a laser beam. Then, a fine registration is performed using an ICP algorithm. The registration accuracy was evaluated comparing the position of points engraved in a 3D-printed fibula with their position in the registered model and evaluating resulting osteotomies. Accuracy and execution time were compared to a conventional stylus-based registration method. The work was validated in vivo. RESULTS The experiment performed on a 3D-printed model showed that execution time is equivalent to surface-based registration using a stylus, with a better accuracy (mean TRE of 0.9 mm vs 1.3 mm using stylus) and guarantee good osteotomies. The preliminary in vivo study proved the feasibility of the method. CONCLUSION The proposed contactless surface-based registration method using structured light camera gave promising results in terms of accuracy and execution speed and should be useful to implement CAS for mandibular reconstruction.
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Affiliation(s)
- Lénaïc Cuau
- LIRMM, University of Montpellier, CNRS, Montpellier, France.
| | - Marie De Boutray
- LIRMM, University of Montpellier, CNRS, Montpellier, France
- Department of Maxillofacial Surgery, Gui de Chauliac University Hospital, Montpellier, France
| | | | - Nabil Zemiti
- LIRMM, University of Montpellier, CNRS, Montpellier, France
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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.
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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
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Maisi S, Dominguez M, Gilong PC, Kiong CT, Hajam S, Badruddin AFA, Siew HF, Gopalan S, Choon KT. In-house Virtual Surgical Planning for Mandibular Reconstruction with Fibula Free Flap: Case series and literature review. ANNALS OF 3D PRINTED MEDICINE 2023. [DOI: 10.1016/j.stlm.2023.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Vascularized Free Fibular Flap in Oral and Maxillofacial Reconstruction: A 20-year Experience at a Single Institution Using 2640 Flaps. J Craniofac Surg 2023:00001665-990000000-00541. [PMID: 36727753 DOI: 10.1097/scs.0000000000009193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 10/10/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND This retrospective study reviewed all patients who underwent oral and maxillofacial reconstruction with fibular flaps in the last 2 decades at a single hospital. MATERIALS AND METHODS We reviewed all patients with fibular flaps from 1999 to 2018. The following data were collected: sex; age; reconstruction region; diagnosis; the number of days spent in the hospital after surgery; time spent using a tourniquet for harvesting a fibula flap; vessels at the recipient site; the prevalence of unplanned reoperations; the prevalence of flap failure; history of preoperative radiotherapy; virtual surgical planning; segments of the fibula. RESULTS In total, 2640 patients were included. The mean age was 45.5 years. The most prevalent region of reconstruction was the mandible (n=2347, 88.9%). The most common diagnosis was squamous cell carcinoma (n=1057, 40.0%). The mean number of days spent in the hospital after surgery decreased year-by-year from 18.3 days to 10.4 days. The first choice of recipient artery was the facial artery (n=1643, 62.2%) and that of the recipient vein was the external jugular vein (n=1196, 45.3%). The prevalence of surgical success was 97.6%. Prevalence of unplanned reoperations was 7.5%. CONCLUSIONS The fibular flap was a good choice for oral and maxillofacial bony reconstruction in most cases.
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Qiu SY, Shan XF, Kang YF, Ding MK, Zhang L, Cai ZG. Accurate occlusion-driven maxillary reconstruction with deep circumflex iliac artery flap using computer-assisted techniques and intraoral anastomosis: a case series study. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00450-7. [DOI: 10.1016/j.ijom.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/21/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
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A Brief Clinical Study: The Use of a Custom Guide for Scapula Free Flap Harvest and Mandibular Reconstruction. J Craniofac Surg 2022; 33:2142-2145. [DOI: 10.1097/scs.0000000000008739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
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Kang YF, Ding MK, Qiu SY, Cai ZG, Zhang L, Shan XF. Mandibular Reconstruction Using Iliac Flap Based on Occlusion-Driven Workflow Transferred by Digital Surgical Guides. J Oral Maxillofac Surg 2022; 80:1858-1865. [DOI: 10.1016/j.joms.2022.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 10/16/2022]
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Sozzi D, Filippi A, Canzi G, De Ponti E, Bozzetti A, Novelli G. Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol. J Clin Med 2022; 11:jcm11072060. [PMID: 35407667 PMCID: PMC8999643 DOI: 10.3390/jcm11072060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
Aim: the purpose of this work is to present an innovative protocol for virtual planning and surgical navigation in post-oncological mandibular reconstruction through fibula free flap. In order to analyze its applicability, an evaluation of accuracy for the surgical protocol has been performed. Methods: 21 patients surgically treated for mandibular neoplasm have been included in the analysis. The Brainlab Vector Vision 3.0® software for surgical navigation has been used for preoperative surgical planning and intra-operative navigation. A post-operative accuracy evaluation has been performed matching the position of mandibular landmarks between pre-operative and post-operative CT scans. Results: the maximal discrepancy observed was included between −3.4 mm and +3.2 mm, assuming negative values for under correction and positive values for overcorrection. An average grade of accuracy included between 0.06 ± 0.58 mm and 0.43 ± 0.68 mm has been observed for every mandibular landmark examined, except for mandibular angles that showed a mean discrepancy value included between 1.36 ± 1.73 mm and 1.46 ± 1.02 mm when compared to preoperative measurements. Conclusion: a satisfying level of accuracy has been observed in the protocol presented, which appears to be more versatile if compared to closed custom-made systems. The technique described may represent a valid option for selected patients, but it cannot be considered for routine activity because of the complexity of the method, the mobility of the jaw, the necessity of surgical navigator and the long surgical learning curve that is required.
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Affiliation(s)
- Davide Sozzi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
- Correspondence:
| | - Andrea Filippi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
- Post-Graduate School of Maxillofacial Surgery, Department of Medicine and Surgery, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Gabriele Canzi
- Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy;
| | - Elena De Ponti
- Department of Medical Physics, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy;
| | - Alberto Bozzetti
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
| | - Giorgio Novelli
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
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de Boutray M, Cavalcanti Santos J, Bourgeade A, Ohayon M, Chammas PE, Garrel R, Poignet P, Zemiti N. Fibular registration using surface matching in navigation-guided osteotomies: a proof of concept study on 3D-printed models. Int J Comput Assist Radiol Surg 2022; 17:1321-1331. [DOI: 10.1007/s11548-022-02608-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 03/10/2022] [Indexed: 01/17/2023]
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de Geer A, Brouwer de Koning S, van Alphen M, van der Mierden S, Zuur C, van Leeuwen F, Loeve A, van Veen R, Karakullukcu M. Registration methods for surgical navigation of the mandible: a systematic review. Int J Oral Maxillofac Surg 2022; 51:1318-1329. [DOI: 10.1016/j.ijom.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/18/2021] [Accepted: 01/26/2022] [Indexed: 12/20/2022]
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Navigation-assisted maxillofacial reconstruction: accuracy and predictability. Int J Oral Maxillofac Surg 2021; 51:874-882. [PMID: 34862088 DOI: 10.1016/j.ijom.2021.11.008] [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: 02/10/2021] [Revised: 08/17/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022]
Abstract
The aim of this study was to evaluate the accuracy of navigation-assisted maxillofacial reconstruction and to identify the predictors of the clinical outcomes. A total of 112 patients who underwent navigation-assisted maxillofacial reconstruction with free flaps between 2014 and 2019, performed by a single surgical team, were assessed. Accuracy was evaluated by superimposing the postoperative computed tomography data with the preoperative virtual surgical plan. Predictors of the clinical outcomes affecting the accuracy were identified and analysed. The mean deviation and root mean square (RMS) estimate of the orbital, maxillary, and mandibular reconstructions were 0.88 ± 3.25 mm and 3.38 ± 0.73 mm, 0.77 ± 3.44 mm and 3.69 ± 0.82 mm, and 1.07 ± 4.16 mm and 4.67 ± 3.95 mm, respectively (P < 0.05). There was no significant difference in orbital volume or projection between the preoperative, postoperative, and healthy orbits (P = 0.093 and P = 0.225, respectively). Multivariate linear regression analysis confirmed significant associations between the accuracy of navigation-assisted mandibular reconstruction and preservation of the condyle, type of reconstruction, type of osteosynthesis plate, and number of bony segments. Navigation-assisted midface reconstruction yielded a higher level of accuracy in the final surgical outcome when compared to mandibular reconstruction. Computer-assisted techniques and intraoperative navigation can be an alternative or adjunct to current surgical techniques to improve the final surgical outcome, especially in more complex maxillofacial reconstructions.
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Kang YF, Lv XM, Qiu SY, Ding MK, Xie S, Zhang L, Cai ZG, Shan XF. Virtual Surgical Planning of Deep Circumflex Iliac Artery Flap for Midface Reconstruction. Front Oncol 2021; 11:718146. [PMID: 34540688 PMCID: PMC8443798 DOI: 10.3389/fonc.2021.718146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Midface reconstruction is challenging for functional and esthetic reasons. The present study analyzed the effect of virtual surgical planning (VSP) of the deep circumflex iliac artery (DCIA) flap for midface reconstruction. Patients and Methods Thirty-four patients who underwent midface reconstruction with the DCIA flap were included in this retrospective study. Of the 34 patients, 16 underwent preoperative VSP, which used a three-dimensionally printed surgical guide, computer-assisted navigation system, and pre-bent titanium implants to transfer VSP into real-world surgery. The other 18 patients underwent traditional midface reconstruction. The following were compared between the two groups: bony contact rate in the buttress region (BCR), dental arch reconstruction rate (DAR), surgical approach, position of vascular anastomosis, and dental implantation rate. The independent-samples t-test and Fisher's exact test were used for analysis. P < 0.05 was considered statistically significant. Results In total, 12 males and 22 females were included in this study. All patients underwent midface reconstruction using the DCIA flap at the same institution. The median age of patients was 33 years (range: 16-68 years). The average BCR and DAR values in the VSP group were 59.4% ± 27.9% and 87.5% ± 18.9%, respectively, which were significantly higher compared with the non-VSP group (P = 0.049 and P = 0.004, respectively). The dental implantation rate in the VSP group (50.0%) was significantly higher compared with the non-VSP group (11.1%; P = 0.023). The intraoral approach for tumor ablation and vascular anastomosis was the most frequent choice in both groups. There was no significant difference between the two groups. All patients were satisfied with facial symmetry postoperatively. Conclusions VSP could effectively augment the effect of midface reconstruction with the DCIA flap. Stronger bone contact in the buttress region and higher DAR provide more opportunity for dental implantation, which might be the best solution to improve masticatory function in patients with midface defects.
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Affiliation(s)
- Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Xiao-Ming Lv
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Shi-Yu Qiu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Meng-Kun Ding
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Shang Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China
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Guo B, Fang X, Shan Y, Li J, Shen Y, Ma C. Salvage mandibular reconstruction: multi-institutional analysis of 17 patients. Int J Oral Maxillofac Surg 2021; 51:191-199. [PMID: 34384647 DOI: 10.1016/j.ijom.2021.07.014] [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: 10/26/2020] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Unsuccessful mandibular reconstruction occasionally occurs, leaving the patient with undesirable function and contours. In such cases, second- or third-time corrective operations are challenging. However, published studies on the complicated retreatment of such patients are scarce. A retrospective analysis covering the years 2015-2019 was conducted in three centers. All 17 patients included had undergone prior failed mandibular reconstructions in other institutions. Salvage secondary or tertiary reconstructive surgeries were attempted and the results are presented. Major factors for these failed reconstructions included exposed non-vascularized bone grafts (n = 7, 41.2%), flap loss (n = 4, 23.5%), exposed artificial joint (n = 3, 17.6%), skewed occlusion with deformity (n = 1, 5.9%), non-union (n = 1, 5.9%), and recurrence (n = 1, 5.9%). Fibula flaps were transferred in 15 patients, while iliac flaps were used in two patients for mandibular re-do reconstructions. Virtual surgical designs were conducted in nine (52.9%) patients, with navigation-guided approaches performed in three cases. Postoperative functions were relatively favorable in these complicated mandibular re-do reconstruction cases. Mandibular symmetry (mandibular length and height; P = 0.002) and condylar position (P < 0.001) were regained after these re-do attempts. Secondary or tertiary mandibular re-do reconstruction can still achieve good functional outcomes with appropriate preoperative selection and well-conceived designs, especially with the aid of virtual surgery and navigation.
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Affiliation(s)
- B Guo
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - X Fang
- Department of Oral and Maxillofacial Surgery, Xiangya Stomatological Hospital, Central South University, Changsha, Hunan, China
| | - Y Shan
- Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - J Li
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Y Shen
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - C Ma
- Department of Oral and Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
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Mandibular Reconstruction With the Iliac Flap Under the Guidance of A Series of Digital Surgical Guides. J Craniofac Surg 2021; 32:1777-1779. [PMID: 33534315 DOI: 10.1097/scs.0000000000007494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The authors aimed to evaluate the accuracy of mandibular reconstruction with the iliac flap under the guidance of a series of digital surgical guides. Seven patients were enrolled to evaluate the accuracy of reconstruction immediately after surgery. Patients underwent mandibular reconstruction with a vascularized iliac flap guided by a series of digital surgical guides at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, from September 2017 to June 2018.All flaps survived. Chromatographic analysis showed that the area with a chromatographic difference of ≤1 mm between preoperative virtual surgical planning model and postoperative mandible accounted for 73.97% ± 3.89% of mandible surface, the area ≤2 mm accounted for 87.21% ± 2.65%, and the area ≤3 mm accounted for 94.09% ± 2.50%. In all of the 7 cases, the mean of maximum deviation was 6.25 ± 1.00 mm, and the mean of average deviation was 0.95 ± 0.13 mm. The authors conclude that mandibular reconstruction with the iliac flap under the guidance of a series of digital surgical guides is accurate and effective.
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17
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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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Brouwer de Koning SG, Geldof F, van Veen RLP, van Alphen MJA, Karssemakers LHE, Nijkamp J, Schreuder WH, Ruers TJM, Karakullukcu MB. Electromagnetic surgical navigation in patients undergoing mandibular surgery. Sci Rep 2021; 11:4657. [PMID: 33633247 PMCID: PMC7907338 DOI: 10.1038/s41598-021-84129-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/10/2021] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study was to evaluate the feasibility of electromagnetic (EM) navigation for guidance on osteotomies in patients undergoing oncologic mandibular surgery. Preoperatively, a 3D rendered model of the mandible was constructed from diagnostic computed tomography (CT) images. Cutting guides and patient specific reconstruction plates were designed and printed for intraoperative use. Intraoperative patient registration was performed using a cone beam CT scan (CBCT). The location of the mandible was tracked with an EM sensor fixated to the mandible. The real-time location of both the mandible and a pointer were displayed on the navigation system. Accuracy measurements were performed by pinpointing four anatomical landmarks and four landmarks on the cutting guide using the pointer on the patient and comparing these locations to the corresponding locations on the CBCT. Differences between actual and virtual locations were expressed as target registration error (TRE). The procedure was performed in eleven patients. TREs were 3.2 ± 1.1 mm and 2.6 ± 1.5 mm using anatomical landmarks and landmarks on the cutting guide, respectively. The navigation procedure added on average half an hour to the duration of the surgery. This is the first study that reports on the accuracy of EM navigation in patients undergoing mandibular surgery.
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Affiliation(s)
- S G Brouwer de Koning
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - F Geldof
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - R L P van Veen
- Department of Head and Neck Surgery & Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Head and Neck Surgery & Oncology, Verwelius 3D Lab, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - M J A van Alphen
- Department of Head and Neck Surgery & Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Head and Neck Surgery & Oncology, Verwelius 3D Lab, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - L H E Karssemakers
- Department of Head and Neck Surgery & Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Head and Neck Surgery & Oncology, Verwelius 3D Lab, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - J Nijkamp
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - W H Schreuder
- Department of Head and Neck Surgery & Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Head and Neck Surgery & Oncology, Verwelius 3D Lab, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - T J M Ruers
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - M B Karakullukcu
- Department of Head and Neck Surgery & Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Head and Neck Surgery & Oncology, Verwelius 3D Lab, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
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Meng FH, Zhu ZH, Lei ZH, Zhang XH, Shao L, Zhang HZ, Zhang T. Feasibility of the application of mixed reality in mandible reconstruction with fibula flap: A cadaveric specimen study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:e45-e49. [PMID: 33434746 DOI: 10.1016/j.jormas.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In recent years, a new technology, mixed reality (MR), has emerged and surpassed the limitations of augmented reality (AR) with its inability to interact with hologram. This study aimed to investigate the feasibility of the application of MR in mandible reconstruction with fibula flap. METHODS Computed tomography (CT) examination was performed for one cadaveric mandible and ten fibula bones. Using professional software Proplan CMF 3.0 (Materialize, Leuven, Belgium), we created a defected mandibular model and simulated the reconstruction design with these 10 fibula bones. The surgical plans were transferred to the HoloLens. We used HoloLens to guide the osteotomy and shaping of the fibular bone. After fixing the fibular segments using the Ti template, all segments underwent a CT examination. Before and after objects were compared for measurements of the location of fibular osteotomies, angular deviation of fibular segments, and intergonial angle distances. RESULTS The mean location of the fibular osteotomies, angular deviation of the fibular segments, and intergonial angle distances were 2.11 ± 1.31 mm, 2.85°± 1.97°, and 7.24 ± 3.42 mm, respectively. CONCLUSION The experimental results revealed that slight deviations remained in the accuracy of fibular osteotomy. With the further development of technology, it has the potential to improve the efficiency and precision of the reconstructive surgery.
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Affiliation(s)
- F H Meng
- Chinese PLA General Hospital, Department of Oral and Maxillofacial Surgery, 100853, Beijing, China
| | - Z H Zhu
- Peking Union Medical College Hospital, Department of Oral and Maxillofacial Surgery, 100730, Beijing, China
| | - Z H Lei
- Peking Union Medical College Hospital, Department of Oral and Maxillofacial Surgery, 100730, Beijing, China
| | - X H Zhang
- Shenzhen Luohu Hospital Group Luohu People's Hospital, Department of Oral and Maxillofacial Surgery, 518020, Shenzhen, China
| | - L Shao
- Beijing Institute of Technology, Optoelectronic College, 100081, Beijing, China
| | - H Z Zhang
- Chinese PLA General Hospital, Department of Oral and Maxillofacial Surgery, 100853, Beijing, China.
| | - T Zhang
- Peking Union Medical College Hospital, Department of Oral and Maxillofacial Surgery, 100730, Beijing, China.
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20
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Tarassoli SP, Shield ME, Allen RS, Jessop ZM, Dobbs TD, Whitaker IS. Facial Reconstruction: A Systematic Review of Current Image Acquisition and Processing Techniques. Front Surg 2020; 7:537616. [PMID: 33365327 PMCID: PMC7750399 DOI: 10.3389/fsurg.2020.537616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/19/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction: Plastic and reconstructive surgery is based on a culmination of technological advances, diverse techniques, creative adaptations and strategic planning. 3D imaging is a modality that encompasses several of these criteria while encouraging the others. Imaging techniques used in facial imaging come in many different modalities and sub-modalities which is imperative for such a complex area of the body; there is a clear clinical need for hyper-specialized practice. However, with this complexity comes variability and thus there will always be an element of bias in the choices made for imaging techniques. Aims and Objectives: The aim of this review is to systematically analyse the imaging techniques used in facial reconstruction and produce a comprehensive summary and comparison of imaging techniques currently available, including both traditional and novel methods. Methods: The systematic search was performed on EMBASE, PubMed, Scopus, Web of Science and Cochrane reviews using keywords such as "image technique/acquisition/processing," "3-Dimensional," "Facial," and "Reconstruction." The PRISMA guidelines were used to carry out the systematic review. Studies were then subsequently collected and collated; followed by a screening and exclusion process with a final full-text review for further clarification in regard to the selection criteria. A risk of bias assessment was also carried out on each study systematically using the respective tool in relation to the study in question. Results: From the initial 6,147 studies, 75 were deemed to fulfill all selection criteria and selected for meta-analysis. The majority of papers involved the use of computer tomography, though the use of magnetic resonance and handheld scanners using sonography have become more common in the field. The studies ranged in patient population, clinical indication. Seminal papers were highlighted within the group of papers for further analysis. Conclusions: There are clearly many factors that affect the choice of image acquisition techniques and their potential at being ideal for a given role. Ultimately the surgical team's choice will guide much of the decision, but it is crucial to be aware of not just the diagnostic ability of such modalities, but their treatment possibilities as well.
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Affiliation(s)
- Sam P. Tarassoli
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Matthew E. Shield
- College of Medicine, Swansea University Medical School, Swansea, United Kingdom
| | - Rhian S. Allen
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Zita M. Jessop
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Thomas D. Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Iain S. Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
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21
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Advances in computer-aided design for bony free-flap reconstruction. Curr Opin Otolaryngol Head Neck Surg 2018; 26:319-325. [DOI: 10.1097/moo.0000000000000472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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van Baar GJC, Forouzanfar T, Liberton NPTJ, Winters HAH, Leusink FKJ. Accuracy of computer-assisted surgery in mandibular reconstruction: A systematic review. Oral Oncol 2018; 84:52-60. [PMID: 30115476 DOI: 10.1016/j.oraloncology.2018.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 11/18/2022]
Abstract
Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software programs have entered the market, offering numerous approaches for preoperative planning and postoperative evaluation of the CAS process of mandibular reconstruction. In this systematic review, we reviewed planning and evaluation methods in studies that quantitatively assessed accuracy of mandibular reconstruction performed with CAS. We included 42 studies describing 413 mandibular reconstructions planned and evaluated using CAS. The commonest software was Proplan/Surgicase CMF (55%). In most cases, the postoperative virtual 3-dimensional model was compared to the preoperative 3-dimensional model, revised to the virtual plan (64%). The commonest landmark for accuracy measurements was the condyle (54%). Accuracy deviations ranged between 0 mm and 12.5 mm and between 0.9° and 17.5°. Because of a lack of uniformity in planning (e.g., image acquisition, mandibular resection size) and evaluation methodologies, the ability to compare postoperative outcomes was limited; meta-analysis was not performed. A practical and simple guideline for standardizing planning and evaluation methods needs to be considered to allow valid comparisons of postoperative results and facilitate meta-analysis in the future.
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Affiliation(s)
- Gustaaf J C van Baar
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Niels P T J Liberton
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Henri A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Frank K J Leusink
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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23
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Ren W, Gao L, Li S, Chen C, Li F, Wang Q, Zhi Y, Song J, Dou Z, Xue L, Zhi K. Virtual Planning and 3D printing modeling for mandibular reconstruction with fibula free flap. Med Oral Patol Oral Cir Bucal 2018; 23:e359-e366. [PMID: 29680849 PMCID: PMC5945234 DOI: 10.4317/medoral.22295] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background This study was to evaluate the use of virtual planning and 3D printing modeling in mandibular reconstruction and compare the operation time and surgical outcome of this technique with conventional method. Material and Methods Between 2014 and 2017, 15 patients underwent vascularized fibula flap mandibular reconstruction using virtual planning and 3D printing modeling. Titanium plates were pre-bent using the models and cutting guides were used for osteotomies. 15 patients who underwent mandibular reconstruction using fibula flap without aid of virtual planning and 3D printing models were selected as control group. The operation time was recorded and compared in two groups. Accuracy of reconstruction was measured by superimposing the preoperative image onto the postoperative image of mandible. The selected bony landmark, distance and angle were measured. Results The mean total operation time and reconstruction time were 1.60±0.37 and 5.54±0.50 hours in computer-assisted group, respectively; These were 2.58±0.45 and 6.54±0.70 hours in conventional group, respectively. Both operation time and reconstruction time were shorter in computer-assisted group. The difference between the preoperative and postoperative intercondylar distances, intergonial angle distances, anteroposterior distances and gonial angles were 2.92±1.15 and 4.48±1.41mm, 2.93±1.19 and 4.79±1.48mm, 4.31±1.24 and 5.61±1.41mm, 3.85±1.68° and 5.88±2.12° in the computer-assisted and conventional group, respectively. The differences between the preoperative and postoperative mandible is smaller in the computer-assisted group. Conclusions Virtual planning and 3D printing modeling have the potential to increase mandibular reconstruction accuracy and reduce operation time. we believe that this technology for mandibular reconstruction in selected patients will become a used method and improve the quality of reconstruction. Key words:Mandibular reconstruction, fibula flap, virtual planning, computer-assisted design, 3D printing.
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Affiliation(s)
- W Ren
- Department of Oral and Maxillofacial Surgery, The affiliated hospital of Qingdao University, No.1677, Wutai mountain Road, Qingdao, Shandong, P. R. China. 255666
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Zheng L, Lv X, Zhang J, Liu S, Zhang J, Zhang Y. Translating Computer-Aided Design and Surgical Planning Into Successful Mandibular Reconstruction Using a Vascularized Iliac-Crest Flap. J Oral Maxillofac Surg 2017; 76:886-893. [PMID: 29178981 DOI: 10.1016/j.joms.2017.10.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE This study evaluated the computer-aided approach to the reconstruction of mandibular defects using a vascularized iliac-crest flap. MATERIALS AND METHODS From December 2015 to October 2016, 14 patients (8 men and 6 women) 18 to 64 years old (median age, 29 yr) were treated at the Peking University School and Stomatology Hospital (Beijing, China). Biopsy specimens from all patients were subjected to histologic examination before segmental mandibulectomy. Computer-based surgical techniques, including virtual surgical planning, computer-aided design and manufacturing, rapid prototyping, and intraoperative navigation, were used to restore the anatomic continuity and configuration of the mandible using a vascularized iliac-crest flap. Two transverse dimensions and 1 anteroposterior (A-P) dimension were evaluated based on the virtual plan and postoperative computed tomogram. Lines from condylar head to condylar head and from gonial angle to gonial angle were defined as the transverse dimensions. A perpendicular line drawn from the mandibular midline to the center point on the condylar head to condylar head measurement was defined as the A-P dimension. Complications were evaluated during follow-up. RESULTS The flap success rate was 92.9% (13 of 14), with 1 flap failure. After the operation, there were no other serious complications in 13 of the 14 patients, who exhibited a good mandibular configuration with good occlusion. Furthermore, the height of bone graft was sufficient for implants. Healing of the recipient and donor sites with no serious complication was uneventful. The average surgical errors in the A-P dimension and transverse dimensions were 1.8 ± 1.0 mm (range, 0.2 to 3.7 mm), 2.2 ± 1.1 mm (range, 0.9 to 5.0 mm), and 2.6 ± 1.6 mm (range, 0.3 to 7.2 mm), respectively. CONCLUSIONS The use of these digital techniques was found to be a viable option for reconstruction of mandibular defects, but the results should be interpreted cautiously because of the small number of patients and the relatively short follow-up.
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Affiliation(s)
- Lei Zheng
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoming Lv
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jie Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shuming Liu
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jianguo Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Yi Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Harbison RA, Shan XF, Douglas Z, Bevans S, Li Y, Moe KS, Futran N, Houlton JJ. Navigation Guidance During Free Flap Mandibular Reconstruction: A Cadaveric Trial. JAMA Otolaryngol Head Neck Surg 2017; 143:226-233. [PMID: 27893003 DOI: 10.1001/jamaoto.2016.3204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Segmental mandibulectomy for tumors that distort the buccal surface of the mandible present a reconstructive challenge. Objective To determine whether mandible alignment after navigation-guided mandible reconstruction is better than alignment after non-template-assisted freehand reconstruction and as good as template-assisted reconstruction in a cadaveric trial. Design, Setting, and Participants A cadaveric trial using 10 specimens was conducted at a tertiary academic center. Fiducials were created on the ramus to compare alignment with each intervention. Segmental mandibulectomy was performed on each cadaver. Each cadaver underwent navigation-guided reconstruction, template-assisted reconstruction using a manually shaped plate, and non-template-assisted freehand reconstruction with plate contouring performed after mandibulectomy. The study was conducted from October 1, 2015, to January 1, 2016; data analysis was performed from February 1, 2016, to March 1, 2016. Interventions Segmental mandibulectomy, navigation-guided reconstruction, template-assisted reconstruction using a manually shaped plate, and non-template-assisted freehand reconstruction. Main Outcomes and Measures Ramus fiducial coordinates were recorded at baseline and after each intervention. Mandible dimensions were measured using cephalometric landmarks. Postintervention and baseline differences in ramus and mandible position were calculated. Results Ramus alignment was not significantly different between navigation-guided and template-assisted reconstruction, differing by 0.54 mm (98.3% CI, -0.38 to 1.47 mm). Non-template-assisted freehand reconstruction was associated with a 3.14-mm difference in alignment compared with template-assisted reconstruction (98.3% CI, 1.09 to 5.19 mm). Navigation-guided alignment resulted in a 3.69-mm improvement in alignment compared with non-template-assisted freehand reconstruction (98.3% CI, 1.79 to 5.58 mm). There was some improvement in the gonion-gonion and lingula mandibulae-lingula mandibulae (Lm-Lm) alignment for navigation-assisted compared with non-template-assisted freehand reconstruction by 1.97 mm (98.3% CI, -0.65 to 4.58 mm) and 1.39 mm (98.3% CI, -0.17 to 2.95 mm), respectively. There was marginal evidence of better Lm-Lm alignment for navigation-guided than template-assisted reconstruction (0.44 mm; 98.3% CI, -0.06 to 0.95 mm). Conclusions and Relevance Mandible alignment following navigation-guided reconstruction is similar to template-assisted reconstruction. Navigation-guided alignment is likely better than non-template-assisted freehand reconstruction, and navigation guidance offers a reliable technique for real-time adjustment when reconstructing complex surgical defects, such as tumors effacing the buccal cortex of the mandible.
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Affiliation(s)
- R Alex Harbison
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zachary Douglas
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Scott Bevans
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Yangming Li
- Department of Electrical Engineering, University of Washington, Seattle
| | - Kris S Moe
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Neal Futran
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Jeffrey J Houlton
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
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