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Yang Q, Weng X, Xia C, Shi C, Liu J, Liang C, Liu Y, Wang Y. Comparison between guide plate navigation and virtual fixtures in robot-assisted osteotomy. Comput Methods Biomech Biomed Engin 2024; 27:1387-1397. [PMID: 37547946 DOI: 10.1080/10255842.2023.2243359] [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: 05/17/2023] [Revised: 07/04/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
To verify the advantages of Virtual Fixtures (VFs) by comparing the result of guide plate navigation (GPN) and VFs in robot-assisted osteotomy. Robot-assisted surgery has been extensively applied in traditional orthopedic surgeries. It fundamentally improves surgeries' cutting accuracy. In addition, many key techniques have been applied in bone cutting to increase the procedure's safety in various ways. In this paper, two robot-assisted osteotomy methods are proposed. Three operators with no osteotomy experience performed plane cutting with the assistance of a robot. GPN and VFs were applied to assist the Sawbones cutting. Each operator has five attempts using each method to perform bone cutting, distance errors and angular errors were recorded. The advantage of Sawbones is that there is no influence from soft tissues and blood. It can give a more precise measurement. The results show that both methods have high accuracy with the robot's assistance. VFs have higher accuracy in comparison with GPN. With GPN, the mean distance and angular error of the three operators were 2.974 ± 0.282 mm and 4.737 ± 0.254°. With VFs, the mean range and angular error of the three operators were 1.857 ± 0.349 mm and 2.24 ± 0.123°, respectively. VFs limited the robot's end in the planned area, increasing the accuracy and safety of robot-assisted osteotomy.
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Affiliation(s)
- Qing Yang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Chunjie Xia
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chao Shi
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jixuan Liu
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Chendi Liang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yanzhen Liu
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yu Wang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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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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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: 1] [Impact Index Per Article: 1.0] [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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Kim MK, Ham MJ, Kim WR, Kim HG, Kwon KJ, Kim SG, Park YW. Investigating the accuracy of mandibulectomy and reconstructive surgery using 3D customized implants and surgical guides in a rabbit model. Maxillofac Plast Reconstr Surg 2023; 45:8. [PMID: 36701071 PMCID: PMC9880108 DOI: 10.1186/s40902-023-00375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aimed to analyze the accuracy of the output of three-dimensional (3D) customized surgical guides and titanium implants in a rabbit model, and of mandibulectomy, reconstructive surgery, and surgical outcome; additionally, the correlation between surgical accuracy and surgical outcomes, including the differences in surgical outcome according to surgical accuracy, was analyzed. RESULTS The output of implants was accurately implemented within the error range (- 0.03-0.03 mm), and the surgical accuracy varied depending on the measured area (range - 0.4-1.1 mm). Regarding surgical outcomes, angle between the mandibular lower borders showed the most sensitive results and distance between the lingual cusps of the first molars represented the most accurate outcomes. A significant correlation was noted between surgical accuracy in the anteroposterior length of the upper borders pre- and postoperatively and the angle between the mandibular lower borders (regression coefficient = 0.491, p = 0.028). In the group wherein surgery was performed more accurately, the angle between the mandibular lower borders was reproduced more accurately (p = 0.021). A selective laser melting machine accurately printed the implants as designed. Considering the positive correlation among surgical accuracy in the mandibular upper borders, angle between the mandibular lower borders, and more accurately reproduced angle between the mandibular lower borders, the angle between the mandibular lower borders is considered a good indicator for evaluating the outcomes of reconstructive surgery. CONCLUSION To reduce errors in surgical outcomes, it is necessary to devise a positioner for the surgical guide and design a 3D surgical guide to constantly maintain the direction of bone resection. A fixed area considering the concept of three-point fixation should be selected for stable positioning of the implant; in some cases, bilateral cortical bone fixation should be considered. The angle between the mandibular lower borders is a sensitive indicator for evaluating the outcomes of reconstructive surgery.
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Affiliation(s)
- Min Keun Kim
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Min Ji Ham
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Won Rae Kim
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Hyung Giun Kim
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Kwang Jun Kwon
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Seong Gon Kim
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Young Wook Park
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
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Clinical Application of Digital Joint Guide in the Fracture of the Condyle Neck. J Craniofac Surg 2022; 33:e636-e641. [PMID: 35882243 DOI: 10.1097/scs.0000000000008717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study is to use a digital guide plate for joint positioning to assist the reduction of condylar neck fractures and evaluate the accuracy of the reduction after surgery. MATERIALS AND METHODS In this study, 20 patients were selected from January 2016 to October 2020, and the reduction of the mandibular condyle neck fracture was designed virtual and digital based on the computed tomography data of the patients, based on the position of the condyle in the articular socket, the height of the ascending mandibular ramus, and the joints. The average value of the anterior space and the posterior space of the joint is these indicators, the position of the condyle is reconstructed, and the fracture reduction finger guide plate is designed. During the operation, the digital guide plate is used to assist the reduction of the condyle neck fracture. The postoperative follow-up was 4 to 12 months to check the accuracy of the reduction. RESULTS A total of 20 patients, all fractures achieved complete bone healing, the patients' mouth opening was normal, no obvious complications were found, and none of the patients had facial paralysis. In the postoperative evaluation and preoperative virtual design plan, the chromatographic error was within 2 mm, and the magnetic resonance of the temporomandibular joint showed no displacement of the articular disc. CONCLUSION The digital joint guide can reduce the fracture of the condyle neck while ensuring the position of the condyle in the joint socket, which is beneficial to reduce the occurrence of subsequent temporomandibular joint complications.
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Sun R, Zhou Y, Malouta MZ, Cai Y, Shui C, Zhu L, Wang X, Zhu J, Li C. Digital surgery group versus traditional experience group in head and neck reconstruction: a retrospective controlled study to analyze clinical value and time-economic-social effect. World J Surg Oncol 2022; 20:220. [PMID: 35773716 PMCID: PMC9245239 DOI: 10.1186/s12957-022-02677-0] [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: 08/14/2021] [Accepted: 04/29/2022] [Indexed: 02/08/2023] Open
Abstract
Objective Discuss the application value of digital surgical technology in the reconstruction of head and neck defects after tumor resection and comprehensively evaluate time-economic-benefit cost. Methods A retrospective analysis of head and neck cancer patients who underwent reconstructive operations in head and neck surgery at Sichuan Cancer Hospital from January 2015 to January 2021 was performed. According to the inclusion and exclusion criteria, a total of 52 cases were included, including 25 cases using digital surgery (DS) and 27 cases using the conventional surgery (CS). The clinical-pathological characteristics, postoperative complications, functional aesthetic evaluation indexes, and time-cost-satisfaction evaluation indexes between the two groups were compared and statistically analyzed. Typical cases using digital surgery were shared. Results Outcomes between the two groups were comparable, and there was no significant difference in survival outcome and follow-up time between the two groups (P > 0.05). There was no significant difference between the two groups in the defect size, pathological type, other major clinicopathological features, or operation-related indicators (P > 0.05). The incidence of titanium plate displacement, deformation or exposure, and facial scar deformity in the DS group was significantly lower than that in the CS group (P < 0.05). However, there was no significant difference in other short-term or long-term complications (P > 0.05). The incidence of dysphagia and eating disorders in the DS group was significantly reduced (P < 0.05). The speech and social functions were improved, but not significantly (P > 0.05). Meanwhile, there was no significant difference in the evaluation index of facial aesthetics in this study (P > 0.05). Furthermore, the total operation time, preparation time of bone flap from the donor site, osteotomy time, and reconstruction time in the DS group were significantly lower than those in the traditional operation group (P < 0.05), but the shaping time and vascular anastomosis time of recipient area could not be shortened (P > 0.05). In addition, there was no significant difference in total hospitalization days between the DS group and CS group (P > 0.05), but the time of ICU treatment and postoperative intravenous nutrition support in the DS group were shorter than those in the CS group (P < 0.05). In particular, the preoperative doctor-patient communication of the DS group was more effective, and the treatment satisfaction of patients including their families was higher after operation (P < 0.05). Conclusion Comprehensive application of digital surgical technology (CAD, CAM, VR, MA, etc.) in the reconstruction of the head and neck after tumor resection is feasible in clinical practice, which can not only improve the accuracy of repair, decrease some surgical complications, better preserve and improve patient’s diet and speech function, and reduce the operation and hospitalization time, but also increase the treatment cost. Furthermore, it is conducive to doctor-patient communication and improves patient satisfaction.
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Affiliation(s)
- Ronghao Sun
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.,Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Michelle Z Malouta
- Department of Psychiatry, Bloomington Meadows Hospital, 3600 N Prow Rd, Bloomington, IN, 47404, USA
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Chunyan Shui
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Li Zhu
- Department of Head and Neck Surgery, Chengdu Renpin Otolaryngology Hospital, Chengdu, 610000, China
| | - Xu Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China.
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Pop SI, Dudescu M, Mihali SG, Păcurar M, Bratu DC. Effects of Disinfection and Steam Sterilization on the Mechanical Properties of 3D SLA- and DLP-Printed Surgical Guides for Orthodontic Implant Placement. Polymers (Basel) 2022; 14:polym14102107. [PMID: 35631989 PMCID: PMC9144921 DOI: 10.3390/polym14102107] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
Three-dimensional printed surgical guides increase the precision of orthodontic mini-implant placement. The purpose of this research was to investigate the effects of disinfection and of two types of autoclave sterilization on the mechanical properties of 3D printed surgical guides obtained via the SLA (stereolithography) and DLP (digital light processing) printing methods. A total of 96 standard specimens (48 SLA and 48 DLP) were printed to analyze the tensile and flexural properties of the materials. A total of 80 surgical guide (40 SLA and 40 DLP) specimens from each printing method were classified into four groups: CG (control group); G1, disinfected with 4% Gigasept (Gigasept Instru AF; Schülke & Mayer Gmbh, Norderstedt, Germany); G2, autoclave-sterilized (121 °C); and G3, autoclave-sterilized (134 °C). Significant differences in the maximum compressive load were determined between the groups comprising the DLP-(p < 0.001) and the SLA- (p < 0.001) printed surgical guides. Groups G2 (p = 0.001) and G3 (p = 0.029) showed significant parameter modifications compared with the CG. Disinfection with 4% Gigasept (Gigasept Instru AF; Schülke & Mayer Gmbh, Norderstedt, Germany) is suitable both for SLA- and DLP-printed surgical guides. Heat sterilization at both 121 °C and 134 °C modified the mechanical properties of the surgical guides.
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Affiliation(s)
- Silvia Izabella Pop
- Orthodontic Department, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania; (S.I.P.); (M.P.)
| | - Mircea Dudescu
- Department of Mechanical Engineering, Technical University of Cluj-Napoca, 28 Memorandumului Street, 400114 Cluj-Napoca, Romania
- Correspondence: (M.D.); (S.G.M.)
| | - Sorin Gheorghe Mihali
- Department of Prosthodontics, Faculty of Dentistry, “Vasile Goldis” Western University of Arad, 94 Revolutiei Blvd, 310025 Arad, Romania
- Correspondence: (M.D.); (S.G.M.)
| | - Mariana Păcurar
- Orthodontic Department, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania; (S.I.P.); (M.P.)
| | - Dana Cristina Bratu
- Department of Orthodontics and Dento-Facial Orthopedics, Orthodontic Research Center, Faculty of Dental Medicine, Victor Babeș University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timișoara, Romania;
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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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孙 悦, 郭 蕴, 李 建, 刘 亮, 杨 东, 陈 默, 胡 恺. [Mandibular defect reconstruction using digital design-assisted free fibula flap and threedimensional finite element analysis of stress distribution]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1892-1898. [PMID: 35012924 PMCID: PMC8752416 DOI: 10.12122/j.issn.1673-4254.2021.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate of the clinical value of preoperative digital design-assisted free fibular flap for reconstruction of different types of mandibular tissue defects using three-dimensional finite element analysis. METHODS This retrospective analysis was conducted in 48 patients undergoing reconstruction of mandibular defects following tumor resection using free fibular flaps. In 24 of the cases, digital design of free fibular flap was performed before the operation (experimental group), and the other 24 patients with digital design of the flap served as the control group. At 1 year after the surgery, the patients underwent mandibular CT examination and a 3-dimensional finite element model of the mandible was constructed using Mimics, Geomagic, Solidworks and Ansys. The stress distribution on the reconstructed mandibles with the H, L, or LCL types of defects, classified according to the HCL classification method, was determined under specific constraints and load conditions and compared between the experimental and control groups. RESULTS The operations were completed successfully in all the patients, and none of them had tumor recurrence at 1 year after the operation. On the reconstructed mandibles using free fibular flaps, the stress was concentrated mainly on the neck of the bilateral condyle, the anterior and posterior edges of the ascending mandibular ramus, and the connection between the posterior end of the fibula and the mandible. A large size of mandibular defects caused greater stress at the contralateral condyle. For L-shaped defects, the maximum stress at the healthy and ipsilateral condyle necks and transplanted fibula were significantly lower, while the stress level at the healthy side mandibular angle was significantly greater in the experimental group than in the control group (P < 0.05). For LCL type defects, the maximum stress at the contralateral condyle neck was smaller but the stress in the condyle area on the affected side, the bilateral mandibular angle area and the fibula area were all significantly greater in the experimental group than in the control group (P < 0.05). CONCLUSION Digital design of the free fibular flap improves the accuracy of reconstruction of mandibular defects and helps to achieve uniform stress distribution on the reconstructed mandible.
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Affiliation(s)
- 悦 孙
- />蚌埠医学院第一附属医院口腔颌面外科,安徽 蚌埠 233004Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 蕴 郭
- />蚌埠医学院第一附属医院口腔颌面外科,安徽 蚌埠 233004Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 建成 李
- />蚌埠医学院第一附属医院口腔颌面外科,安徽 蚌埠 233004Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 亮 刘
- />蚌埠医学院第一附属医院口腔颌面外科,安徽 蚌埠 233004Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 东昆 杨
- />蚌埠医学院第一附属医院口腔颌面外科,安徽 蚌埠 233004Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 默 陈
- />蚌埠医学院第一附属医院口腔颌面外科,安徽 蚌埠 233004Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 恺 胡
- />蚌埠医学院第一附属医院口腔颌面外科,安徽 蚌埠 233004Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
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Virtual Surgical Planning and Three-Dimensional Printing to Aid the Anatomical Reduction of an Old Malunited Fracture of the Mandible. J Craniofac Surg 2021; 32:e647-e649. [PMID: 33852522 DOI: 10.1097/scs.0000000000007653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Mandible fracture is a common injury in maxillofacial surgery. It causes not only maxillofacial dysfunction but also facial deformities. Malunited fractures of the mandible have been a vast challenge in clinical treatment due to the misalignment of the broken ends and the occurrence of occlusal disorders. This case report describes using virtual surgical planning and three-dimensional printing to treat a patient with malunited fracture of the mandible. Failing to perform mandibular surgery due to severe brain trauma after the car accident, the patient got malunited healing of mandible. The authors applied virtual surgical planning to perform preoperative analysis and surgical design on this patient, three-dimensional printing to fabricate occlusal plate, and models of the preoperative and postoperative mandible to guide the operation. Finally, the authors achieved the reduction and reconstruction of the mandible with satisfactory clinical results.
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Giovacchini F, Gilli M, Mitro V, Monarchi G, Bensi C, Tullio A. Rapid prototyping: applications in oral and maxillofacial surgery. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2020. [DOI: 10.1051/mbcb/2020050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article documents four mandibular reconstructions performed using free fibula flaps. CT scan DICOM (Digital Imaging and COmmunication in Medicine) files were obtained in order to print stereolithographic models of the mandible, and in one case cutting guides for fibular osteotomies. One case study details the treatment a cancer recurrence on a right emimandibulectomy. Because of a lack of access to previous CT scans, the left part of the mandible was mirrored to obtain an accurate 3D model. In one case, due to the young age of the woman, a double barrel fibula flap was used. All cases resulted in satisfactory chewing function and aesthetic outcome, with no flap failures. The report concludes that Virtual Planning and Rapid Prototyping are helpful as they reduce costs and intraoperative times while simultaneously improving surgical precision.
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Xia Y, Feng ZC, Li C, Wu H, Tang C, Wang L, Li H. Application of additive manufacturing in customized titanium mandibular implants for patients with oral tumors. Oncol Lett 2020; 20:51. [PMID: 32788938 PMCID: PMC7416405 DOI: 10.3892/ol.2020.11912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 06/18/2020] [Indexed: 01/03/2023] Open
Abstract
The application of additive manufacturing (AM) technology has been widely used in various medical fields, including craniomaxillofacial surgery. The aim of the present study was to examine the surgical efficiency and post-operative outcomes of patient-specific titanium mandibular reconstruction using AM. Major steps in directly designing and manufacturing 3D customized titanium implants are discussed. Furthermore, pre-operative preparations, surgical procedures and post-operative treatment outcomes were compared among patients who received mandibular reconstruction using a customized 3D titanium implant, titanium reconstruction plates or vascularized autologous fibular grafting. Use of a customized titanium implant significantly improved surgical efficiency and precision. When compared with mandibular reconstruction using the two conventional approaches, patients who received the customized implant were significantly more satisfied with their facial appearance, and exhibited minimal post-operative complications in the 12-month follow-up period. Patients who underwent mandibular reconstruction using a customized titanium implant displayed improved mandibular contour symmetry, restored occlusal function, normal range of mouth opening and no temporomandibular joint related pain; all complications frequently experienced by patients who undergo conventional approaches of mandibular reconstruction.
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Affiliation(s)
- Yan Xia
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Zhi Chao Feng
- Rutgers School of Dental Medicine, Rutgers University, Newark, NJ 07103, USA
| | - Changchun Li
- Department of Stomatology, The Second Hospital of Nanjing, Nanjing, Jiangsu 210003, P.R. China
| | - Heming Wu
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Chunbo Tang
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Lihua Wang
- AK Medical Holdings Limited, Beijing 100101, P.R China
| | - Hongwei Li
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Kim SR, Jang S, Ahn KM, Lee JH. Evaluation of Effective Condyle Positioning Assisted by 3D Surgical Guide in Mandibular Reconstruction Using Osteocutaneous Free Flap. MATERIALS 2020; 13:ma13102333. [PMID: 32438671 PMCID: PMC7287575 DOI: 10.3390/ma13102333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Abstract
In the present study, the reproducibility and postoperative stability of a 3D printed surgical guide were evaluated in mandibular reconstruction with an osteocutaneous free flap (OCFF), including a fibular free flap (FFF) and deep circumflex iliac artery free flap (DCIA). Fifteen patients were enrolled, and a 3D surgical guide was fabricated by simulation surgery using preoperative (T0) Computed tomography (CT) images. Mandibular reconstruction was performed with OCFF using the 3D surgical guide. Postoperative CTs were taken immediately, 1 week (T1), and 6 months (T2) after surgery, to evaluate the reproducibility of the 3D surgical guide and condyle stability. Error of the 3D surgical guide ranged from 0.85 to 2.56 mm. There were no differences in reproducibility according to flap type. Condylar error and error at mandible midpoint were significantly different in FFF. However, there was no difference in DCIA error between the condyle and mandible midpoint. Regarding condyle stability 6 months after surgery, condyles moved more than 2 mm (up to 2.85 mm) in FFF, whereas there were no significant movement in DCIA. Careful intraoperative flap fixation and closed postoperative observation should be considered for stable clinical outcome, especially in the case of FFF.
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Affiliation(s)
- Seong Ryoung Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, ASAN MEDICAL CENTER, Seoul 05505, Korea; (S.R.K.); (K.-M.A.)
| | - Sam Jang
- Coreline Soft, Seoul 03991, Korea;
| | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, ASAN MEDICAL CENTER, Seoul 05505, Korea; (S.R.K.); (K.-M.A.)
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, ASAN MEDICAL CENTER, Seoul 05505, Korea; (S.R.K.); (K.-M.A.)
- Correspondence: or ; Tel.: +82-2-3010-1757
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Sharma N, Cao S, Msallem B, Kunz C, Brantner P, Honigmann P, Thieringer FM. Effects of Steam Sterilization on 3D Printed Biocompatible Resin Materials for Surgical Guides-An Accuracy Assessment Study. J Clin Med 2020; 9:jcm9051506. [PMID: 32429549 PMCID: PMC7291001 DOI: 10.3390/jcm9051506] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022] Open
Abstract
Computer-assisted surgery with three-dimensional (3D) printed surgical guides provides more accurate results than free-hand surgery. Steam sterilization could be one of the factors that affect the dimensions of surgical guide resin materials, leading to inaccuracies during surgeries. The purpose of this study was to evaluate the effects of steam sterilization on the dimensional accuracy of indication-specific hollow cube test bodies, manufactured in-house using Class IIa biocompatible resin materials (proprietary and third-party). To evaluate the pre- and post-sterilization dimensional accuracy, root mean square (RMS) values were calculated. The results indicate that, in all the groups, steam sterilization resulted in an overall linear expansion of the photopolymeric resin material, with an increase in outer dimensions and a decrease in inner dimensions. The effects on the dimensional accuracy of test bodies were not statistically significant in all the groups, except PolyJet Glossy (p > 0.05). The overall pre- and post-sterilization RMS values were below 100 and 200 µm, respectively. The highest accuracies were seen in proprietary resin materials, i.e., PolyJet Glossy and SLA-LT, in pre- and post-sterilization measurements, respectively. The dimensional accuracy of third-party resin materials, i.e., SLA-Luxa and SLA-NextDent, were within a comparable range as proprietary materials and can serve as an economical alternative.
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Affiliation(s)
- Neha Sharma
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
| | - Shuaishuai Cao
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
| | - Bilal Msallem
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
| | - Christoph Kunz
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
| | - Philipp Brantner
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
- Radiology Department, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Philipp Honigmann
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
- Hand Surgery, Cantonal Hospital Basel-land, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (N.S.); (S.C.); (B.M.); (C.K.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 16, 4123 Allschwil, Switzerland; (P.B.); (P.H.)
- Correspondence:
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Supporting mandibular resection with intraoperative navigation utilizing augmented reality technology – A proof of concept study. J Craniomaxillofac Surg 2019; 47:854-859. [DOI: 10.1016/j.jcms.2019.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/30/2019] [Accepted: 03/04/2019] [Indexed: 11/22/2022] Open
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Kang SH, Lee S, Nam W. Condyle dislocation following mandibular reconstruction using a fibula free flap: complication cases. Maxillofac Plast Reconstr Surg 2019; 41:14. [PMID: 30997360 PMCID: PMC6441667 DOI: 10.1186/s40902-019-0197-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/28/2019] [Indexed: 11/16/2022] Open
Abstract
Background Condylar dislocation can arise as a complication in patients who required mandibular and/or condylar reconstruction and were operated on with fibula free flap (FFF) using surgical guides designed using simulation surgery. Surgeons should be aware of the complications in these present cases when planning and performing reconstructions as well as predicting prognoses. Cases presentation Two cases showed condylar dislocation in mandibular reconstruction using a FFF fixed with a reconstruction plate. Three cases showed condylar dislocation in mandibular reconstruction using a fibula free flap fixed with a mini-plate. Conclusion Despite the lack of clinical symptoms in these cases following mandibular reconstruction using an FFF, the mandibular condyle was severely displaced away from the glenoid fossa. A surgeon must have sufficient time to consider the use of a long flap with thickness similar to that of the mandible, ways to minimize span and bending, and methods of fixation. The patient, moreover, should be educated on condylar dislocation. Customized CAD/CAM-prototyped temporomandibular condyle-connected plates may be a good alternative even if virtual simulation surgery is to be performed before surgery. These considerations may help reduce the incidence of complications after mandibular reconstruction.
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Affiliation(s)
- Sang-Hoon Kang
- 1Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsan-donggu, Goyang, Gyeonggi-do 10444 Republic of Korea
| | - Sanghoon Lee
- 1Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea
| | - Woong Nam
- 1Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea
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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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Iglesias-Martín F, Oliveros-López LG, Fernández-Olavarría A, Serrera-Figallo MA, Gutiérrez-Corrales A, Torres-Lagares D, Gutiérrez-Pérez JL. Advantages of surgical simulation in the surgical reconstruction of oncological patients. Med Oral Patol Oral Cir Bucal 2018; 23:e596-e601. [PMID: 30148473 PMCID: PMC6167105 DOI: 10.4317/medoral.22336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 07/30/2018] [Indexed: 11/17/2022] Open
Abstract
Background Stereolithography, which consists of computer-aided designed/computer-aided manufactured (CAD-CAM) and computer simulations, is a manufacturing technologies used for the production of definitive models and prototypes printed in three dimensions, and is widely used in Oral and Maxillofacial Surgery. Surgical procedures using models made by these technologies offer several advantages. Material and Methods This article describes three clinical cases of our experiences with patients diagnosed with squamous cell carcinoma and mandibular osteosarcoma, who underwent surgical removal of the lesions and subsequent mandibular reconstruction with a free fibula graft using surgical guides. Results In all three clinical cases, surgical guides were used for the mandibular osteotomy, fibula osteotomy, and graft placement in the recipient area. Conclusion Surgical guidelines are useful for improving the accuracy of surgical interventions and are appropriate for many types of resection and mandibular reconstruction. Key words:Fibula flap, virtual surgical planning, mandibular reconstruction, precise medicine.
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Affiliation(s)
- F Iglesias-Martín
- Dentistry Department, University of Seville, C/Avicena s/n, 41009 Seville, Spain,
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Verhelst PJ, Dons F, Van Bever PJ, Schoenaers J, Nanhekhan L, Politis C. Fibula Free Flap in Head and Neck Reconstruction: Identifying Risk Factors for Flap Failure and Analysis of Postoperative Complications in a Low Volume Setting. Craniomaxillofac Trauma Reconstr 2018; 12:183-192. [PMID: 31428242 DOI: 10.1055/s-0038-1651515] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/05/2018] [Indexed: 10/14/2022] Open
Abstract
The fibula free flap (FFF) has been a workhorse in maxillofacial reconstruction. High success rates of this technique are reported. However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. A retrospective analysis was conducted of all FFFs performed over a 20-year period at a low-volume single tertiary center to identify risk factors and postoperative complications. A total of 129 FFFs were included (122 mandible, 7 maxilla). Complete flap failure occurred in 12.4% and partial flap failure in 7.8% of patients. A significant relation was found between younger age and flap failure, and most failures were associated with venous thrombosis. In-hospital surgical complications occurred in 60.5%, in-hospital medical complications in 49.6%, and out-of-hospital complications in 77.5% of patients. The in-hospital reintervention rate was 27.1%, and including salvaged flaps, flap survival rate was 87.6%. Osteomyocutaneous FFF failure (complete 12.4%; partial 7.8%) is an important clinical reality in a low-volume head and neck reconstruction center resulting in an in-hospital reintervention rate of 27.1%. Postoperative complications are frequent, both surgical and out-hospital complications. These results provide a better understanding of the limitations of the FFF in a low-volume center and can be used to optimize care in this kind of setting.
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Affiliation(s)
- Pieter-Jan Verhelst
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Flore Dons
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Pieter-Jan Van Bever
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Joseph Schoenaers
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Lloyd Nanhekhan
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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Ganry L, Quilichini J, Bandini C, Leyder P, Hersant B, Meningaud J. Three-dimensional surgical modelling with an open-source software protocol: study of precision and reproducibility in mandibular reconstruction with the fibula free flap. Int J Oral Maxillofac Surg 2017; 46:946-957. [DOI: 10.1016/j.ijom.2017.02.1276] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/09/2017] [Accepted: 02/28/2017] [Indexed: 11/29/2022]
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