In-house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time-efficient than commercial procedures

BACKGROUND

To compare an in-house and a commercially available surgical planning solution for mandibular reconstruction in terms of postoperative reconstruction accuracy and economic benefit.

METHODS

Twenty-nine consecutive patients with advanced oral squamous cell carcinoma (OSCC) requiring segmental mandibular reconstruction were enrolled. Fifteen patients underwent in-house surgical planning and 14 patients underwent a commercially available planning solution. A morphometric comparison of preoperative and postoperative computed tomography (CT) data sets and a cost-benefit comparison were performed.

RESULTS

Volumes of planned and reconstructed bone segments differed significantly for both in-house planning (p = 0.0431) and commercial planning (p < 0.0001). Significant differences in osteotomy angles were demonstrated for in-house planning (p = 0.0391). Commercial planning was superior to in-house planning for total mandibular deviation (p = 0.0217), intersegmental space volumes (p = 0.0035), and lengths (p = 0.0007). No significant difference was found between the two planning solutions in terms of intersegmental ossification and the incidence of wound healing disorders. In-house planning took less time than commercial planning (p < 0.0001). Component manufacturing costs (p < 0.0001) and total cumulative costs (p < 0.0001) were significantly lower for in-house planning.

CONCLUSIONS

In-house surgical planning is less accurate but has a cost advantage and could be performed in less time.

Postoperative facial appearance of patients with extensive oral squamous cell carcinoma can be adequately preserved with in‑house virtually planned mandibular reconstruction

The present study aimed to assess the concordance of preoperative and postoperative hard and soft tissues in patients with advanced oral squamous cell carcinoma (OSCC) following virtual surgical planning (VSP) mandibular reconstruction. In the present study, a cohort of 32 patients with OSCC underwent in-house VSP, followed by guided mandibular reconstruction utilizing vascularized free tissue grafts sourced from the fibula or scapula. A morphometric analysis was conducted comparing preoperative and postoperative three-dimensional virtual models to evaluate discrepancies and identify potential risk factors associated with poor reconstruction outcomes. The outcome variables were the differences in root mean square (RMS) and mean surface distance (MSD) resulting from the application of an iterative closest point algorithm to the virtual data. The validity of soft tissue comparison data is limited due to its susceptibility to various confounding variables. The present study conducted a comprehensive re-evaluation of these variables. High tumor stage, positive N status and the use of adjuvant therapy contributed to more noticeable differences in preoperative and postoperative facial soft tissue appearance. The accuracy of postoperative bone reconstruction results was higher in patients who underwent neomandibular formation using a fibular graft compared with those who received a scapular graft. Preoperative and postoperative soft tissue analyses were conducted for comparison. The MSD showed a deviation of 3.2 mm (± 2.0 mm SD; range 1.3-9.5 mm), whereas the RMS was 5.3 (± 2.9 SD; range 2.1-14). In conclusion, in-house VSP and guided mandibular reconstructions can yield clinically accurate results, preserving patient appearance and offering the advantage of rapid feasibility.

Diagnostic value of routine dental radiographs for predicting the mandibular canal localization validated by cone-beam computed tomogram measurements

OBJECTIVES

To test the hypothesis that routine dental radiographs can be used to draw conclusions regarding the mandibular canal (MC) localization. MATERIAL AND METHODS: A total of 108 radiographs (36 orthopantomograms [OPTs], 36 lateral cephalograms [LCs], and 36 cone-beam computed tomograms [CBCTs]) of 36 patients were analyzed. Statistical analysis included all cephalometric parameters obtained by OPTs, LCs, and CBCTs. Potential influencing parameters were calculated using linear and logistic regression with a backward removal algorithm. For predictability of MC localization, parameters were correlated using Pearson's correlation.

RESULTS

The MC ran along the lingual half (n = 24) twice as often as in the buccal half (n = 12) in the population studied. The position was always symmetrical contralaterally. No sex-specific influence was observed (p = .34). Lingual and buccal MC courses were statistically significantly correlated to increased and decreased jaw angles (LC/OPT), respectively (p = .003; r = -.48/p = .010; r = -.42). An increased jaw angle was significantly correlated with a more cranial MC position (p = .013; r = -.41); a deep and distal bite position was significantly correlated with a caudal and buccal MC position (p = .004; r = -.47/p = .001; r = .57). Moreover, an increase of 1 point in the Hasund score predicted an increased probability of a buccal MC position by 18.6%. The jaw angle analyzed in OPT and LC images were positively correlated (r = .89, p < .001).

CONCLUSIONS

Routine dental radiographs provide informative guidance on the location of the MC in the vertical and transverse levels. This finding could be used in the initial consultation and treatment planning to consider more invasive diagnostic methods further down the line.

Combined quality of life and posttraumatic growth evaluation during follow-up care of patients suffering from oral squamous cell carcinoma

Oral cancer therapy is associated with a loss in health-related quality of life (HRQOL) and can also lead to post-traumatic growth (PTG). The current study analyzed the relationship between HRQOL, PTG and influencing clinical factors after treatment. The coherent clinical data of 15 patients were retrospectively analyzed over a 1-year study period. HRQOL and PTG were studied using the University of Washington Quality of Life Version 4 (UW-QOL v4) and Posttraumatic Growth Inventory (PTGI) questionnaires. The results revealed that HRQOL was significantly decreased in a pre- to postoperative manner (P=0.011). Sex demonstrated a nearly significant effect on HRQOL (P=0.058). PTG was experienced the most after surgery, and continuously decreased over the 1-year study period. Patient age had a significant effect on PTG (P=0.040). A significant correlation was also established between HRQOL and PTG (P<0.05). HRQOL and PTG are important influencing factors during postoperative tumor follow-up care and should be simultaneously recorded to address individual patient needs and improve quality of treatment.