Advances in oncologic head and neck reconstruction: Systematic review and future considerations of virtual surgical planning and computer aided design/computer aided modeling

Background: Marginal mandible resection is required to achieve healing in some cases of medication-related osteonecrosis of the jaws (MRONJ). Despite the sparsity of the literature, computer-aided design/computer-aided manufacturing (CAD/CAM) materials may provide superior outcomes for patients with an increased risk of mandible fracture. The aim of this study was to report a digital workflow for surgical interventions to prevent mandible fracture in MRONJ patients. Methods: We present two cases in which virtual surgical planning (VSP) and CAD/CAM surgical guides and reconstruction plates were used to prevent mandible fractures in elderly MRONJ patients submitted for marginal resection. Two osteoporotic patients, aged 73 and 84 years, presented with stage 3 MRONJ of the right mandibular body with inferior alveolar nerve involvement. The unaffected bone height was 6 mm in both cases, implying a high risk of mandible fracture. After preoperative VSP, surgery was performed through a combined intraoral–transbuccal approach. CAD/CAM-customized cutting guides and reconstruction plates were used for the marginal resection of necrotic bone and internal fixation. Results: Complete healing was achieved and the patients remained asymptomatic up to 1 year post-surgery. Conclusions: VSP and CAD/CAM-customized materials facilitated the complete resection of necrotic bone and rigid fixation in MRONJ patients, allowing a simplified approach with shorter operative times, reduced morbidity, and predictable results.

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The use of 3D virtual surgical planning and computer aided design in reconstruction of maxillary surgical defects

Current Opinion in Otolaryngology & Head & Neck Surgery ◽

10.1097/moo.0000000000000618 ◽

2020 ◽

pp. 1

Author(s):

Haye H. Glas ◽

Nathalie Vosselman ◽

Sebastiaan A.H.J. de Visscher

Keyword(s):

Computer Aided Design ◽

Surgical Planning ◽

Virtual Surgical Planning ◽

Computer Aided ◽

Aided Design

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The Judgement for Development of Virtual Surgical Planning and Three-Dimensional Bio-Printing for Superior Reconstruction of Mandibular Defect by Fibular Graft on Head-Neck Cancer

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2020.00724 ◽

2021 ◽

Vol 64 (3) ◽

pp. 135-147

Author(s):

Nadia Sultana Shuborna ◽

Bishwa Prakash Bhattarai ◽

Teeranut Chaiyasamut ◽

Sirichai Kiattavornchareon ◽

Natthamet Wongsirichat

Keyword(s):

Neck Cancer ◽

Computer Aided Design ◽

Surgical Planning ◽

Head And Neck Reconstruction ◽

Fibular Graft ◽

Head Neck Cancer ◽

Virtual Surgical Planning ◽

Increased Risk ◽

Computer Aided ◽

Head Neck

Oncological resection followed by reconstruction with a free fibular graft is still considered to be the gold standard treatment for functional and prosthetic rehabilitation of oral cancer patients. But this tedious traditional process is challenging for surgeons, as they have to deal with associated curve anatomy, surrounding innervations, and maintenance of functional and aesthetical acceptability. Such manual and operator’s skill dependent surgery can commonly demand a longer treatment duration; leading to an increased risk for prolonging the period of ischemia with increased morbidity, which frequently ends with an uncertain, unsatisfactory outcome. Technological advancements in the 20th and 21st centuries present a revolutionary improvement in the field of reconstructive surgery. Virtual surgical planning (VSP) and threedimensional (3D) bio-printing incorporating computer-aided design and computer-aided modeling is a promising tech in modern head and neck reconstruction. This recent innovation is more polished regarding initiation of patient-customized models, pre-bent plates, and osteotomy guides which further increase surgical precision, improve operative efficiency, ensure proper wound healing, shorten operative time, reduce operative cost, and decrease morbidities. This review focuses on the virtual surgical planning and 3D bio-printing technologies to evaluate their efficiency of qualitative and quantitative outcomes of resection and reconstruction of mandible in head-neck cancer using fibular graft.

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