Precise osteotomies for mandibular distraction in infants with Robin sequence using virtual surgical planning

Immediate obturation of the patient undergoing maxillectomy who is not undergoing formal autologous reconstruction is important for immediate form and function of the patient. Exophytic tumors, that are large in dimension can make pre-operative obturator formation challenging. Traditional methods of obturator fabrication involve a physical or digital impression. Preoperative virtual surgical planning for tumor resection and reconstruction using free tissue transfer has become a mainstay in head and neck reconstruction. We describe a variation of this for a patient unable to undergo free tissue transfer where the authors used preoperative virtual surgical planning and CAD/CAM technologies to perform tumor resection, and fabricated an obturator based on the CT imaging alone.

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Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/19433875211026432 ◽

2021 ◽

pp. 194338752110264

Author(s):

Sean A. Knudson ◽

Kristopher M. Day ◽

Patrick Kelley ◽

Pablo Padilla ◽

Ian X. Collier ◽

...

Keyword(s):

Systematic Review ◽

Surgical Planning ◽

Average Length ◽

Case Series ◽

Retrospective Case ◽

Oral Nutrition ◽

Microsurgical Reconstruction ◽

Virtual Surgical Planning ◽

And Function ◽

Ballistic Trauma

Study Design: Retrospective case series; systematic review. Objective: It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods: A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results: Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions: Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.

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Virtual Surgical Planning, Stereolitographic Models and CAD/CAM Titanium Mesh for Three-Dimensional Reconstruction of Fibula Flap with Iliac Crest Graft and Dental Implants

Journal of Clinical Medicine ◽

10.3390/jcm10091922 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1922

Author(s):

Carlos Navarro Cuéllar ◽

Manuel Tousidonis Rial ◽

Raúl Antúnez-Conde ◽

Santiago Ochandiano Caicoya ◽

Ignacio Navarro Cuéllar ◽

...

Keyword(s):

Bone Resorption ◽

Surgical Planning ◽

Iliac Crest ◽

Three Dimensional ◽

Titanium Mesh ◽

Iliac Crest Graft ◽

Virtual Surgical Planning ◽

Fibula Flap ◽

Dimensional Reconstruction ◽

Cad Cam

Mandibular reconstruction with fibula flap shows a 3D discrepancy between the fibula and the remnant mandible. Eight patients underwent three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), stereolitographic models (STL) and CAD/CAM titanium mesh. Vertical ridge augmentation and horizontal dimensions of the fibula, peri-implant bone resorption of the iliac crest graft, implant success rate and functional and aesthetic results were evaluated. Vertical reconstruction ranged from 13.4 mm to 10.1 mm, with an average of 12.22 mm. Iliac crest graft and titanium mesh were able to preserve the width of the fibula, which ranged from 8.9 mm to 11.7 mm, with an average of 10.1 mm. A total of 38 implants were placed in the new mandible, with an average of 4.75 ± 0.4 implants per patient and an osseointegration success rate of 94.7%. Two implants were lost during the osseointegration period (5.3%). Bone resorption was measured as peri-implant bone resorption at the mesial and distal level of each implant, with a variation between 0.5 mm and 2.4 mm, and with a mean of 1.43 mm. All patients were rehabilitated with a fixed implant prosthesis with good aesthetic and functional results.

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Accuracy of mandibular proximal segment position using virtual surgical planning and custom osteosynthesis plates

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2021.04.002 ◽

2021 ◽

Author(s):

J. Harding ◽

J.K. Hartsfield ◽

A.S. Mian ◽

B.P. Allan ◽

S. Naoum ◽

...

Keyword(s):

Surgical Planning ◽

Proximal Segment ◽

Virtual Surgical Planning

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A Systematic Review of Mandibular Distraction Osteogenesis Versus Orthodontic Airway Plate for Airway Obstruction Treatment in Pierre Robin Sequence

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211011886 ◽

2021 ◽

pp. 105566562110118

Author(s):

Darren B. Abbas ◽

Christopher Lavin ◽

Evan J. Fahy ◽

HyeRan Choo ◽

Mai Thy Truong ◽

...

Keyword(s):

Airway Obstruction ◽

Distraction Osteogenesis ◽

Literature Search ◽

Oral Feeding ◽

Treatment Modalities ◽

Pierre Robin Sequence ◽

Mandibular Distraction ◽

Robin Sequence ◽

Mandibular Distraction Osteogenesis ◽

Pierre Robin

Objective: Mandibular distraction osteogenesis (MDO) is frequently performed to address airway obstruction in patients with Pierre Robin sequence (PRS), though more recently the technique of orthodontic airway plating (OAP) has gained traction. We aimed to evaluate OAP compared to MDO for airway obstruction in PRS. Design: A systematic literature search across PubMed, Embase, and Google Scholar identified all studies published in English, which involved MDO or any form of OAP as treatments for PRS. All relevant articles were reviewed in detail and reported on, adhering to PRISMA guidelines. Main Outcome Measures: Airway (tracheostomy avoidance, decannulation rate), feeding (full oral feeding tolerance). Results: Literature search identified 970 articles, of which 42 MDO studies and 9 OAP studies met criteria for review. A total of 1159 individuals were treated with MDO, and 322 individuals were treated with OAP. Primary outcomes appear similar for MDO and OAP at face value; however, this must be interpreted with different pretreatment contexts in mind. Conclusions: Orthodontic airway plating may be considered for airway obstruction in PRS, as some airway-related and feeding-related outcomes appear similar with MDO, per existing evidence in the literature. However, since PRS severity differed between studies, OAP cannot be uniformly considered a replacement for MDO. Further research is required to more comprehensively assess these treatment modalities inclusive of metrics that allow for direct comparison.

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