Changes in Condylar Position After Mandibular Reconstruction With Condylar Head Preservation by Computed Tomography

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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Effect of Bimaxillary Surgery on Adaptive Condylar Head Remodeling: Metric Analysis and Image Interpretation Using Cone-Beam Computed Tomography Volume Superimposition

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2011.08.017 ◽

2012 ◽

Vol 70 (8) ◽

pp. 1951-1959 ◽

Cited By ~ 45

Author(s):

Soo-Byung Park ◽

Yu-Mi Yang ◽

Yong-Il Kim ◽

Bong-Hae Cho ◽

Yun-Hoa Jung ◽

...

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Image Interpretation ◽

Cone Beam ◽

Metric Analysis ◽

Condylar Head ◽

Bimaxillary Surgery

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Experience of mAndibular reconstruction using a metal plate with condylar head for 4 hemimandibulectomy patients and estimation its post operative function.

Japanese Journal of Oral & Maxillofacial Surgery ◽

10.5794/jjoms.35.1909 ◽

1989 ◽

Vol 35 (7) ◽

pp. 1909-1916

Author(s):

Kuniko SUZUKI ◽

Fumiaki SAITOU ◽

Masashi SUGISAKI ◽

Haruyasu TANABE

Keyword(s):

Metal Plate ◽

Mandibular Reconstruction ◽

Condylar Head

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Deviation Analyses of Computer-Assisted, Template-Guided Mandibular Reconstruction With Combined Osteotomy and Reconstruction Pre-Shaped Plate Position Technology: A Comparative Study

Frontiers in Oncology ◽

10.3389/fonc.2021.719466 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jie Chen ◽

Ruipu Zhang ◽

Ye Liang ◽

Yujie Ma ◽

Saiwen Song ◽

...

Keyword(s):

Coracoid Process ◽

Mandibular Reconstruction ◽

Computer Assisted ◽

Anatomical Landmarks ◽

Virtual Planning ◽

Actual Length ◽

Deviation Analysis ◽

Resection Line ◽

Condylar Head ◽

Fibular Flap

BackgroundComputer-assisted and template-guided mandibular reconstruction provides higher accuracy and less variation than conventional freehand surgeries. The combined osteotomy and reconstruction pre-shaped plate position (CORPPP) technique is a reliable choice for mandibular reconstruction. This study aimed to evaluate the accuracy of CORPPP-guided fibular flap mandibular reconstruction and analyze the possible causes of the deviations.Patients and MethodsFrom June 2015 to December 2016, 28 patients underwent fibular flap mandibular reconstruction. Virtual planning and personalized CORPPP-guided templates were applied in 15 patients while 13 patients received conventional freehand surgeries. Deviations during mandibulectomy and fibular osteotomy, and overall and triaxial deviation of the corresponding mandibular anatomical landmarks were measured by superimposing the pre- and postoperative virtual models.ResultsThe deviation of the resection line and resection angle was 1.23 ± 0.98 mm and 4.11° ± 2.60°. The actual length of fibula segments was longer than the designed length in 7 cases (mean: 0.35 ± 0.32 mm) and shorter in 22 cases (mean: 1.53 ± 1.19 mm). In patients without ramus reconstruction, deviations of the ipsilateral condylar head point (Co.), gonion point (Go.), and coracoid process point (Cor.) were 6.71 ± 3.42 mm, 5.38 ± 1.71 mm, and 11.05 ± 3.24 mm in the freehand group and 1.73 ± 1.13 mm, 1.86 ± 0.96 mm, and 2.54 ± 0.50 mm in the CORPPP group, respectively, with significant statistical differences (p < 0.05). In patients with ramus reconstruction, deviations of ipsilateral Co. and Go. were 9.79 ± 4.74 mm vs. 3.57 ± 1.62 mm (p < 0.05), and 15.17 ± 6.53 mm vs. 4.36 ± 1.68 mm (p < 0.05) in the freehand group and CORPPP group, respectively.ConclusionMandibular reconstructions employing virtual planning and personalized CORPPP-guided templates show significantly higher predictability, convenience, and accuracy of mandibular reconstruction compared with conventional freehand surgeries. However, more clinical cases were required for further dimensional deviation analysis. The application and exploration of clinical practice would also continuously improve the design of templates.

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