scholarly journals Surgical benefit of mandibular morphometric analysis: A new tool to standardize mandibular reconstruction

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0240558
Author(s):  
Alice Prevost ◽  
Franck Delanoe ◽  
Zoé Cavallier ◽  
Samuel Muller ◽  
Raphael Lopez ◽  
...  
Keyword(s):  
Morphometric Analysis ◽  
Descriptive Analysis ◽  
Donor Site ◽  
Three Dimensional ◽  
Free Flaps ◽  
Reference Points ◽  
Mandibular Reconstruction ◽  
Gonial Angle ◽  
Custom Made ◽  
Cutting Guides

Purpose The gold-standard for reconstruction of large mandibular defects is the use of free flaps of vascularized autologous bone with the fibula as the preferred donor site. The use of "custom cutting guides" for this indication is becoming increasingly prevalent. But cost of the procedure averages around 2,500 dollars per patient excluding treatment and entails selection criteria. We think it is possible to standardize mandibular reconstructions from an anatomical mean. The objective of this study was to perform a mandibular morphometric analysis in order to obtain a set of "mean" measurements, which can be used by all surgeons interested in mandibular reconstruction. Methods We performed a morphometric analysis consisting of three-dimensional mandibular reconstructions of 30 men and 30 women. Several reference points were set and defined to evaluate specific lengths and angles of interest. We conducted an intra and inter-sexual descriptive analysis of measurements obtained. Results We did not identify any major intra-sexual differences within each group. The gonial angle is more open in women and the measurements characterizing the basilar contour are more prominent in men. We did not identify any differences in alveolar region parameters. Conclusion The results of this study constitute a morphological tool for surgeons, from bone graft to free flap. These results also confirm us that the use of «custom cutting guides» for mandibular reconstruction may be excessive. It is pertinent to examine the value of "custom made" mandibular reconstructions since the differences observed are of the order of millimeters.

scholarly journals Sole Reconstruction Using Anterolateral Thigh Free Flap: A Review of 4 Cases

1970 ◽  
Vol 2 (3) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Afriyanti Sandhi
Keyword(s):  
Free Flap ◽  
Weight Bearing ◽  
Donor Site ◽  
Three Dimensional ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Common Procedure ◽  
Anterolateral Thigh ◽  
Protective Sensation ◽  
And Function

Background: The ideal technique for sole reconstruction should meet such requisite as a durable and comfortable weight-bearing surface, solid anchoring to deep tissue for resistance to shear force and adequate protective sensation. The anterolateral thigh (ALT) perforator free flap provides a large, pliable skin island and sufficient bulk, allowing three-dimensional tailoring to complex defects. The present article is about our experience of sole reconstruction ALT perforator free flap. Patient and Method: Total of 4 flaps in the foot defects was performed in February 2009 to December 2012. We reconstructed soft tissue defects in the sole using ALT free flaps, the complications, aesthetic and function results were monitored. Result: ALT perforator free flap provided stable and durable long-term wound cover in all patients, resulting in early rehabilitation and function outcomes were completely achieved. Complications were few and manageable in all cases. Summary: ALT perforator free flap has become common procedure in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experiences, we found that the use of ALT perforator free flap in sole defect reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

Three-Dimensional Custom-Made Surgical Guides in Facial Feminization Surgery: Prospective Study on Safety and Accuracy

2021 ◽  
Author(s):  
Pierre Tawa ◽  
Nicolas Brault ◽  
Vlad Luca-Pozner ◽  
Laurent Ganry ◽  
Ghassen Chebbi ◽  
...  
Keyword(s):  
Maxillofacial Surgery ◽  
Three Dimensional ◽  
Cerebrospinal Fluid Leak ◽  
Mandibular Angle ◽  
Virtual Planning ◽  
Surgical Guides ◽  
Sinus Wall ◽  
Custom Made ◽  
Cutting Guides ◽  
Fluid Leak

Abstract Background Facial feminization surgery (FFS) includes several osseous modifications of the forehead, mandible and chin, procedures which require precision in order to provide the patient with a satisfactory result. Mispositioned osteotomies can lead to serious complications and bad aesthetic outcomes. Surgical cutting guides are commonly used in plastic and maxillofacial surgery to improve safety and accuracy. Yet, there is no report in the literature on the clinical application of cutting guides in FFS. Objectives The aim of this paper is to assess the safety and accuracy of custom surgical cutting guides in FFS procedures. Methods A prospective follow-up of forty-five patients regarding FFS with preoperative virtual planning and 3D custom-made surgical guides for anterior frontal sinus wall setback, mandibular angle reduction and/or osseous genioplasty was conducted. Accuracy (superimposing preoperative data on postoperative data by global registration with a 1 mm margin of error), safety (intradural intrusion for the forehead procedures and injury of the infra alveolar nerve for chin and mandibular angles) and patient satisfaction were assessed. Results A total of 133 procedures were documented. There was no cerebrospinal fluid leak on the forehead procedures nor any infra alveolar nerve or tooth root injury on both chin and mandibular angle operations (safety, 100%). Accuracy was 90.80 % on the forehead (n=25), 85.72% on the mandibular angles (n=44) and 96.20% on the chin (n=26). An overall satisfaction of 94.40% was recorded. Conclusions Custom-made surgical cutting guides could be a safe and accurate tool for forehead, mandibular angles and chin procedures for FFS.

scholarly journals Recent advances in head and neck cancer reconstruction

2014 ◽  
Vol 47 (02) ◽  
pp. 185-190 ◽  
Author(s):  
Prabha Yadav
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Three Dimensional ◽  
Life Quality ◽  
Oral Intake ◽  
Radical Excision ◽  
Functional Requirements ◽  
Custom Made ◽  
Choice Of Treatment ◽  
Tissue Flaps

ABSTRACTTreatment of cancer is race against time! Following radical excision, breathing, speech, mastication and swallowing are hampered. Face is invariably involved. Beside functional normalcy, excellent cosmetic restoration is necessary for patient’s life quality. Primary wound healing, quick resumption of adequate oral intake, prompt initiation of chemo-radiotherapy has direct bearing on cure. Primary reconstruction with pedicle or free flap is the choice of treatment in most protocols. Composite defects are requiring bone, muscle and skin restrict choice of donor site and may have shortfalls in aesthetic and functional requirements. To improve further newer, and newer modalities are being developed and used to give best aesthetic and functions. Navigation, use of three-dimensional imaging, stereo lithic model and custom made implant for reconstruction are recommended as they promise improvement in aesthetics. Robotic surgeries allow access for resection of tumours and reconstruction with free flap in deep oropharynx obviating need of doing mandibulotomy. Researchers in stem cell and tissue engineering are looking forward to regenerating tissues and avoid the need of autologous tissue flaps. Desired tissue combination across counter may be available in the future. Excellent immunosuppressant drugs have made it possible to reconstruct composite facial anatomical units with allotransplant in a single surgery, along sensory and motor recovery! Mythological heterogenic head transplant like clone Ganesha, will be a reality in the near future!!

‘Sit and tilt’ preparation for subscapular system free flaps

2018 ◽  
Vol 132 (2) ◽  
pp. 180-183 ◽  
Author(s):  
J Mark ◽  
H Patwa ◽  
M S Costello ◽  
Y Patil
Keyword(s):  
Head And Neck ◽  
Operative Time ◽  
Donor Site ◽  
Three Dimensional ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Head And Neck Reconstruction ◽  
Advanced Head ◽  
Neck Reconstruction ◽  
Harvesting Technique

AbstractBackground:The ablation of advanced head and neck cancer often results in large three-dimensional defects that require free tissue transfer to optimally address functional and cosmetic issues. The subscapular system is a highly versatile donor site for flaps used for head and neck reconstruction. Traditional methods of harvesting subscapular flaps require repositioning and re-preparing, which significantly increases the operative time and prevents simultaneous harvesting of the flap.Method:This paper presents our experience of a single-stage ‘sit and tilt’ technique, which provides a convenient method for harvesting subscapular system free flaps without significant repositioning.Results and conclusion:This technique was used for a variety of head and neck defects, and body habitus did not seem to affect free tissue harvesting. It is hoped that utilisation of this preparation and harvesting technique will make head and neck surgeons more willing to take advantage of the subscapular system.

scholarly journals Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4373
Author(s):  
Remo Accorona ◽  
Luca Gazzini ◽  
Roberto Grigolato ◽  
Enrico Fazio ◽  
Letizia Nitro ◽  
...  
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Locally Advanced ◽  
Free Flaps ◽  
Mandibular Reconstruction ◽  
Cochrane Library ◽  
Medical Subject Headings ◽  
Promising Tool ◽  
Mesh Terms ◽  
Radial Forearm

Introduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold represents a possible alternative in compromised patient, BFF failure, or relapsing cancers as salvage treatment. However, only few clinical applications in head and neck are reported in literature. Purpose of the study was to systematically analyse the results of functional and oncologic maxillary and mandibular reconstruction with FPF with scaffold. Materials and Methods: A comprehensive review of the dedicated literature was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, Embase, Researchgate and Google Scholar databases using relevant keywords, phrases and medical subject headings (MeSH) terms. An excursus on the most valuable FPF’ harvesting sites was also carried out. Results: A total of 7 studies with 55 patients were included. Overall, the majority of the patients (n = 54, 98.1%) underwent an FPF reconstruction of the mandibular site. The most used technique was the radial forearm FPF with autologous frozen bone as scaffold (n = 40, 72.7%). The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Conclusions: Maxillary and mandibular reconstruction with FPF and scaffold is a possible alternative in patient unfit for complex BFF reconstruction and it should be considered as a valid alternative in the sequential salvage surgery for locally advanced cancer. Moreover, it opens future scenarios in head and neck reconstructive surgery, as a promising tool that can be modelled to tailor complex 3D defects, with less morbidities to the donor site.

Unusual Forearm Deformity Solved by 3D Custom Made Guides

2019 ◽  
Vol 24 (04) ◽  
pp. 483-487
Author(s):  
Maria de los Angeles De la Red Gallego ◽  
Jose Couceiro Otero ◽  
Marta De Prado Tovar ◽  
Higinio Ayala Gutierrez ◽  
Manuel Ruben Sanchez Crespo
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
3D Model ◽  
Three Dimensional ◽  
Distal Ulna ◽  
Ulnar Head ◽  
Custom Made ◽  
Ulnar Fracture ◽  
Cutting Guides

We report a case of a symptomatic forearm deformity due to a premature distal ulnar fracture solved by 3D custom made cutting guides. Our patient is a sixteen years old girl referred to us due to a forearm deformity and a dysplasic ulnar head associated to pain at the dorsum of the distal ulna and at the radial head at the elbow. Using custom-made cutting guides on a 3D model, a both bone forearm osteotomy was performed. At 18 months of follow up, the range of motion did not improve significantly but our patient referred no pain and she was satisfied with the procedure. The accuracy of single cut osteotomies, utilizing three-dimensional planning and custom patient guides has been previously established. This technique helped with the pain in our case.

scholarly journals Filtering Biomechanical Signals in Movement Analysis

Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4580
Author(s):  
Francesco Crenna ◽  
Giovanni Battista Rossi ◽  
Marta Berardengo
Keyword(s):  
Measurement Uncertainty ◽  
Dimensional Space ◽  
Three Dimensional ◽  
Movement Analysis ◽  
Analytical Signal ◽  
Human Movement ◽  
Reference Points ◽  
Biomechanical Analysis ◽  
Method Performance ◽  
Acceleration Signal

Biomechanical analysis of human movement is based on dynamic measurements of reference points on the subject’s body and orientation measurements of body segments. Collected data include positions’ measurement, in a three-dimensional space. Signal enhancement by proper filtering is often recommended. Velocity and acceleration signal must be obtained from position/angular measurement records, needing numerical processing effort. In this paper, we propose a comparative filtering method study procedure, based on measurement uncertainty related parameters’ set, based upon simulated and experimental signals. The final aim is to propose guidelines to optimize dynamic biomechanical measurement, considering the measurement uncertainty contribution due to the processing method. Performance of the considered methods are examined and compared with an analytical signal, considering both stationary and transient conditions. Finally, four experimental test cases are evaluated at best filtering conditions for measurement uncertainty contributions.

scholarly journals Accuracy and Reproducibility of Facial Measurements of Digital Photographs and Wrapped Cone Beam Computed Tomography (CBCT) Photographs

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 757
Author(s):  
Maged Sultan Alhammadi ◽  
Abeer Abdulkareem Al-mashraqi ◽  
Rayid Hussain Alnami ◽  
Nawaf Mohammad Ashqar ◽  
Omar Hassan Alamir ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Cone Beam Computed Tomography ◽  
High Reliability ◽  
Three Dimensional ◽  
Cone Beam ◽  
Cross Sectional ◽  
Facial Profile ◽  
Digital Photographs ◽  
Gonial Angle

The study sought to assess whether the soft tissue facial profile measurements of direct Cone Beam Computed Tomography (CBCT) and wrapped CBCT images of non-standardized facial photographs are accurate compared to the standardized digital photographs. In this cross-sectional study, 60 patients with an age range of 18–30 years, who were indicated for CBCT, were enrolled. Two facial photographs were taken per patient: standardized and random (non-standardized). The non-standardized ones were wrapped with the CBCT images. The most used soft tissue facial profile landmarks/parameters (linear and angular) were measured on direct soft tissue three-dimensional (3D) images and on the photographs wrapped over the 3D-CBCT images, and then compared to the standardized photographs. The reliability analysis was performed using concordance correlation coefficients (CCC) and depicted graphically using Bland–Altman plots. Most of the linear and angular measurements showed high reliability (0.91 to 0.998). Nevertheless, four soft tissue measurements were unreliable; namely, posterior gonial angle (0.085 and 0.11 for wrapped and direct CBCT soft tissue, respectively), mandibular plane angle (0.006 and 0.0016 for wrapped and direct CBCT soft tissue, respectively), posterior facial height (0.63 and 0.62 for wrapped and direct CBCT soft tissue, respectively) and total soft tissue facial convexity (0.52 for both wrapped and direct CBCT soft tissue, respectively). The soft tissue facial profile measurements from either the direct 3D-CBCT images or the wrapped CBCT images of non-standardized frontal photographs were accurate, and can be used to analyze most of the soft tissue facial profile measurements.

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