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

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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Computer-assisted versus traditional freehand technique for mandibular reconstruction with free vascularized fibular flap: A matched-pair study

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2021.03.121 ◽

2021 ◽

Author(s):

Hongyang Ma ◽

Sohaib Shujaat ◽

Michel Bila ◽

Yi Sun ◽

Jan Vranckx ◽

...

Keyword(s):

Mandibular Reconstruction ◽

Matched Pair ◽

Computer Assisted ◽

Freehand Technique ◽

Fibular Flap

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Evaluation of computer-assisted mandibular reconstruction with vascularized fibular flap compared to conventional surgery

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2015.08.897 ◽

2015 ◽

Vol 44 ◽

pp. e174

Author(s):

L. Zhang ◽

Z. Liu ◽

B. Li ◽

H. Yu ◽

X. Wang

Keyword(s):

Mandibular Reconstruction ◽

Computer Assisted ◽

Conventional Surgery ◽

Fibular Flap

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Evaluation of computer-assisted mandibular reconstruction with vascularized fibular flap compared to conventional surgery

Oral Surgery Oral Medicine Oral Pathology and Oral Radiology ◽

10.1016/j.oooo.2015.10.005 ◽

2016 ◽

Vol 121 (2) ◽

pp. 139-148 ◽

Cited By ~ 26

Author(s):

Lei Zhang ◽

Zhixu Liu ◽

Biao Li ◽

Hongbo Yu ◽

Steve Guofang Shen ◽

...

Keyword(s):

Mandibular Reconstruction ◽

Computer Assisted ◽

Conventional Surgery ◽

Fibular Flap

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Mandibular Reconstruction Using ProPlan CMF: A Review

Craniomaxillofacial Trauma & Reconstruction Open ◽

10.1055/s-0037-1606835 ◽

2017 ◽

Vol 1 (1) ◽

pp. s-0037-1606835 ◽

Cited By ~ 2

Author(s):

Ryo Sasaki ◽

Michael Rasse

Keyword(s):

Computer Assisted Surgery ◽

Mandibular Reconstruction ◽

Patient Specific ◽

Computer Assisted ◽

Planning Service ◽

Virtual Planning ◽

Surgical Guide ◽

Surgical Guides ◽

Computer Aided

ProPlan CMF (Depuy Synthes, Solothurn, Switzerland, and Materialise, Leuven, Belgium) is a computer-aided surgical virtual planning service using an online meeting with professional medical engineers and transfers patient-specific surgical guide to the virtual plan. Moreover, prebent reconstruction plates or patient-specific computer-aided manufacturing-fabricated reconstruction can also be used. This service started in 2011. Currently, it is widely used in Europe. Current status of mandibular reconstruction with ProPlan CMF vertical planning service with the surgical guide was reviewed. The accuracy was excellent in terms of contact of the osteotomized parts and the contact to the remaining skeleton. The authors found that currently, a small number of reports regarding the mandibular reconstruction with virtual planning service and surgical guides are available. These reports also have a small number of cases and short-term follow-up results. In this situation, this review revealed that (1) mainly the resection guides, cutting guides, and patient-specific mandible reconstruction plates were adequately well fitted to the surgical site intraoperatively, (2) the ischemic time might be more reduced than that of the conventional surgery (3) the accuracy of computer-assisted surgery in the mandibular reconstruction was clinically acceptable, and (4) condyle positions after the computer-assisted surgery was mainly normal. The higher additional cost than that of the conventional technique is presently an issue. Large-scale clinical studies and long-term follow-up studies are demanded.

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Computer-assisted resection of mandibular cancer and repair with fibula free flap. Case report

Hellenic Archives of Oral and Maxillofacial Surgery ◽

10.54936/haoms222109117 ◽

2021 ◽

pp. 109-117

Author(s):

Ioannis CHATZISTEFANOU ◽

◽

Ioannis Tilaveridis ◽

Vasileios Banikas ◽

Dimitris Deligiannidis ◽

...

Keyword(s):

Case Report ◽

Oral Cancer ◽

Free Flap ◽

Gold Standard ◽

Digital Design ◽

Computer Assisted ◽

Virtual Planning ◽

Fibula Free Flap ◽

Cutting Guides ◽

Fibular Flap

Oral cancer is a disease, in the treatment of which the surgical resection of the lesion plays a lead- ing role. Oncological resections in the maxillofacial area create large deficits that affect the functionality and aesthetics of the patient to a large extent, while many times make oncological resection impossible due to their inability to restore. The mandibular deficits are particularly difficult, with the free osteocutaneous fibular flap being the gold standard in repairing large mandibular deficits. In recent years, technology has offered significant as- sistance in the successful restoration of functional and aesthetic disorders through the virtual planning of the operation. In this paper we present a case of oral cancer whose resection and reconstruction with fibula free flap were done after digital design and under the guidance of special cutting guides. To our knowledge, this case of computer-guided reconstruction with FFF represents the first description of such a technique for mandibular reconstruction in the available greek medico-dental literature.

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Knowledge Acquisition and Construction of a RDF-Ontology for Computer-Assisted Surgery

Studies in Health Technology and Informatics - Public Health and Informatics ◽

10.3233/shti210113 ◽

2021 ◽

Author(s):

Niclas Hagen ◽

Reinald Kühle ◽

Frederic Weichel ◽

Urs Eisenmann ◽

Petra Knaup-Gregori ◽

...

Keyword(s):

Knowledge Acquisition ◽

Maxillofacial Surgery ◽

Computer Assisted Surgery ◽

Mandibular Reconstruction ◽

University Hospital ◽

Planning System ◽

Oral And Maxillofacial Surgery ◽

Computer Assisted ◽

Planning Systems ◽

Virtual Planning

The integration of surgical knowledge into virtual planning systems plays a key role in computer-assisted surgery. The knowledge is often implicitly contained in the implemented algorithms. However, a strict separation would be desirable for reasons of maintainability, reusability and readability. Along with the Department of Oral and Maxillofacial Surgery at Heidelberg University Hospital, we are working on the development of a virtual planning system for mandibular reconstruction. In this work we describe a process for the structured acquisition and representation of surgical knowledge for mandibular reconstruction. Based on the acquired knowledge, an RDF(S) ontology was created. The ontology is connected to the virtual planning system via a SPARQL interface. The described process of knowledge acquisition can be transferred to other surgical use cases. Furthermore, the developed ontology is characterised by a reusable and easily expandable data model.

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Surgical Margins After Computer-Assisted Mandibular Reconstruction: A Retrospective Study

Frontiers in Oral Health ◽

10.3389/froh.2021.806477 ◽

2022 ◽

Vol 2 ◽

Author(s):

Erika Crosetti ◽

Giovanni Succo ◽

Bruno Battiston ◽

Federica D'Addabbo ◽

Martina Tascone ◽

...

Keyword(s):

Surgical Planning ◽

Perioperative Complications ◽

Free Flaps ◽

Neck Surgery ◽

Mandibular Reconstruction ◽

Surgical Margins ◽

Computer Assisted ◽

Virtual Planning ◽

Oncological Safety ◽

Virtual Surgical Planning

Purpose: The use of virtual surgical planning in head and neck surgery is growing strongly. In the literature, its validity, accuracy and clinical utility for mandibular reconstruction are widely documented. Virtual planning of surgical bone resection and reconstruction takes place several days before surgery and its very sensitive nature can negatively affect an intervention aimed at maximum precision in term of oncological safety.Methods: The study focuses on a retrospective evaluation of the surgical margins in 26 consecutive cases with oral cavity malignancy and who underwent computer-assisted mandibular resection/reconstruction guided by the different types of bone, periosteal and peri-mandibular tissue involvement. The goal was to analyze the strategic and technical aspects useful to minimize the risk of positive or close margins and to vary the reconstructive strategy in the case of intraoperative findings of a non-radical planned resection.Results: No intraoperative or perioperative complications occurred. In 20 patients, virtual surgical planning permitted mandibular reconstruction to be performed using composite fibular free flaps, characterized by high accuracy and negative bone margins. In the remaining 6 patients, also virtually planned but otherwise reconstructed due to poor general condition (advanced age, severe comorbidity), negative bone margins were obtained. Intraoperative enlargement of the resection was carried out in one case and positive soft tissue margins were observed in another case.Conclusion: The results were satisfactory in terms of oncological radicality and precision. The functional benefits and reduction in operating times, previously demonstrated in other articles also by the authors, seem to justify the side effects related to the risk of modifying the planned surgery. During virtual planning, the surgeons must bear in mind that an unexpected progression of the tumor or a limited planned resection will entail modifying the extent of the resection intraoperatively and nullifying the virtual planning on which the reconstruction was based. Further investigations are necessary to clarify all aspects of virtual surgical planning in this setting.

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Mandibular Reconstruction with Bridging Customized Plate after Ablative Surgery for ONJ: A Multi-Centric Case Series

Applied Sciences ◽

10.3390/app112211069 ◽

2021 ◽

Vol 11 (22) ◽

pp. 11069

Author(s):

Salvatore Battaglia ◽

Francesco Ricotta ◽

Salvatore Crimi ◽

Rosalia Mineo ◽

Fabio Michelon ◽

...

Keyword(s):

Maxillofacial Surgery ◽

Case Series ◽

Mandibular Reconstruction ◽

Computer Assisted ◽

Virtual Planning ◽

Reconstructive Procedures ◽

Average Accuracy ◽

Ablative Surgery ◽

Cad Cam ◽

Safe Technique

Purpose: Computer-aided methods for mandibular reconstruction have improved both functional and morphological results in patients who underwent segmental mandibular resection. The purpose of this study is to evaluate the overlaying of virtual planning in terms of measures of the Computer Assisted Design/Computer Assisted Manufacturing CAD/CAM plate for mandibular reconstruction in patients who are ineligible for the insertion of reconstructing the titanium plate supported by fibular free flap, due to their poor health status, or in the presence of specific contraindications to autologous bone flap harvest. Materials and methods: The retrospective study performed analyzed the results of nine patients. The patients were treated at the Maxillofacial Surgery Unit of Policlinico S. Orsola of Bologna, Italy, and Policlinico San Marco, Catania, Italy, from April 2016 to June 2021. Superimposition between planning and post operative Computed Tomography CT scan was performed to assess the accuracy. Results: All reconstructive procedures were carried out successfully. No microsurgery-related complications occurred. In two cases, we had plate misplacement, and in one case, plate exposure that led to plate removal. The average accuracy of the series assessed after CT superimposition, as previously described, was 0.95 mm. Conclusions: Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customized bridging mandibular prosthesis (CBMP), whether or not it is associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.

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