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

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.

scholarly journals Total joint reconstruction using computer-assisted surgery with stock prostheses for a patient with bilateral TMJ ankylosis

2019 ◽  
Vol 41 (1) ◽  
Author(s):  
Seung-Hyun Rhee ◽  
Seung-Hak Baek ◽  
Sang-Hun Park ◽  
Jong-Cheol Kim ◽  
Chun-Gi Jeong ◽  
...  
Keyword(s):  
Surgical Planning ◽  
Virtual Surgery ◽  
Computer Assisted ◽  
Lower Margin ◽  
Tmj Ankylosis ◽  
Reconstruction Surgery ◽  
Joint Reconstruction ◽  
Virtual Surgical Planning ◽  
Surgical Guides ◽  
Cad Cam

Abstract Backgrounds The purpose of this study is to discuss the total joint reconstruction surgery for a patient with recurrent ankylosis in bilateral temporomandibular joints (TMJs) using three-dimensional (3D) virtual surgical planning, computer-aided manufacturing (CAD/CAM)-fabricated surgical guides, and stock TMJ prostheses. Case presentation A 66-year-old female patient, who had a history of multiple TMJ surgeries, complained of severe difficulty in eating and trismus. The 3D virtual surgery was performed with a virtual surgery software (FACEGIDE, MegaGen implant, Daegu, South Korea). After confirmation of the location of the upper margin for resection of the root of the zygoma and the lower margin for resection of the ankylosed condyle, and the position of the fossa and condyle components of stock TMJ prosthesis (Biomet, Jacksonville, FL, USA), the surgical guides were fabricated with CAD/CAM technology. Under general anesthesia, osteotomy and placement of the stock TMJ prosthesis (Biomet) were carried out according to the surgical planning. At 2 months after the operation, the patient was able to open her mouth up to 30 mm without complication. Conclusion For a patient who has recurrent ankylosis in bilateral TMJs, total joint reconstruction surgery using 3D virtual surgical planning, CAD/CAM-fabricated surgical guides, and stock TMJ prostheses may be an effective surgical treatment option.

Clinical evaluation of an automated virtual surgical planning platform for mandibular reconstruction

Head & Neck ◽  
2020 ◽  
Vol 42 (12) ◽  
pp. 3506-3514 ◽  
Author(s):  
Edward Wang ◽  
J. Scott Durham ◽  
Donald W. Anderson ◽  
Eitan Prisman
Keyword(s):  
Clinical Evaluation ◽  
Surgical Planning ◽  
Mandibular Reconstruction ◽  
Virtual Surgical Planning

scholarly journals Correction of a Posttraumatic Orbital Deformity Using Three-Dimensional Modeling, Virtual Surgical Planning with Computer-Assisted Design, and Three-Dimensional Printing of Custom Implants

2018 ◽  
Vol 11 (1) ◽  
pp. 078-082 ◽  
Author(s):  
Kristopher M. Day ◽  
Paul M. Phillips ◽  
Larry A. Sargent
Keyword(s):  
Computer Technology ◽  
Surgical Planning ◽  
Bone Fractures ◽  
Three Dimensional ◽  
Lower Eyelid ◽  
Frontal Bone ◽  
Facial Trauma ◽  
Computer Assisted ◽  
Virtual Surgical Planning ◽  
Three Dimensional Modeling

We describe a case of complex, posttraumatic skull and orbital deformities that were evaluated and treated with advanced computer technology, including virtual surgical planning, three-dimensional (3D) modeling, and printed patient custom implants (PCI) fabricated by 3D printing. A 50-year-old man presented to our craniofacial referral center 1 year after failed reduction of complex left orbital, zygomatic, and frontal bone fractures due to a motorcycle collision. The patient's chief complaint was debilitating diplopia in all fields of gaze. On examination, he had left enophthalmos, left canthal displacement, lower eyelid ectropion, vertical orbital dystopia, and a laterally and inferiorly displaced, comminuted zygoma with orbital rim and frontal bone defects. The normal orbit was mirrored to precisely guide repositioning of the globe, orbital reconstruction, and cranioplasty. Preinjury appearance with normal globe position was restored with complete resolution of diplopia. Modern 3D technology allows the surgeon to better analyze complex orbital deformities and precisely plan surgical correction with the option of printing a PCI. These techniques were successfully applied to resolve a case of debilitating diplopia and aesthetic deficits after facial trauma. Further application of advanced 3D computer technology can potentially improve the results of severe orbital and craniofacial trauma reconstruction.

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