Advantages of surgical simulation in the surgical reconstruction 
of oncological patients

Iglesias-Martín, Fernando; Oliveros-Lopez, LG; Fernández-Olavarría, Ana; Serrera-Figallo, María-Ángeles; Gutiérrez-Corrales, Aída; Torrés-Lagares, Daniel; Gutiérrez-Pérez, José-Luís

doi:10.4317/medoral.22336

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…11 This makes the procedure more efficient and the reconstruction result more predictable and precise. 18 The surgical planning process is available from commercial vendors worldwide, but can also be implemented in an in-house procedure. In the present study, we compared both surgical planning and implementation solutions (in-house vs. commercial) in terms of postoperative reconstruction accuracy, functional aspects (bone union and wound healing disorders), and economic benefit.…”

Section: Discussionmentioning

confidence: 99%

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In‐house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time‐efficient than commercial procedures

Block,

Khromov,

Hoene

et al. 2024

Head & Neck

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BackgroundTo compare an in‐house and a commercially available surgical planning solution for mandibular reconstruction in terms of postoperative reconstruction accuracy and economic benefit.MethodsTwenty‐nine consecutive patients with advanced oral squamous cell carcinoma (OSCC) requiring segmental mandibular reconstruction were enrolled. Fifteen patients underwent in‐house surgical planning and 14 patients underwent a commercially available planning solution. A morphometric comparison of preoperative and postoperative computed tomography (CT) data sets and a cost–benefit comparison were performed.ResultsVolumes of planned and reconstructed bone segments differed significantly for both in‐house planning (p = 0.0431) and commercial planning (p < 0.0001). Significant differences in osteotomy angles were demonstrated for in‐house planning (p = 0.0391). Commercial planning was superior to in‐house planning for total mandibular deviation (p = 0.0217), intersegmental space volumes (p = 0.0035), and lengths (p = 0.0007). No significant difference was found between the two planning solutions in terms of intersegmental ossification and the incidence of wound healing disorders. In‐house planning took less time than commercial planning (p < 0.0001). Component manufacturing costs (p < 0.0001) and total cumulative costs (p < 0.0001) were significantly lower for in‐house planning.ConclusionsIn‐house surgical planning is less accurate but has a cost advantage and could be performed in less time.

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Section: Discussionmentioning

confidence: 99%

“…Today, it is performed with the aid of preoperative VSP and CAD/CAM‐based fabrication of surgical guides for a guided surgical approach 11 . This makes the procedure more efficient and the reconstruction result more predictable and precise 18 …”

Section: Discussionmentioning

confidence: 99%

In‐house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time‐efficient than commercial procedures

Block,

Khromov,

Hoene

et al. 2024

Head & Neck

View full text Add to dashboard Cite

show abstract

“…Mandibular reconstruction involving vascularized free tissue transfer is a surgically challenging and time-consuming procedure. Therefore, the use of VSP and guided surgery should contribute to increased efficiency, as well as enhance predictability and precision in the outcomes (16).…”

Section: Discussionmentioning

confidence: 99%

Postoperative facial appearance of patients with extensive oral squamous cell carcinoma can be adequately preserved with in‑house virtually planned mandibular reconstruction

Hoene,

Moser,

Schminke

et al. 2023

Mol Clin Oncol

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The present study aimed to assess the concordance of preoperative and postoperative hard and soft tissues in patients with advanced oral squamous cell carcinoma (OSCC) following virtual surgical planning (VSP) mandibular reconstruction. In the present study, a cohort of 32 patients with OSCC underwent in-house VSP, followed by guided mandibular reconstruction utilizing vascularized free tissue grafts sourced from the fibula or scapula. A morphometric analysis was conducted comparing preoperative and postoperative three-dimensional virtual models to evaluate discrepancies and identify potential risk factors associated with poor reconstruction outcomes. The outcome variables were the differences in root mean square (RMS) and mean surface distance (MSD) resulting from the application of an iterative closest point algorithm to the virtual data. The validity of soft tissue comparison data is limited due to its susceptibility to various confounding variables. The present study conducted a comprehensive re-evaluation of these variables. High tumor stage, positive N status and the use of adjuvant therapy contributed to more noticeable differences in preoperative and postoperative facial soft tissue appearance. The accuracy of postoperative bone reconstruction results was higher in patients who underwent neomandibular formation using a fibular graft compared with those who received a scapular graft. Preoperative and postoperative soft tissue analyses were conducted for comparison. The MSD showed a deviation of 3.2 mm (± 2.0 mm SD; range 1.3-9.5 mm), whereas the RMS was 5.3 (± 2.9 SD; range 2.1-14). In conclusion, in-house VSP and guided mandibular reconstructions can yield clinically accurate results, preserving patient appearance and offering the advantage of rapid feasibility.

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Virtual surgical planning and cone beam computed tomography in reconstruction of head and neck tumors – pilot study

et al. 2020

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The aim of study was to prove that combination of visual surgical planning (VSP) together with cone beam computed tomography (CBCT) is an optimal technique in fibular free flap reconstructions after complex tumor resections in the head and neck region and that it results in better functional and aesthetic outcome. Subjects and methods: 6 patients (3 females, 3 males) with head and neck tumors were included in the study. The region concerned midface in 2 cases and mandible in 4 patients. On the basis of computed tomography of the head, fibular free flap (FFF) reconstruction was planned with the VSP technique. 3D-printed models were prepared. At the beginning of the operation and few minutes after the reconstruction an xCAT CBCT by XORAN was performed. Minor corrections of the angles of the reconstructed bony parts were made where needed. The time of the operation was assessed for each case. Functional and cosmetic results were evaluated in 1-year follow up. Results: The average time of operation was 6 hours 48 minutes, which was app.1hour 40 minutes less than standard reconstructive surgery. Functional recovery was achieved in all patients. Aesthetic result was unsatisfactory for 2 patients due to insufficient soft tissue masses of the FFF. Conclusions: The authors claim that intraoperative CBCT imaging, regardless the cost, improves accuracy of aesthetic outcome of the reconstructive surgeries based on VSP, especially in the region of midface and mandible. Further studies on larger amount of subjects are required.

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Advantages of surgical simulation in the surgical reconstruction of oncological patients

Cited by 3 publications

References 19 publications

In‐house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time‐efficient than commercial procedures

In‐house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time‐efficient than commercial procedures

Postoperative facial appearance of patients with extensive oral squamous cell carcinoma can be adequately preserved with in‑house virtually planned mandibular reconstruction

Virtual surgical planning and cone beam computed tomography in reconstruction of head and neck tumors – pilot study

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