Aesthetic reconstruction of onco-surgical maxillary defects using free scapular flap with and without CAD/CAM customized osteotomy guide

Abstract

Background Reconstruction of the maxillary defects following tumor ablation remains to be a challenge for surgeons. Virtual surgical planning (VSP), intraoperative cutting guides and stereolithographic models provides the head and neck reconstructive surgeon with powerful tools for complex reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular free flap has not been as widely reported. The aim of this study was to compare aesthetic results and operation time of free scapular flap, with and without computer-aided design and computer-aided manufacturing (CAD/CAM) customized osteotomy guide, for reconstruction of maxillary defects. Methods In this prospective randomized controlled clinical trial study, we randomly assigned 22 patients with maxillary defects who were scheduled to undergo maxillary reconstruction with either free scapular flap with CAD/CAM customized osteotomy guide; study group (n = 11) or free scapular flap without CAD/CAM customized osteotomy guide; control group (n = 11). All patients were followed up for 3 months. The aesthetic outcome, operation and ischemic times were evaluated and compared. Results Aesthetic outcomes were evaluated objectively by means of differential surface area (sagittal and axial) measurement, which showed improved aesthetic outcome (contour symmetry) in the study group with a mean of (241.39 ± 113.74 mm2), compared to patients in control group with a mean of (358.70 ± 143.99 mm2). There were significant differences between the two groups (P < 0.05). Aesthetic outcomes were also evaluated subjectively by means of visual analogue scale (VAS) and patient’s satisfaction score (PSS). The postoperative aesthetic appearance was better in the study group with more patients satisfied than that in control group and there were statistically significant differences (P = 0.039). The mean total operative time was 678.81 min and 777.18 min in the study group and control group respectively (P < 0.05) and the mean ischemia time was 133.18 min and 195.72 min for study group and control group respectively (P < 0.05). The ischemia time and total operative time were shorter in the study group compared to those in the control group and there were no flap losses in both groups. Conclusion The use of CAD/CAM prefabricated cutting guides facilitates scapular flap molding and placement, minimizes ischemic time and operating time as well as improves aesthetic outcomes. Trialregistration This trial was registered at ClinicalTrials.gov. Registration number: NCT03757286. Registration date: 28/11/2018

Predictability and Effectiveness of Jaws Reconstructive Prosthesis after Tumor Removal: A Systematic Review and Meta-Analysis

“…Compared to conventional methods of freehand contouring, 3d model printing and VSP (3D/VSP) had an essential osteointegration of the fibular flap. Significantly less time was spent on the entire surgical procedure and the rebuilding of 3d/VSP patients [29,30]. The time to the bony union also considerably decreased, statistically, from 1.4 years with conventional methods to 0.8 years with the 3D/VSP.…”

The application of virtual reality and augmented reality in dentistry – a literature review

“…CAD/CAM guides may be superior to AR-aided surgical guides for bone cutting in maxillofacial osteotomies but with more precision and accuracy they may come on equal standings with the current gold standard. 33 An example of this is the MentorEye system that incorporates a virtual surgical plan (VSP) software using CAD/CAM support. 34,35 A head-mounted wearable system facilitating augmented surgery developed by Badiali et al 35 as a standalone, video-based device which facilitates maxillofacial bone surgery yielded great results for wafer less maxillary repositioning.…”

Evolution of Medical Modeling and 3D Printing in Microvascular Midface Reconstruction: Literature Review and Experience at MD Anderson Cancer Center

“…However, when the fibula is not available, and for certain types of defects, alternative osteocutaneous flaps should also be considered. While the overwhelming majority of cases are reconstructed with a fibula, VSP technology can also be used with high reliability for other flaps, such as the scapula or iliac crest [24][25][26][27]. A more recent advance in bony reconstruction of the midface was the introduction of the medial femoral condyle (MFC) flap for the reconstruction of midface defects [28].…”