Axiographic results of CAD/CAM-assisted microvascular, fibular free flap reconstruction of the mandible: A prospective study of 21 consecutive cases

Ritschl, Lucas M.; Mücke, Thomas; Fichter, Andreas M.; Roth, Maximilian; Kaltenhauser, Clemens; Duc, Jean Marc Pho; Kesting, Marco; Wolff, Klaus‐Dietrich; Loeffelbein, Denys J.

doi:10.1016/j.jcms.2016.11.001

Cited by 14 publications

(16 citation statements)

References 29 publications

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“…The application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology in primary and secondary mandibular reconstruction with the free fibula flap (FFF) following ablative surgery is considered to be state of the art nowadays. Several studies have proven its benefits and superiority in terms of operating time, ischemic time, symmetry, bony consolidation, and function (1)(2)(3)(4), which may result in a positive cost-benefit balance sheet (5,6) as well as better functional and aesthetic results (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

et al. 2021

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BackgroundMandibular reconstruction is conventionally performed freehand, CAD/CAM-assisted, or by using partially adjustable resection aids. CAD/CAM-assisted reconstructions are usually done in cooperation with osteosynthesis manufacturers, which entails additional costs and longer lead time. The purpose of this study is to analyze an in-house, open-source software-based solution for virtual planning.Methods and MaterialsAll consecutive cases between January 2019 and April 2021 that underwent in-house, software-based (Blender) mandibular reconstruction with a free fibula flap (FFF) were included in this cross-sectional study. The pre- and postoperative Digital Imaging and Com munications in Medicine (DICOM) data were converted to standard tessellation language (STL) files. In addition to documenting general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time), conventional measurements and three-dimensional analysis methods (root mean square error [RMSE], mean surface distance [MSD], and Hausdorff distance [HD]) were used.ResultsTwenty consecutive cases were enrolled. Three-dimensional analysis of preoperative and virtually planned neomandibula models was associated with a median RMSE of 1.4 (0.4–7.2), MSD of 0.3 (-0.1–2.9), and HD of 0.7 (0.1–3.1). Three-dimensional comparison of preoperative and postoperative models showed a median RMSE of 2.2 (1.5–11.1), MSD of 0.5 (-0.6–6.1), and HD of 1.5 (1.1–6.5) and the differences were significantly different for RMSE (p < 0.001) and HD (p < 0.001). The difference was not significantly different for MSD (p = 0.554). Three-dimensional analysis of virtual and postoperative models had a median RMSE of 2.3 (1.3–10.7), MSD of -0.1 (-1.0–5.6), and HD of 1.7 (0.1–5.9).ConclusionsOpen-source software-based in-house planning is a feasible, inexpensive, and fast method that enables accurate reconstructions. Additionally, it is excellent for teaching purposes.

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Section: Introductionmentioning

confidence: 99%

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

et al. 2021

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“…Mandibular reconstruction after partial or continuity resection is a complex procedure with non-negligible sequela on the oro-pharyngeal integrity and function, aesthetics and quality of life [1][2][3]. With continuous technical and surgical improvements, the restoration of mandibular continuity has become a highly standardized procedure in high-volume centres over the last decades.…”

Section: Introductionmentioning

confidence: 99%

“…Another milestone in the continuous development and improvement of mandibular reconstruction was the introduction of computer-aided design and computer-aided manufacturing (CAD/CAM) in this field. The application of the CAD/CAM technique increased the quality, function, safety and symmetry of this surgical procedure and reduced the operating time significantly [2,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

et al. 2020

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Objectives The purpose of this study was to evaluate the incidence of complications following mandibular reconstruction and to analyse possible contributing factors. Materials and methods Clinical data and computed tomography scans of all patients who needed a mandibular reconstruction with a reconstruction plate, free fibula flap (FFF) or iliac crest (DCIA) flap between August 2010 and August 2015 were retrospectively analysed. Results One hundred and ninety patients were enrolled, encompassing 77 reconstructions with reconstruction plate, 89 reconstructions with FFF and 24 reconstructions with DCIA flaps. Cutaneous perforation was most frequently detected in the plate subgroup within the early interval and overall (each p = 0.004). Low body mass index (BMI) and total radiation dosage were the most relevant risk factors for the development of analysed complications. Conclusions Microvascular bone flaps have overall less skin perforation than reconstruction plates. BMI and expected total radiation dosage have to be respected in choice of reconstructive technique. Clinical relevance A treatment algorithm for mandibular reconstructions on the basis of our results is presented.

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“…Analysis of the functional outcome of virtually planned mandibular reconstructions are lacking, and comparative studies come to paradoxical conclusions. 24,[52][53][54] Copyright © 2023 American Society of Plastic Unauthorized reproduction of this article is prohibited.…”

Section: Discussionmentioning

confidence: 99%

“Maxillo-mandibular reconstruction with vascularized bone flaps using insourced virtual surgical planning and home-made CAD-CAM: A 5-year single-center evolution in 75 patients.”

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et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD/CAM) of surgical guides and jigs have dramatically changed the predictability of bony reconstruction of the jaw. VSP craftsmanship can lead to precision and enables the surgeon to complement the donor bone osteotomies with bony resection of the jaw. In recent years, immediate dental rehabilitation has become an integral part of VSP. However, outsourced CAD/CAM technology is expensive and may not be an option for many institutions worldwide. Methods: The authors present here a consecutive series of 75 maxillofacial reconstructions from 2015 to 2020. We established an insourced “in-house” protocol for VSP and “home-made” CAD/CAM for the reconstruction of maxilla-mandibular defects with fibula, iliac crest, and scapular angle flaps. All patient files were analyzed retrospectively, and relevant parameters influencing the reconstructive outcome were determined. Results: The authors went from a fibula-based protocol toward the selection of optimal vascularized bone for immediate placement of osteointegrated implants. Bone flap survival was 94.7% after 4 months. The 3-year patient survival is 77.6%. The authors show the multiple steps required for the routine use of in-house CAD/CAM and report the related financial balance. Conclusions: Insourced VSP and CAD/CAM has evolved into a valuable strategy in maxillomandibular reconstruction that promotes accuracy and precision and allows for occlusion-based planning with quality-of-life and aesthetic outcomes as essential parts of the reconstruction even in high-level oral cancers. Further reductions in the hardware and software acquisition costs may lead to widespread implementation of this innovative technology. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Axiographic results of CAD/CAM-assisted microvascular, fibular free flap reconstruction of the mandible: A prospective study of 21 consecutive cases

Cited by 14 publications

References 29 publications

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

“Maxillo-mandibular reconstruction with vascularized bone flaps using insourced virtual surgical planning and home-made CAD-CAM: A 5-year single-center evolution in 75 patients.”

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