Computer-assisted Mandibular Reconstruction with Vascularized Iliac Crest Bone Graft

Modabber, Ali; Gerressen, Marcus; Stiller, Maria Barbara; Noroozi, Nelson; Füglein, Alexander; Hölzle, Frank; Riediger, D; Ghassemi, Alireza

doi:10.1007/s00266-012-9877-2

Cited by 55 publications

(41 citation statements)

References 18 publications

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“…As expected, the commonest reason for publishing was to report a series demonstrating complete experience with donor sites (12,45) or with a single flap option (49). In the last 5-year period, more reports appeared with the use of 3-D imaging and plate preparation, with an attempt to show shorter operating times and better outcomes (170). There were an additional 27 aims cited (not shown in Table 2) that included subjects as diverse as distraction versus reconstruction (160) and calcification of the pedicle (172).…”

Section: Resultsmentioning

confidence: 99%

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Brown

Lowe

Kanatas³

et al. 2017

British Journal of Oral and Maxillofacial Surgery

137

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A systematic review was undertaken to explore the mandibular reconstruction techniques and outcomes, using composite free flaps.A total of 9499 mandibular defects were reconstructed with 6178 fibulas, 1380 iliac crests, 1127 composite radials, 709 scapulas, 63 serratus anterior and rib, 32 metatarsals and 10 lateral arm flaps including humerus. The flap failure rate was higher for the iliac crest at 6.2% (66/1059) compared to 3.4% (202/6018) if the fibula, radial or scapula was used (p<0.001). Details relating to osteotomy rate, non-union and fistula rates were evaluated. Iliac crest was most often rehabilitated with implantretained prosthesis (44%, 100/229), compared to 26% (605/2295) (p<0.001) if another flap was used. Changing trends over the study period were not apparent, regarding flap choice or related complications.Although we are able to show some significant differences relating to the type of flap used, it is disappointing to present the underreporting of fundamental outcomes such as the osteotomy rate, non-union and fistula rates. This review demonstrates the need for more comprehensive and consistent outcome reporting, that will allow the comparison of different techniques for similar defects.

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Section: Resultsmentioning

confidence: 99%

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Brown

Lowe

Kanatas³

et al. 2017

British Journal of Oral and Maxillofacial Surgery

137

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“…Three-dimensional computed tomography (CT) is used for preoperative planning in reconstructive surgery as it is able to provide information in relation to the availability and quality of the graft [18,19]. However, only the study of Yavuz et al [13] has evaluated the amount of harvestable bone graft in the mandibular symphysis using CT, and other types of donor sites were not considered.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional evaluation of the different donor sites of the mandible for autologous bone grafts

et al. 2014

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“…The present study, which used the ProPlan CMF computer-assisted method previously described for mandibular and maxillary reconstruction with microvascular bone flaps,18,26–28 delivered surgical guides for intraoperative use based on an accurate virtual surgery plan, which was achieved with the aid of preoperative simulation. The goal was to evaluate the accuracy of this method for primary mandibular reconstruction with an osteomyocutaneous fibula flap and an iliac crest bone flap in patients with a similar bony defect and location, using an iterative closest point algorithm.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a reduction in operation time, decrease of complications, and better aesthetic and functional outcomes have been demonstrated using computer-assisted surgery 18–21. The implementation of computer-assisted surgery varies from stereolithographic three-dimensional models, cutting guides, and prebent plates to preshaped titanium mesh implants 22–24…”

Section: Introductionmentioning

confidence: 99%

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The accuracy of computer-assisted primary mandibular reconstruction with vascularized bone flaps: iliac crest bone flap versus osteomyocutaneous fibula flap

Modabber¹,

Ayoub²,

Möhlhenrich³

et al. 2014

MDER

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BackgroundThe intention of mandibular reconstruction is to restore the complex anatomy with maximum possible functionality and high accuracy. The aim of this study was to evaluate the accuracy of computer-assisted surgery in primary mandibular reconstruction with an iliac crest bone flap compared with an osteomyocutaneous fibula flap.Materials and methodsPreoperative computed tomography data of the mandible and the iliac crest or fibula donor site were imported into a specific surgical planning software program. Surgical guides were manufactured using a rapid prototyping technique for translating the virtual plan, including information on the transplant dimensions and shape, into real-time surgery. Using postoperative computed tomography scans and an automatic surface-comparison algorithm, the actual postoperative situation was compared with the preoperative virtual simulation.ResultsThe actual flap position showed a mean difference from the virtual plan of 2.43 mm (standard deviation [SD] ±1.26) and a surface deviation of 39% <2 mm and 15% <1 mm for the iliac crest bone flap, and a mean difference of 2.18 mm (SD ±1.93) and a surface deviation of 60% <2 mm and 37% <1 mm for the osteomyocutaneous fibula flap. The position of the neomandible reconstructed with an osteomyocutaneous fibula flap indicated a mean difference from the virtual plan of 1.25 mm (SD ±1.31) and a surface deviation of 82% <2 mm and 57% <1 mm, in contrast to a mean difference of 1.68 mm (SD ±1.25) and a surface deviation of 63% <2 mm and 38% <1 mm for the neomandible after reconstruction with an iliac crest bone flap. For shape analysis, a similarly high accuracy could be calculated for both flaps.ConclusionVirtual surgical planning is an effective method for mandibular reconstruction with vascularized bone flaps, and can help to restore the anatomy of the mandible with high accuracy in position and shape. It seems that primary mandibular reconstruction with the osteomyocutaneous fibula flap is more accurate compared with the vascularized iliac crest bone flap.

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Computer-assisted Mandibular Reconstruction with Vascularized Iliac Crest Bone Graft

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Cited by 55 publications

References 18 publications

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Three-dimensional evaluation of the different donor sites of the mandible for autologous bone grafts

The accuracy of computer-assisted primary mandibular reconstruction with vascularized bone flaps: iliac crest bone flap versus osteomyocutaneous fibula flap

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