Computer-Assisted Surgery Increases Efficiency of Mandibular Reconstruction with Fibula Free Flap

Yang, Wei‐En; Powcharoen, Warit; Su, Yu‐xiong

doi:10.1097/prs.0000000000007296

Cited by 7 publications

(4 citation statements)

References 5 publications

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“…Patients with both the condyle and ramus removed had significantly higher deviations in terms of the condyle and joint space. Previous studies have confirmed the benefits of CAS in improving the accuracy of mandibular reconstruction 6,13,22 . However, the results of the present study are novel in showing that 3D-printed surgical plates improved the spatial accuracy of the TMJ.…”

Section: Discussionmentioning

confidence: 69%

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Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

Yang

Choi

Zhu

et al. 2022

International Journal of Oral and Maxillofacial Surgery

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Spatial deviations of the temporomandibular joint (TMJ) after oncological mandibular reconstruction are important to the aesthetic and functional rehabilitation. The aim of this study was to clarify whether and how three dimensionally (3D) printed patient-specific surgical plates, and the preservation of the condyle or ramus, affect spatial deviations of the TMJ. A total of 33 patients who underwent mandibular reconstruction via computer-assisted surgery were included. Regarding absolute deviations, patients in the 3D-printed plate group showed smaller TMJ deviations compared to those in the conventional plate group. There was no difference in absolute deviations of the TMJ regardless of whether the condyle or ramus was preserved. Regarding physiological deviations, the impact on the contralateral TMJ was smaller in the 3D-printed plate group. Patients with both the condyle and ramus removed had significantly higher deviations of the condyle and joint space. In summary, 3D-printed patient-specific surgical plates improved the spatial accuracy of the TMJ. Under physiological conditions, TMJ deviations on the operated side were mainly affected by the preservation of the condyle. Removal of both the condyle and ramus caused more severe spatial interference to the TMJ; this should be further confirmed.

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Section: Discussionmentioning

confidence: 69%

“…Computer-assisted surgery (CAS) facilitates the accurate harvest of transplanted bone grafts by preoperative virtual surgery and 3D-printed cutting guides 6,[11][12][13] . More recently, the advent of 3D-printed patientspecific surgical plates has further enhanced the precise alignment and fixation of bone grafts 14,15 .…”

mentioning

confidence: 99%

Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

Yang

Choi

Zhu

et al. 2022

International Journal of Oral and Maxillofacial Surgery

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“…Personalized guiding templates can be fabricated, and the titanium plates can be pre-shaped in advance to shorten the operation duration. Template-guided mandibular reconstruction provides higher accuracy, acceptability, and less variation than the conventional free-hand surgeries ( 8 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

Deviation Analyses of Computer-Assisted, Template-Guided Mandibular Reconstruction With Combined Osteotomy and Reconstruction Pre-Shaped Plate Position Technology: A Comparative Study

et al. 2021

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BackgroundComputer-assisted and template-guided mandibular reconstruction provides higher accuracy and less variation than conventional freehand surgeries. The combined osteotomy and reconstruction pre-shaped plate position (CORPPP) technique is a reliable choice for mandibular reconstruction. This study aimed to evaluate the accuracy of CORPPP-guided fibular flap mandibular reconstruction and analyze the possible causes of the deviations.Patients and MethodsFrom June 2015 to December 2016, 28 patients underwent fibular flap mandibular reconstruction. Virtual planning and personalized CORPPP-guided templates were applied in 15 patients while 13 patients received conventional freehand surgeries. Deviations during mandibulectomy and fibular osteotomy, and overall and triaxial deviation of the corresponding mandibular anatomical landmarks were measured by superimposing the pre- and postoperative virtual models.ResultsThe deviation of the resection line and resection angle was 1.23 ± 0.98 mm and 4.11° ± 2.60°. The actual length of fibula segments was longer than the designed length in 7 cases (mean: 0.35 ± 0.32 mm) and shorter in 22 cases (mean: 1.53 ± 1.19 mm). In patients without ramus reconstruction, deviations of the ipsilateral condylar head point (Co.), gonion point (Go.), and coracoid process point (Cor.) were 6.71 ± 3.42 mm, 5.38 ± 1.71 mm, and 11.05 ± 3.24 mm in the freehand group and 1.73 ± 1.13 mm, 1.86 ± 0.96 mm, and 2.54 ± 0.50 mm in the CORPPP group, respectively, with significant statistical differences (p < 0.05). In patients with ramus reconstruction, deviations of ipsilateral Co. and Go. were 9.79 ± 4.74 mm vs. 3.57 ± 1.62 mm (p < 0.05), and 15.17 ± 6.53 mm vs. 4.36 ± 1.68 mm (p < 0.05) in the freehand group and CORPPP group, respectively.ConclusionMandibular reconstructions employing virtual planning and personalized CORPPP-guided templates show significantly higher predictability, convenience, and accuracy of mandibular reconstruction compared with conventional freehand surgeries. However, more clinical cases were required for further dimensional deviation analysis. The application and exploration of clinical practice would also continuously improve the design of templates.

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“…Major procedures included tumor resection, bone flap harvest, and mandibular reconstruction. CAS was performed on all patients in the study group, including preoperative virtual surgery, real surgery, and postoperative accuracy analysis [14,24,25]. Patient-specific cutting and shaping guides and pre-bent surgical plates were designed and fabricated by UEG Medical (Shanghai, China).…”

Section: Surgical Proceduresmentioning

confidence: 99%

Changes in condylar position and morphology after mandibular reconstruction by vascularized fibular free flap with condyle preservation

Chen,

Li,

Sun

et al. 2023

Clin Oral Invest

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ObjectsChanges in condylar position and morphology after mandibular reconstruction are important to aesthetic and functional rehabilitation. We evaluated changes in condylar position and morphology at different stages after mandibular reconstruction with condyle preservation. Materials and MethodsA total of 23 patients who underwent mandibular reconstruction with bular ap were included in this retrospective study. CT data of all patients were recorded before surgery (T0), 7 to 14 days after surgery (T1), and at least 6 months after surgery (T2). 5 parameters describing the condylar position and 4 parameters describing the morphology were measured in sagittal and coronal views of CT images. The association between clinical characteristics and changes in condylar position and morphology. A nite element model was established to investigate the stress distribution and to predict the spatial movement tendency of the condyle after reconstruction surgery. ResultsThe condylar position changed over time after mandibular reconstruction. The ipsilateral condyles moved inferiorly after surgery (T0 to T1) and continually move anteriorly, inferiorly, and laterally during long-term follow-up (T1 to T2). Contrary changes were noted in the contralateral condyles with no statistical signi cance. No morphological changes were detected. No signi cant relationship between clinical characteristics and changes in condylar position and morphology. A consistent result was observed in the nite element analysis. ConclusionCondylar positions showed obvious changes over time after mandibular reconstruction with condylar preservation. Nevertheless, Further studies should be conducted to evaluate the clinical function outcomes and condylar position Clinical relevanceThese ndings can form the basis for the evaluation of short-term and long-term changes in condylar position and morphology among patients who have previously undergone mandibular reconstruction by FFF with condyle preservation.

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Computer-Assisted Surgery Increases Efficiency of Mandibular Reconstruction with Fibula Free Flap

Cited by 7 publications

References 5 publications

Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

Deviation Analyses of Computer-Assisted, Template-Guided Mandibular Reconstruction With Combined Osteotomy and Reconstruction Pre-Shaped Plate Position Technology: A Comparative Study

Changes in condylar position and morphology after mandibular reconstruction by vascularized fibular free flap with condyle preservation

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