Factors influencing CAD/CAM accuracy in fibula free flap mandibular reconstruction

Sweed, Ahmed Hassan; Bolzoni, Alessandro; Kadubiec, Aleksandra; Beltramini, Giada Anna; Cherchi, Alessandro; Baj, A.

doi:10.14639/0392-100x-n0400

Cited by 9 publications

(4 citation statements)

References 15 publications

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“…The first group used CAD/CAM combined with patient-specific plate. [15][16][17] The second group used CAD/CAM combined with manually bending reconstruction plate. 4,5,[18][19][20][21][22][23][24][25][26] The last group used CAD/CAM combined with miniplate.…”

Section: Discussionmentioning

confidence: 99%

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The Precision of Different Types of Plates Fabricated With a Computer-Aided Design and Manufacturing System in Mandibular Reconstruction With Fibular-Free Flaps

Yodrabum¹,

Rudeejaroonrung

Viriya

et al. 2022

Journal of Craniofacial Surgery

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BackgroundComputer-assisted surgery (CAS) has been introduced to mandible reconstruction with bular free ap in cutting guide placement. When CAS is cooperated with different plate xations, the results show various degrees of errors by which this study aimed to evaluate. MethodsMock surgeries were conducted in 3D-printed mandibles with either 2 types of defects; limited or extensive, reconstructed from 2 ameloblastoma patients. Three types of xations; miniplate, manually bending reconstruction plate and patient-speci c plates are tested, each of which was performed 3 times in each type of defects, adding up to 18 surgeries. One with the least errors was selected and applied with patients whose 3D-printed mandibles derived. Finally, in vivo errors were compared with the mock. ResultsIn limited defect, average errors show no statistical signi cance among all types. In extensive defect, patient-speci c plate had a signi cantly lower average condylar error than manually bending reconstruction plate and miniplate (8.09±2.52 mm vs. 25.49±2.72 and 23.13±13.54 mm, respectively).When patient-speci c plate was applied in vivo, the errors were not signi cantly different from the mock. ConclusionPatient-speci c plates cooperated with CAS shows the least errors. Nevertheless, manually bent reconstruction plates and miniplates could be applied in limited defects with caution.

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Section: Discussionmentioning

confidence: 99%

“…According to published literature, the subjects were separated into 3 categories by using different plate fixation methods. The first group used CAD/CAM combined with patient-specific plate 15–17. The second group used CAD/CAM combined with manually bending reconstruction plate 4,5,18–26.…”

Section: Discussionmentioning

confidence: 99%

The Precision of Different Types of Plates Fabricated With a Computer-Aided Design and Manufacturing System in Mandibular Reconstruction With Fibular-Free Flaps

Yodrabum¹,

Rudeejaroonrung

Viriya

et al. 2022

Journal of Craniofacial Surgery

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“…This process eliminates the need to bend plates intraoperatively, a technique which creates points of weakness and likely contributes to the improved outcomes seen with patients who have preoperative CAD/CAM. [20][21][22][23] In examining complications following FFF-based reconstruction of mandibular defects, the operating surgeon should ensure familiarity with patient-specific factors and comorbidities that may contribute to deleterious and undesirable results. For instance, certain medical comorbidities and environmental exposures, including diabetes mellitus, underlying cardiovascular disease, and smoking status should be considered in the preoperative workup.…”

Section: Discussionmentioning

confidence: 99%

Miniplate Versus Reconstruction Bar Fixation for Oncologic Mandibular Reconstruction with Free Fibula Flaps

Cohen

Graziano

Shamsunder

et al. 2023

J Reconstr Microsurg

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Purpose Fibula free flaps (FFF) are the gold standard tissue for reconstruction of segmental mandibular defects. A comparison of mini-plate (MP) and reconstruction bar (RB)-based fixation of FFFs has been previously described in a systematic review. Long-term studies comparing the two plating methods are lacking. The authors aim to examine the complication profile between MPs and RBs at a single tertiary cancer center. We hypothesized that increased components and a lack of rigid fixation inherent to MPs would lead to higher rates of hardware exposure/failure. Methods A retrospective review was performed from a prospectively maintained database at Memorial Sloan Kettering Cancer Center. Patients who underwent FFF-based reconstruction of mandibular defects between 2015-2021 were included. Data on patient demographics, risk factors, operative indications, and chemoradiation was collected. Primary outcomes of interest were perioperative flap-related complications, union rates, osteoradionecrosis (ORN), return to the operating room (OR), and hardware exposure/failure. Recipient site complications were stratified into two groups: early (<90 days) and late (>90 days). Results 96 patients met inclusion criteria (RB=63, MP=33). Patients in were similar with respect to age, comorbidities, smoking history, and operative characteristics. The mean follow-up period was 17.24 months. There were no differences in rates of hardware failure overall; however, in patients with an initial complication after 90 days, MPs had significantly higher rates of hardware exposure (3 vs. 0, p=0.046).  Conclusions MPs were found to have a higher risk of exposed hardware in patients with a late initial recipient site complication. It is possible that improved fixation with highly adaptive RBs designed by computer-aided design/manufacturing (CAD/CAM) technology explains these results. Future studies are needed to assess the effects of rigid mandibular fixation on patient reported outcome measures in this unique population.

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“…Thus, CAD-CAM surgery can be considered as a useful tool to improve the quality of the reconstruction and reduce the need for secondary revision procedures (flap repositioning for occlusion restoration or plate dislocation). Moreover, guided surgery has the potential not only to reduce surgical time, but also to reduce ischaemic time for the fibular flap 5,6 . Regarding the second issue, we have to highlight that the amount of titanium needed for this type of restoration can increase the risk of plate exposure after radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Mandibular reconstruction using a new design for a patient-specific plate to support a fibular free flap and avoid double-barrel technique

Tarsitano

Battaglia

Corinaldesi

et al. 2021

Acta Otorhinolaryngol Ital

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Factors influencing CAD/CAM accuracy in fibula free flap mandibular reconstruction

Abstract: I fattori che influenzano l'accuratezza del CAD/CAM nella ricostruzione mandibolare del lembo libero di fibula

Cited by 9 publications

References 15 publications

The Precision of Different Types of Plates Fabricated With a Computer-Aided Design and Manufacturing System in Mandibular Reconstruction With Fibular-Free Flaps

The Precision of Different Types of Plates Fabricated With a Computer-Aided Design and Manufacturing System in Mandibular Reconstruction With Fibular-Free Flaps

Miniplate Versus Reconstruction Bar Fixation for Oncologic Mandibular Reconstruction with Free Fibula Flaps

Mandibular reconstruction using a new design for a patient-specific plate to support a fibular free flap and avoid double-barrel technique

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