Impact of Planning Method (Conventional versus Virtual) on Time to Therapy Initiation and Resection Margins: A Retrospective Analysis of 104 Immediate Jaw Reconstructions

Abstract

Virtual surgical planning (VSP) and patient-specific implants are currently increasing for immediate jaw reconstruction after ablative oncologic surgery. This technique contributes to more accurate and efficient preoperative planning and shorter operation time. The present retrospective, single-center study analyzes the influence of time delay caused by VSP vs. conventional (non-VSP) reconstruction planning on the soft and hard tissue resection margins for necessary oncologic safety. A total number of 104 cases of immediate jaw reconstruction with free fibula flap are included in the present study. The selected method of reconstruction (conventionally, non-VSP: n = 63; digitally, VSP: n = 41) are analyzed in detail. The study reveals a statistically significant (p = 0.008) prolonged time to therapy initiation with a median of 42 days when the VSP method compared with non-VSP (31.0 days) is used. VSP did not significantly affect bony or soft tissue resection margin status. Apart from this observation, no significant differences concerning local tumor recurrence, lymph node, and distant metastases rates are found according to the reconstruction method, and affect soft or bone tissue resection margins. Thus, we conclude that VSP for immediate jaw reconstruction is safe for oncological purposes.

Computed Tomography Angiography (CTA) before Reconstructive Jaw Surgery Using Fibula Free Flap: Retrospective Analysis of Vascular Architecture

“…Despite those significant advantages, surgery remains challenging in modifying the planned flap design or a prepared patient specific implant (PSI); if perforator vessels are insufficient, unforeseen difficulties on the vascular bundle occur, or the prepared oncologic resection margins are inadequate [45,46]. The necessity for exploring the contralateral leg and/or dissection of an additional microvascular flap can arise.…”

Surgical Margins After Computer-Assisted Mandibular Reconstruction: A Retrospective Study

“…Mandibular reconstruction with free flaps and customized plates was certainly considered to be an important step forward in recent years, especially after the advent of CAD/CAM, stereolithographic models, and virtual surgical planning. The positive impact of these technologies is certainly characterized by greater intraoperative precision and a reduction in surgical time [ 9 , 10 , 22 , 23 ], but also by the improved functional rehabilitation of the treated patients [ 8 ]. Thanks to virtual surgical planning, all of the phases of fibula modeling and insetting of the reconstructive plate can be carried out before detaching the vascular pedicle and this represents a further advantage, especially in composite flap harvesting [ 10 ].…”

“…If there is an unexpected progression of the tumor or a limited planned resection, the surgeon may have to modify the extent of the resection intraoperatively, nullifying the virtual planning on which the reconstruction was based. This last aspect can also be influenced by the delay required to virtually plan the surgery, although different opinions can be found in the literature [ 22 , 23 ]. Virtual planning, regardless of the technique, requires a thin-layer CT scan of the head and neck and of the lower limbs.…”

“…When a segmental mandibulectomy is required, a precise and functional reconstruction of the mandible can be achieved most often with a FFF [9,[16][17][18][19][20]. The benefits are well-known and related to function/contour restoration and, when possible, to dental rehabilitation [20][21][22][23][24], to improve the patients' residual quality of life [8,21]. Mandibular reconstruction with free flaps and customized plates was certainly considered to be an important step forward in recent years, especially after the advent of CAD/CAM, stereolithographic models, and virtual surgical planning.…”

Impact of Periosteal Branches and Septo-Cutaneous Perforators on Free Fibula Flap Outcome: A Retrospective Analysis of Computed Tomography Angiography Scans in Virtual Surgical Planning

“…Success rates of the FFF ranging between 90% to 95% have been reported in the literature (31)(32)(33)(34). Despite these significant benefits, surgery remains challenging in terms of insufficient perforator vessels, vascular bundle complications, or inadequate resections margins (35,36). A thorough preoperative examination of the vascular system using a computed tomography angiography scan (CTA) to reduce those risks is required, as CTA scans allow for simultaneous evaluation of bony and vascularly structures (37).…”