Institutional-based and commercial virtual surgical planning in maxillomandibular reconstruction – Comparing the digital plan and postoperative scan

Johal, Michelle; Ma, Jolande; Parthasarathi, Krishnan; Dunn, Masako; Howes, Dale; Wallace, Christine; Palme, CE; Leinkram, David; Cheng, Kai; Clark, JR

doi:10.1016/j.bjps.2021.11.075

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…VSP has facilitated more rapid dental rehabilitation, improved health‐related quality of life outcomes, 21–23 and bespoke options including the prefabricated fibula, 21 the ‘Alberta’ and ‘Sydney Modified Alberta Reconstruction Technique’, 20,24 and ‘Jaw in a Day’ approaches 25 . More recently, in‐house (point‐of‐care) digital planning and manufacturing has made these dental rehabilitative options even more accessible 26–29 …”

Section: Discussionmentioning

confidence: 99%

“…This has changed referral patterns and influenced the flap choice in ways that are unlikely to be representative of other tertiary and quaternary referral institutions. They have also used reconstructive approaches that are not routinely employed by all institutions including dynamic facial reanimation using the chimeric VALT, 11,12,33 scapular flaps for osseous reconstruction, 31,32 the SCIP flap for oral reconstruction, 17,34 fascial flaps such as the TPF flap for laryngotracheal reconstruction and osteoradionecrosis, 35–37 and point‐of‐care VSP with primary dental implants for maxillomandibular reconstruction 18–24,26–32,38 …”

Section: Discussionmentioning

confidence: 99%

“…25 More recently, inhouse (point-of-care) digital planning and manufacturing has made these dental rehabilitative options even more accessible. [26][27][28][29] The use of VSP and dental implants has also had a major impact on flap selection. The fibula is the easiest bone flap to use for digital planning, place surgical guides, and achieve primary stability of dental implants at sufficient torque for immediate loading.…”

Section: Impact Of Technologymentioning

confidence: 99%

“…They have also used reconstructive approaches that are not routinely employed by all institutions including dynamic facial reanimation using the chimeric VALT, 11,12,33 scapular flaps for osseous reconstruction, 31,32 the SCIP flap for oral reconstruction, 17,34 fascial flaps such as the TPF flap for laryngotracheal reconstruction and osteoradionecrosis, [35][36][37] and point-of-care VSP with primary dental implants for maxillomandibular reconstruction. [18][19][20][21][22][23][24][26][27][28][29][30][31][32]38…”

Section: Generalisability Of Findings and Limitationsmentioning

confidence: 99%

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Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers

Papanikolas,

Clark

2023

ANZ Journal of Surgery

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BackgroundFree tissue transfer has fundamentally changed head and neck surgery, enabling reliable reconstruction of large defects with better function and aesthetics. This study assesses two decades of trends in free flap reconstruction, and how disease incidence, survival, surgeon caseload, team approach, and technology have impacted practice.MethodsRetrospective analysis of 1027 head and neck free flaps from 2006 to 2022. Outcomes examined include chronological changes in flap selection, indication, length of stay, incorporation of virtual surgical planning (VSP), annual caseload, survival, and their associations with the single versus multi‐team approach.ResultsThere were 764 soft‐tissue and 263 osseous reconstructions utilizing 21 different flaps. Anterolateral thigh and radial forearm accounted for 76.7% of soft tissue flaps, with recent increase in superficial circumflex iliac perforator flaps in young patients. Osseous flap proportion remained stable, but fibula flaps increased five‐fold with more VSP, dental implants, oral cancer, and multi‐team surgery. Outcomes such as complication rates, length of stay and disease specific/overall survival have improved over time despite increasing complexity (P = 0.001, P = 0.001, P < 0.001, and P < 0.001, respectively). However, there was no significant difference in operative time, complication rate, or disease specific/overall survival between single team or multi‐team approaches (P = 0.45, P = 0.054, P = 0.57, and P = 0.60, respectively).ConclusionSingle and multi‐team approaches may have similar fundamental outcomes, but as caseload, complexity, and life‐expectancy increases, both patients and surgeons benefit from a collaborative multi‐team approach that focuses on improving long‐term functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Impact Of Technologymentioning

confidence: 99%

Section: Generalisability Of Findings and Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers

Papanikolas,

Clark

2023

ANZ Journal of Surgery

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“…The Integrated Prosthetics and Reconstruction (IPR) research program , aims to restore the form and function of jawbones damaged by the effects of oral cancer treatment, particularly following radical tumor resections. This includes (1) the structural design and optimization of scaffold-based reconstruction devices using computed-tomographic (CT)-based finite element (FE) modeling combined with multiobjective optimization algorithms, (2) additive manufacturing, stem cell bioprinting, and biomaterials development, (3) the test and evaluation of new implant prototypes for reconstructing bone defects in the maxilla or mandibular bone in large in vivo animal models, and (4) the ex vivo assessment of implant performance in bone healing and neo-tissue regeneration using histology, imaging, and laboratory mechanical testing.…”

Section: Introductionmentioning

confidence: 99%

A Preclinical Trial Protocol Using an Ovine Model to Assess Scaffold Implant Biomaterials for Repair of Critical-Sized Mandibular Defects

Xin,

Ferguson,

Wan

et al. 2024

ACS Biomater. Sci. Eng.

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The present work describes a preclinical trial (in silico, in vivo and in vitro) protocol to assess the biomechanical performance and osteogenic capability of 3D-printed polymeric scaffolds implants used to repair partial defects in a sheep mandible. The protocol spans multiple steps of the medical device development pipeline, including initial concept design of the scaffold implant, digital twin in silico finite element modeling, manufacturing of the device prototype, in vivo device implantation, and in vitro laboratory mechanical testing. First, a patient-specific one-body scaffold implant used for reconstructing a critical-sized defect along the lower border of the sheep mandible ramus was designed using on computed-tomographic (CT) imagery and computer-aided design software. Next, the biomechanical performance of the implant was predicted numerically by simulating physiological load conditions in a digital twin in silico finite element model of the sheep mandible. This allowed for possible redesigning of the implant prior to commencing in vivo experimentation. Then, two types of polymeric biomaterials were used to manufacture the mandibular scaffold implants: poly ether ether ketone (PEEK) and poly ether ketone (PEK) printed with fused deposition modeling (FDM) and selective laser sintering (SLS), respectively. Then, after being implanted for 13 weeks in vivo, the implant and surrounding bone tissue was harvested and microCT scanned to visualize and quantify neotissue formation in the porous space of the scaffold. Finally, the implant and local bone tissue was assessed by in vitro laboratory mechanical testing to quantify the osteointegration. The protocol consists of six component procedures: (i) scaffold design and finite element analysis to predict its biomechanical response, (ii) scaffold fabrication with FDM and SLS 3D printing, (iii) surface treatment of the scaffold with plasma immersion ion implantation (PIII) techniques, (iv) ovine mandibular implantation, (v) postoperative sheep recovery, euthanasia, and harvesting of the scaffold and surrounding host bone, microCT scanning, and (vi) in vitro laboratory mechanical tests of the harvested scaffolds. The results of microCT imagery and 3-point mechanical bend testing demonstrate that PIII-SLS-PEK is a promising biomaterial for the manufacturing of scaffold implants to enhance the bone-scaffold contact and bone ingrowth in porous scaffold implants. MicroCT images of the harvested implant and surrounding bone tissue showed encouraging new bone growth at the scaffold-bone interface and inside the porous network of the lattice structure of the SLS-PEK scaffolds.

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What is the force required to treat trismus in patients undergoing oral cavity free flap reconstruction?

Charters,

Loy,

Cheng

et al. 2024

Head & Neck

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BackgroundTrismus therapy is often delayed after jaw reconstruction to avoid hardware failure or non‐union. The aim of this study is to document the forces that have been applied to patients undergoing free flap reconstruction of the oral cavity in the 12 months following oral cavity reconstruction, and to analyze the associations between force and maximal interincisal opening (MIO) over time.MethodsParticipants with trismus after free flap reconstruction of the oral cavity completed a 10‐week jaw stretching program using Restorabite™. Primary outcome measures included the minimum and maximal force applied by a trismus device during rehabilitation, MIO, bone union, and health‐related quality of life outcomes up to 12 months postoperatively.ResultsA mean of 20.6 Newtons (N) was used during passive exercises and 38.9 N during active exercises was used during trismus therapy. The mean increase in MIO for the 45 participants after 10 weeks, 6 months, and 12 months of therapy was 8.4 mm (p < 0.001), 12.6 mm (p < 0.001), 12.7 mm (p < 0.001), respectively. There was no significant difference in the mean minimal (p = 0.37) or mean maximal (p = 0.08) force applied between those who underwent osseous free flap reconstruction compared to fasciocutaneous only, respectively. In patients who underwent osseous reconstruction, 25 (67.6%) had complete bone union and 12 (32.4%) had partial union at 12 months postsurgery.ConclusionsIn participants undergoing osseous free flap reconstruction, there was no association between the force applied to the rates of bone union. Further research to define safe and optimal loading may benefit patients undergoing jaw reconstruction.

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Institutional-based and commercial virtual surgical planning in maxillomandibular reconstruction – Comparing the digital plan and postoperative scan

Cited by 7 publications

References 18 publications

Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers

Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers

A Preclinical Trial Protocol Using an Ovine Model to Assess Scaffold Implant Biomaterials for Repair of Critical-Sized Mandibular Defects

What is the force required to treat trismus in patients undergoing oral cavity free flap reconstruction?

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