Introduction of an algorithm for planning of autologous fibular transfer in mandibular reconstruction based on individual bone curvatures

Raith, Stefan; Rauen, Alexandra; Möhlhenrich, Stephan Christian; Ayoub, N.; Peters, Florian; Steiner, Timm; Hölzle, Frank; Modabber, Ali

doi:10.1002/rcs.1894

Cited by 12 publications

(12 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other groups have published on computational workflows for surgical planning. Raith et al 29 described a custom algorithm for planning mandibular reconstructions that approximates the fibula and mandibular resection with curves, and then matches the curves to create the reconstruction. Their algorithm was recently evaluated ex vivo by Modabber et al 30 Nakao et al 31 described a significantly more complex algorithm that accounts for the 3D shape of the mandible rather than a curve approximation and evaluate it ex‐vivo.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of an automated virtual surgical planning platform for mandibular reconstruction

et al. 2020

View full text Add to dashboard Cite

Background: Virtual surgical planning (VSP), via commercial services or developed in-house, has been applied to facilitate head and neck reconstruction. We evaluate a custom, automated planning software. Methods: Prospectively, VSP of 25 consecutive patients undergoing segmental mandibular reconstruction was performed. Postoperative CT was used to assess structural accuracy of VSP. Operative time, length of stay, and complication rate of the prospective cohort were compared with those of 25 consecutive retrospective historical cases. Results: The deviations between the plan and execution in mandibular width, projection, and volumetric overlap were 2.32 ± 3.91, 2.39 ± 1.72, and 0.59 ± 0.51 mm respectively. Compared with historical data, there was a significant reduction in operative time and length of stay, and no significant difference in complication rates. Conclusion: This is the largest prospective series evaluating an in-house VSP workflow for mandibular reconstruction and the first clinical evaluation of an automated planning platform.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of an automated virtual surgical planning platform for mandibular reconstruction

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In recent years computer-assisted planning is clinical routine and, in addition to custom-made resection and cutting guides, patient-specific manufactured osteosynthesis plates are available [ 59 , 60 , 61 , 62 , 63 , 64 ]. The selection of the donor region and reconstruction morphology is the subject of current research into the use of algorithm-based automated procedures [ 65 ]. There was no significant difference in the presence of HO between virtually planned and CAD/CAM stabilized fibula (10.69%) grafts than in those of analog and hand-bent osteosynthesis (11.45%).…”

Section: Discussionmentioning

confidence: 99%

Heterotopic Ossification of the Vascular Pedicle after Maxillofacial Reconstructive Surgery Using Fibular Free Flap: Introducing New Classification and Retrospective Analysis

Knitschke¹,

Siu²,

Bäcker³

et al. 2020

JCM

View full text Add to dashboard Cite

Heterotopic ossification (HO) is one of the described phenomena after maxillofacial reconstructive surgery using fibular free flap (FFF) at the reception-site. The aim of this study was to determine the radiological incidence and form of HO along the fibular vascular pedicle as well as the rate of clinical symptoms if present. CT-scans of 102 patients who underwent jaw reconstructive surgery by using FFF from January 2005 to December 2019 were evaluated concerning the presence of HO. Subsequently, the patient files were evaluated to identify the cases with clinical signs and complications related to the presence of HO. A radiological classification of four different HO types was developed. Out of 102 patients, 29 (28.43%) presented radiological findings of HO. Clinical symptoms were recorded in 10 cases (9.8%) (dysphagia (n = 5), trismus (n = 3), bony masses (n = 2)) and from these only five (4.9%) needed surgical removal of calcified structures. HO occurs significantly in younger patients (mean 52.3 year). In maxillary reconstructions, HO was radiologically visible six months earlier than after mandibular reconstruction. Furthermore, HO is observed after every third maxilla and every fourth mandible reconstruction. This study developed for the first time a classification of four distinct HO patterns. HO types 1 and 2 were mostly observed after mandible reconstruction and type 4 predominantly after maxilla reconstruction.

show abstract

“…Matching resection guides are created automatically. The recently published software of Raith et al includes an algorithm that focuses on helping the surgeon to find the best fit of defined fibula segments determined by distinctive parameter setting [ 24 ]. In contrast to this, the planning tool used in our study allows a specific adaption of the reconstruction by shifting and rotating all cutting planes and segments freely.…”

Section: Methodsmentioning

confidence: 99%

Improving mandibular reconstruction by using topology optimization, patient specific design and additive manufacturing?—A biomechanical comparison against miniplates on human specimen

et al. 2021

View full text Add to dashboard Cite

In this study, topology optimized, patient specific osteosynthesis plates (TOPOS-implants) are evaluated for the mandibular reconstruction using fibula segments. These shape optimized implants are compared to a standard treatment with miniplates (thickness: 1.0 mm, titanium grade 4) in biomechanical testing using human cadaveric specimen. Mandible and fibula of 21 body donors were used. Geometrical models were created based on automated segmentation of CT-scans of all specimens. All reconstructions, including cutting guides for osteotomy as well as TOPOS-implants, were planned using a custom-made software tool. The TOPOS-implants were produced by electron beam melting (thickness: 1.0 mm, titanium grade 5). The fibula-reconstructed mandibles were tested in static and dynamic testing in a multi-axial test system, which can adapt to the donor anatomy and apply side-specific loads. Static testing was used to confirm mechanical similarity between the reconstruction groups. Force-controlled dynamic testing was performed with a sinusoidal loading between 60 and 240 N (reconstructed side: 30% reduction to consider resected muscles) at 5 Hz for up to 5 · 105 cycles. There was a significant difference between the groups for dynamic testing: All TOPOS-implants stayed intact during all cycles, while miniplate failure occurred after 26.4% of the planned loading (1.32 · 105 ± 1.46 · 105 cycles). Bone fracture occurred in both groups (miniplates: n = 3, TOPOS-implants: n = 2). A correlation between bone failure and cortical bone thickness in mandible angle as well as the number of bicortical screws used was demonstrated. For both groups no screw failure was detected. In conclusion, the topology optimized, patient specific implants showed superior fatigue properties compared to miniplates in mandibular reconstruction. Additionally, the patient specific shape comes with intrinsic guiding properties to support the reconstruction process during surgery. This demonstrates that the combination of additive manufacturing and topology optimization can be beneficial for future maxillofacial surgery.

show abstract

Introduction of an algorithm for planning of autologous fibular transfer in mandibular reconstruction based on individual bone curvatures

Cited by 12 publications

References 46 publications

Clinical evaluation of an automated virtual surgical planning platform for mandibular reconstruction

Clinical evaluation of an automated virtual surgical planning platform for mandibular reconstruction

Heterotopic Ossification of the Vascular Pedicle after Maxillofacial Reconstructive Surgery Using Fibular Free Flap: Introducing New Classification and Retrospective Analysis

Improving mandibular reconstruction by using topology optimization, patient specific design and additive manufacturing?—A biomechanical comparison against miniplates on human specimen

Contact Info

Product

Resources

About