The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions

Nyirjesy, Sarah; Heller, Margaret; Windheim, Natalia von; Gingras, Amelia; Kang, Stephen Y.; Özer, Enver; Agrawal, Amit; Old, Matthew; Seim, Nolan B.; Carrau, Ricardo L.; Rocco, James W.; VanKoevering, Kyle K.

doi:10.1016/j.oraloncology.2022.105976

Cited by 35 publications

(46 citation statements)

References 141 publications

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“…In recent years, there has been a trend at the authors' institution to be more selective with respect to elective tracheotomy. A contributing factor to this trend is the integration of VSP, which has been demonstrated by this group, and others, to reduce operating time 7,39 . This reduction in operating time is likely associated with less tissue edema and intravenous fluid supplementation and contributes to the reduced perceived need for tracheotomy for airway management.…”

Section: Discussionmentioning

confidence: 81%

Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design

et al. 2022

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Background The study's objective is to assess the feasibility and utility of VSP for maxillary reconstruction with the scapular free flap. Methods An open‐source VSP platform was used to create the reconstruction models and simple guides. Clinical, operative, and postoperative data were collected. Results Ten patients in the VSP cohort and 18 in the non‐VSP control cohort were included in the study. There was a significant reduction in operative time (256.0 ± 69.4 vs. 448.1 ± 108.2 min, p < 0.01), tracheotomy rate (20% vs. 72%, p < 0.01), increased two‐team utilization rate (80% vs. 0%, p < 0.01) and better reconstructive accuracy (7.5 ± 3.4 vs. 11.7 ± 7.6 mm, p = 0.048) for the VSP cohort. Conclusions Maxillary reconstruction planned with an in‐house open‐source VSP platform and accompanied simple guides can facilitate a two‐team approach, reduce operative time, and improve structural accuracy. This open‐source technology has great potential to be readily applied in other institutions to improve efficiency and outcomes.

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Section: Discussionmentioning

confidence: 81%

Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design

et al. 2022

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“…These reports along with our application of a patient-specific 3D-printed device points to the therapeutic potential of such devices in the future. Currently, use of 3D printing in otolaryngology-head and neck surgery is limited to surgical planning while therapeutic applications are rare [ 30 , 31 ]. Given the complexity of head and neck defects and the increased availability of and familiarity with 3D printing technology among high-volume otolaryngology centers, 3D printed devices should be considered in assistance of management of complex defects of the head and neck.…”

Section: Discussionmentioning

confidence: 99%

Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report

et al. 2023

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Background Complex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism. Case presentation A 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. As a solution, under the Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid. After 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function. Conclusions Patient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism.

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“…Steybe et al (2022) analyzed the computer-aided design of a deep circumflex iliac artery flap for mandibular defects to improve the accuracy of mandibular defect repair. Nyirjesy et al (2022) summarized the application of CAD/ CAM and 3D-printed in reconstructing defects after head and neck tumor defects, which can significantly reduce the operation time and improve the surgical effect. Based on the analysis of the co-cited literature and combined with recent studies, we speculate that the oral function and dentition precise repair of mandibular defects, the reconstruction of chewing and swallowing functions through computer-aided design, and 3D printing osteotomy guide plate may be the ongoing research hotspots in the direction of mandibular defects (Bak et al, 2010;Foley et al, 2013;Nyirjesy et al, 2022).…”

Section: Research Hotspot and Frontiersmentioning

confidence: 99%

“…Nyirjesy et al (2022) summarized the application of CAD/ CAM and 3D-printed in reconstructing defects after head and neck tumor defects, which can significantly reduce the operation time and improve the surgical effect. Based on the analysis of the co-cited literature and combined with recent studies, we speculate that the oral function and dentition precise repair of mandibular defects, the reconstruction of chewing and swallowing functions through computer-aided design, and 3D printing osteotomy guide plate may be the ongoing research hotspots in the direction of mandibular defects (Bak et al, 2010;Foley et al, 2013;Nyirjesy et al, 2022). Traditional methods are becoming increasingly difficult to meet the requirements of precise mandibular reconstruction because of the 3D anatomical structure and complex function of the face.…”

Section: Research Hotspot and Frontiersmentioning

confidence: 99%

Current global research on mandibular defect: A bibliometric analysis from 2001 to 2021

Li¹,

Li²,

Tang

et al. 2023

Front. Bioeng. Biotechnol.

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Background: Mandibular defects can result from congenital deformities, trauma, tumor resection, and osteomyelitis. The shape was irregular because the lower jaw was radians. This involves teeth and jaw functions; therefore, the difficulty of bone repair is greater than that in other body parts. Several standard treatments are available, but they result in various problems, such as difficulties in skin flap transplantation and possible zone dysfunction, artificial material boneless combining ability, and a long treatment period. This study aimed to introduce the present status of research on mandibular defects to analyze the current introduction and predict future research trends through a bibliometric study.Methods: From 2001 to 2021, publications on mandibular defects were collected for bibliometric visualization using VOSviewer, CiteSpace, and Scimago Graphica software based on the Web of Science Core Collection.Results: This study analyzed 4,377 articles, including 1,080 published in the United States, 563 in China, and 359 in Germany, with an increase in the number of articles published over the past 20 years. Wikesjoe and Ulf Mai E had the most publications (p = 36) and citations (citations = 1,553). Shanghai Jiaotong University published the highest number of papers among the research institutions (p = 88). The most productive journal was Journal of Oral and Maxillofacial Surgery, and the cited literature was primarily classified as dentistry, dermatology, and surgery. Cluster Analysis of Co-occurrence Keywords revealed that highest number of core words were mandibular defects, mandibular reconstruction, and bone regeneration. The highest cited words were head and neck cancer, accuracy, and osteogenic differentiation. High-frequency terms of Cluster Analysis of References were osteosynthesis plate, tissue engineering, and rapid distraction rate.Conclusion: Over the past 20 years, the number of studies on mandibular defects has gradually increased. New surgical procedures are increasingly being used in clinical practice. Current frontier topics mainly focus on areas such as computer-aided design, 3D printing of osteotomy and reconstruction guide plates, virtual surgical planning, and bone tissue engineering.

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The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions

Cited by 35 publications

References 141 publications

Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design

Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design

Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report

Current global research on mandibular defect: A bibliometric analysis from 2001 to 2021

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