Time and cost-analysis of virtual surgical planning for head and neck reconstruction: A matched pair analysis

Mazzola, Francesco; Smithers, Fiona; Cheng, Kai; Mukherjee, Payal; Low, Tsu-Hui Hubert; Ch’ng, Sydney; Palme, Carsten E.; Clark, Jonathan R.

doi:10.1016/j.oraloncology.2019.104491

Cited by 78 publications

(59 citation statements)

References 19 publications

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“…It suggests that VR environment may offer more measurement accuracy of complex anatomical structures with less measurement and identification errors even for experienced surgeons. This is in accordance to previous clinical studies mainly done in reconstructive surgery, which have shown that VR planning improve the accuracy of the surgical outcomes [22,23,[28][29][30][31].…”

Section: Discussionsupporting

confidence: 92%

Virtual reality improves the accuracy of simulated preoperative planning in temporal bones: a feasibility and validation study

Timonen

Iso-Mustajärvi

Linder

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Consumer-grade virtual reality (VR) has recently enabled various medical applications, but more evidence supporting their validity is needed. We investigated the accuracy of simulated surgical planning in a VR environment (VR) with temporal bones and compared it to conventional cross-sectional image viewing in picture archiving and communication system (PACS) interface. Methods Five experienced otologic surgeons measured significant anatomic structures and fiducials on five fresh-frozen cadaveric temporal bones in VR and cross-sectional viewing. Primary image data were acquired by computed tomography. In total, 275 anatomical landmark measurements and 250 measurements of the distance between fiducials were obtained with both methods. Distance measurements between the fiducials were confirmed by physical measurement obtained by Vernier caliper. The experts evaluated the subjective validity of both methods on a 5-point Likert scale qualitative survey. Results A strong correlation based on intraclass coefficient was found between the methods on both the anatomical (r > 0.900) and fiducial measurements (r > 0.916). Two-tailed paired t-test and Bland–Altman plots demonstrated high equivalences between the VR and cross-sectional viewing with mean differences of 1.9% (p = 0.396) and 0.472 mm (p = 0.065) for anatomical and fiducial measurements, respectively. Gross measurement errors due to the misidentification of fiducials occurred more frequently in the cross-sectional viewing. The mean face and content validity rating for VR were significantly better compared to cross-sectional viewing (total mean score 4.11 vs 3.39, p < 0.001). Conclusion Our study supports good accuracy and reliability of VR environment for simulated surgical planning in temporal bones compared to conventional cross-sectional visualization.

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Section: Discussionsupporting

confidence: 92%

Virtual reality improves the accuracy of simulated preoperative planning in temporal bones: a feasibility and validation study

Timonen

Iso-Mustajärvi

Linder

et al. 2020

Eur Arch Otorhinolaryngol

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“…This method of reconstruction is done by oncosurgeons themselves requiring fewer people to be exposed and less crowding in operation room. This is fast and the operative time is less than the free fibular osteocutaneous flap (180 min vs 474 min) [8,9].…”

Section: Discussionmentioning

confidence: 99%

A Novel and Simple Technique of Reconstructing the Central Arch Mandibular Defects—a Solution During the Resource-Constrained Setting of COVID Crisis

Rajan

Akhtar

Kumar

et al. 2020

Indian J Surg Oncol

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The current COVID 19 pandemic has a major impact on healthcare delivery globally. Oral cancer involving anterior arch of mandible is difficult to reconstruct and ideally, requires free fibular osteomyocutaneous flap. During this time of resource constraint situation, these free flaps are not a great choice, as it increases exposure of both patient and surgical team to the deadly virus. We are describing a novel method of reconstruction after resection of oral cancer involving anterior arch of mandible. In this new technique, we have reconstructed central arch defect by hanging bipaddle pectoralis major myocutaneous flap with orbicularis oris muscle using ethylene terephthalate suture. Operative time, early postoperative complications and early cosmetic and functional outcome were assessed. We have used this novel technique in eight patients of T4a oral cancer involving anterior arch of mandible and skin over chin. Mean operative time was 180 min. One patient had minor flap loss with surgical site infection (Clavien-Dindo grade I). In all patients, we were able to discharge all patients on eighth postoperative day. Cosmetic outcome and functional outcomes were mostly satisfactory. All patients were able to oppose their lips without any oral incompetence and drooling. Tongue mobility was good. There was no incidence of 'Andy Gump deformity'. This is a feasible option for reconstructing anterior arch defect in resource-and time-limited setting of COVID 19 pandemic. This technique can also be used in comorbid conditions where it is not advisable to do very long surgery.

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“…While prefabricated flaps are not appropriate for all patients, this two‐staged procedure not only shifts the focus towards occlusal restoration but also provides an opportunity to carefully plan the resection and bony reconstruction 9 . Although we have had considerable experience using digital planning, 10 in applying the dental bridge we have frequently observed that the custom plate does not position the bone in the planned position and it is actually the dental prosthesis which acts as an external fixator to prevent malpositioning of the fibula during plate fixation, as shown in Figure 5. These errors are primarily due to rotation of bone segments, which can be challenging to correct prosthetically.…”

Section: Discussionmentioning

confidence: 99%

Maxillofacial reconstruction with prefabricated prelaminated osseous free flaps

Diab

Leinkram

Wykes

et al. 2021

ANZ Journal of Surgery

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Background The prefabricated fibula flap is an advanced method of occlusal‐based reconstruction that combines placement of osseointegrated dental implants with prelamination, using a split skin graft on the fibula, weeks prior to the definitive reconstruction. This approach is resource intensive but has several advantages including eliminating the delay from reconstruction to dental rehabilitation. Methods A retrospective cohort study of all prefabricated fibula flaps used for mandible and maxillary reconstruction from 2012 to 2020 was performed. Outcome measures were implant survival, implant utilization and functional dental rehabilitation. Results A total of 17 prefabricated fibula flaps were performed including two analogue and 15 digital plans. There were nine maxillary and eight mandibular reconstructions, of which 11 were primary and seven were secondary. There were no free flap failures. A total of 65 implants were placed (average 3.8, median 3 implants). There was one implant failure at 6 years giving a 1.5% failure rate. There was 91% implant utilization and 94% functional dental rehabilitation. Conclusion The prefabricated fibula flap provides outstanding dental rehabilitation in well‐selected patients.

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Time and cost-analysis of virtual surgical planning for head and neck reconstruction: A matched pair analysis

Cited by 78 publications

References 19 publications

Virtual reality improves the accuracy of simulated preoperative planning in temporal bones: a feasibility and validation study

Virtual reality improves the accuracy of simulated preoperative planning in temporal bones: a feasibility and validation study

A Novel and Simple Technique of Reconstructing the Central Arch Mandibular Defects—a Solution During the Resource-Constrained Setting of COVID Crisis

Maxillofacial reconstruction with prefabricated prelaminated osseous free flaps

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