Virtual planning and <scp>3D</scp>‐printed guides for mandibular reconstruction: Factors impacting accuracy

Annino, Donald J.; Sethi, Rosh K.V.; Hansen, Elisabeth E; Horne, Sylvia; Dey, Tanujit; Rettig, Eleni M.; Uppaluri, Ravindra; Kass, Jason; Goguen, Laura A.

doi:10.1002/lio2.830

Cited by 9 publications

(9 citation statements)

References 48 publications

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“…Participants were predominantly male (n = 10 [59%]) and non-Hispanic White (n = 14 [82%]), consistent with our center’s practice and similar populations nationally . The most common free flap type was fibular (n = 8 [47%]), a higher proportion than national data due to practice patterns at our center …”

Section: Resultsmentioning

confidence: 91%

“…23,24 The most common free flap type was fibular (n = 8 [47%]), a higher proportion than national data due to practice patterns at our center. 23,25 Thematic Analysis Three distinct themes were identified: (1) the tremendous effect of preoperative counseling on surgical decision-making and satisfaction; (2) coexisting and often conflicting priorities regarding survival vs quality of life; and (3) surgery as a momentous and distressing event (Figure).…”

Section: Key Pointsmentioning

confidence: 99%

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Patient Experience of Head and Neck Surgery With Free Flap Reconstruction

Dattilo,

Russell,

Warinner

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceMajor head and neck surgery with microvascular free tissue transfer reconstruction is complex, with considerable risk of morbidity. Little is known about patients’ experiences, including decision-making prior to, and regret following, free flap surgery.ObjectiveTo characterize patient experiences and decision regret of patients undergoing head and neck reconstructive free flap surgery.Design, Setting, and ParticipantsThis mixed-methods cohort study comprising semistructured interviews was conducted June to August 2021 at a single tertiary academic cancer center. Participants underwent head and neck reconstructive surgery with microvascular free tissue transfer (flap) more than 3 months before recruitment (range, 3 months to 4 years). Interview transcripts were qualitatively analyzed for themes. Participants also completed a Decision Regret Scale questionnaire.ExposureMicrovascular free flap surgery for head and neck reconstruction.Main Outcomes and MeasuresThematic analysis of interviews, decision regret score.ResultsSeventeen participants were interviewed. Median (IQR) age was 61 (52-70) years. Overall, 7 participants were women (49%), and 10 of 17 were men (59%). The most common free flap was fibula (8/17, 47%). Three major themes with 9 subthemes were identified: theme 1 was the tremendous effect of preoperative counseling on surgical decision-making and satisfaction, with subthemes including (1) importance of clinical care team counseling on decision to have surgery; (2) emotional context colors preoperative understanding and retention of information; (3) expectation-setting affects satisfaction with preoperative counseling; and (4) desire for diversified delivery of preoperative information. Theme 2 was coexisting and often conflicting priorities, including (1) desire to survive above all else, and (2) desire for quality of life. Theme 3 was perception of surgery as momentous and distressing, including (1) surgery as a traumatic event; (2) centrality of mental health, emotional resolve, and gratitude to enduring surgery and recovery; and (3) sense of accomplishment in recovery. On the Decision Regret Scale, most participants had no regret (n = 8, 47%) or mild regret (n = 5, 29%); 4 had moderate-to-severe regret (24%).Conclusions and RelevanceIn this mixed-methods cohort study, patient experiences surrounding major head and neck reconstructive free flap surgery were described. Opportunities to improve support for this complex and vulnerable population, and to mitigate decision regret, were identified.

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Section: Resultsmentioning

confidence: 91%

Section: Key Pointsmentioning

confidence: 99%

Patient Experience of Head and Neck Surgery With Free Flap Reconstruction

Dattilo,

Russell,

Warinner

et al. 2024

JAMA Otolaryngol Head Neck Surg

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“…In the literature, several CAS approaches were presented in the field of mandibular reconstruction, with a variety of implementations and different reported deviations, ranging from 0-12.5 mm for displacements and 0.9-17.5 • for angles [30]. One approach of Virtual Planning Surgery (VPS) with a 3D printed guide showed deviations between 1.76-3.11 mm, with a decreased accuracy for long donor bone segments [31]. Other mandibular VPS accuracy studies, on a smaller numbers of patients, reported deviations of 2.00 mm and 1.30 mm for mandibular and fibular osteotomies [32], 0.2-2.7 mm [33], 2.06 mm [34], and 0.9-1.3 mm for fibular size [35], 1.8 mm for resection planes and 3.0 mm and 4.2 • for fibular length and angulation [36], 3.06-3.76 mm and 8.5-10.4 • for resection planes [37], and of 2.92-5.61 mm and 3.85-5.88 • for spatial and angular cutting plane deviations [38].…”

Section: Discussionmentioning

confidence: 99%

Accuracy and Technical Predictability of Computer Guided Bone Harvesting from the Mandible: A Cone-Beam CT Analysis in 22 Consecutive Patients

Stavola

Cristoforetti

Fincato

et al. 2022

JFB

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This study assesses the accuracy and technical predictability of a computer-guided procedure for harvesting bone from the external oblique ridge using a patient-specific cutting guide. Twenty-two patients needing bone augmentation for implant placement were subjected to mandibular osteotomy employing a case-specific stereolithographic surgical guide generated through computer aided design. Differences between planned and real cut planes were measured comparing pre- and post-operative Cone Beam Computed Tomography images of the donor site according to six validated angular and displacement indexes. Accuracy and technical predictability were assessed for 119 osteotomy planes over the study population. Three different guide fitting approaches were compared. An average root-mean-square discrepancy of 0.52 (0.30–0.97) mm was detected. The accuracy of apical and medial planes was higher than the mesial and distal planes due to occasional antero-posterior guide shift. Fitting the guide with an extra reference point on the closest tooth performed better than using only the bone surface, with two indexes significantly lower and less disperse. The study showed that the surgical plan was actualized with a 1 mm safety margin, allowing effective nerve preservation and reducing technical variability. When possible, surgical guide design should allow fitting on the closest tooth based on both radiological and/or intra-oral scan data.

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“…These transplants have several advantages, including high success rates, minimal donor-site morbidity, and excellent functional and aesthetic outcomes. The successful implementation of these methods is supported by several devices and tools, such as microsurgical instruments, tissue expanders, and Computer-Aided Design and Manufacturing (CAD/CAM) systems for planning and performing the mandible reconstruction (Annino Jr. et al 2022;Barr et al 2020).…”

Section: Introductionmentioning

confidence: 99%

Developing A Temporary External Fixator (TEF) for Mandibular Reconstruction using Two-Phase QFD and TRIZ Approach

Chaiyachet,

Boonma,

Paipongna

2024

JSM

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A temporary external fixator (TEF) is a device used to bridge resection defects after sequestrectomy and before secondary mandibular reconstruction surgery. A well-designed TEF should be customizable and adjustable to accommodate individual patient needs. This study developed a TEF for mandibular reconstruction using the quality function deployment (QFD) and the theory of inventive problem-solving (TRIZ). Customer needs (CNs) were investigated from literature reviews and a survey. Subsequently, a questionnaire was developed, refined, and delivered to 22 experts to identify the essential principles of TEF. Afterwards, the QFD priorities were analyzed based on the acquired CNs and technical requirements (TRs), and the top priorities were found to be safety and adequate operational space. The guidelines for developing a TEF with TRIZ were established as follows: First, using carbon fiber epoxy composite and Ti-6Al-4V as the material for TEFs is recommended Second, permanent magnet should be inserted into the clamp lock bolts to prevent them from falling off during surgery. Last, replacing one Schanz screw with three Bicortical screws is recommended for the fixator pins. Additionally, it was also found that changing the screw size from 2.5–4.0 mm to 2.0–2.4 mm could reduce hole defects in the mandible.

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Virtual planning and 3D‐printed guides for mandibular reconstruction: Factors impacting accuracy

Cited by 9 publications

References 48 publications

Patient Experience of Head and Neck Surgery With Free Flap Reconstruction

Patient Experience of Head and Neck Surgery With Free Flap Reconstruction

Accuracy and Technical Predictability of Computer Guided Bone Harvesting from the Mandible: A Cone-Beam CT Analysis in 22 Consecutive Patients

Developing A Temporary External Fixator (TEF) for Mandibular Reconstruction using Two-Phase QFD and TRIZ Approach

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