Virtual Surgical Planning for the Management of Severe Atrophic Mandible Fractures

Abstract

Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the reconstruction of two cases of severe atrophic mandible fracture using VSP. Two elderly edentulous/partially dentate patients who presented with fractures of their mandibles and who underwent reconstruction using VSP were included. Both had Class III atrophy at the region of the fracture. While both fractures were complex, the mechanism of injury differed with one being a tractor accident and the other being a pathologic fracture. Both patients presented with critical medical conditions. CT scans were obtained on both. The displaced segments were aligned virtually using mirror images and the midline of the maxilla. Three-dimensional models were fabricated to allow preoperative contouring of 2.5-mm reconstruction plates. Patients were operated under general anesthesia and fractures reduced and stabilized with 2.5-mm reconstruction plates placed at the lateral border of the mandible. Average treatment time for both patients was a little over 2 hours. There was good reduction with both. VSP is a valuable tool to assess and reduce complex fractures with less surgical time and predictable results.

Atrophic mandibular fracture treatment: prototyping as a tool in surgical planning

“…The modeling of the plate used in the fixation allowed by the preparation of the biomodel in the preoperative period, also performed in other similar studies (Kupfer et al, 2016;Brito et al, 2016;Castro-Núñez et al, 2018;Maloney & Rutner, 2019), reduced the surgical time in approximately one hour.…”

“…Brucoli et al (2019) conducted a study in which the average age of patients who had an atrophic mandible fracture was 75 years old. Studies highlight, considering the average age of patients, the presence of a high percentage of subjects with reports of one or more comorbidities (Brucoli et al, 2019;Maloney & Rutner, 2019;Castro-Núñez et al, 2018).…”

“…In surgeries that require a detailed planning, as well as a prediction of the results, as in the case of pathological lesions that cause structural bone weakness (Castro-Núñez et al, 2018), atrophic mandible fracture (Shuker, 2015), in implantology (Zhou et al, 2012), prototyping can be used. This tool has a great value in anatomical measurement, in the simulation of fracture reduction, osteotomies, resection techniques, assisting in the complete surgical planning (Kupfer et al, 2016).…”

Atrophic jaw fracture and predictability in oral rehabilitation: case report

“…However, images in two dimensions can lead to errors of diagnosis and consequently errors in the surgical planning. Thus, computed tomography is the best option to assist the diagnosis of mandibular fractures [5]. In this way, besides being the examination of choice for the evaluation of patients with facial trauma in our service, this exam also allows the planning and printing of sterolithographic models.…”

“…Treatment methods available for this type of fracture include open reduction and rigid internal fixation using mini-plates and reconstruction plates applied with or without simultaneous bone grafting. However, the literature has shown better results when more aggressive approaches are chosen [5,6].…”