Virtual Surgical Planning, Stereolitographic Models and CAD/CAM Titanium Mesh for Three-Dimensional Reconstruction of Fibula Flap with Iliac Crest Graft and Dental Implants

Cuéllar, Carlos Navarro; Rial, Manuel Tousidonis; Antúnez-Conde, Raúl; Caicoya, Santiago Ochandiano; Cuéllar, Ignacio Navarro; Frutos, Gema Arenas de; Urmeneta, Ángela Sada; Alonso, María Isabel García-Hidalgo; Vila, Carlos Navarro; Escobar, Javier I.

doi:10.3390/jcm10091922

Cited by 13 publications

(26 citation statements)

References 18 publications

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“…We consider that the decrease in morbidity in this group of patients is due to: (1) a reduction in the size of the surgical wound with the advantage of better control of tumor resection by using cutting guides [ 7 ]; (2) the avoidance of an approach related to the calvarial donor site; (3) the better anatomical fit of the customized implant [ 8 , 9 ]. Total coverage of the defect was observed in the patients treated through VSP, cutting guides and PSI, which was also more anatomical and did not present angles or peaks that could compromise the integrity of the reconstruction [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, in this case, we found an advantage in the use of the PSI, which, in addition to providing a more anatomical reconstruction, does not present irregular surfaces, edges or protrusions of the osteosynthesis material that could compromise the reconstruction or the patient’s comfort. [ 6 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…This reduction in the number of days of hospitalization was the result of the decrease in surgical morbidity, avoiding the problems derived from harvesting the calvarial bone graft. In addition, since the approach was more limited due to the greater safety of the area to be resected through the use of cutting guides, postoperative pain was reduced in all cases [ 6 , 9 ]. The reduction in surgical time and hospital stay resulted in considerable savings in hospital costs; however, we should not forget the costs associated with VSP, the development and manufacture of the models and cutting guides and the design and production of the customized implants [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The total defect coverage obtained in patients treated with VSP was a result of (1) a more precise resection through the use of cutting guides; (2) a defect with more uniform edges previously planned; (3) the verification of the good PSI fit in STL models before surgery. This correct PSI fit is one of the main advantages of treating this type of lesion using VSP, CAD-CAM-developed cutting guides, STL and PSI models, as more restricted resection defects are created, resulting in smaller surgical approaches with faster healing [ 6 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The increasing demand for aesthetic results as well as the improvement and refinement of procedures and techniques has enabled the application of virtual surgical planning to this field of facial surgery. Virtual surgical planning (VSP), the development of cutting guides using stereolithographic models (STL) and computer-assisted design and manufacturing (CAD-CAM) technology with a patient-specific implant (PSI) provide more predictable and accurate results [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Intraosseous Venous Malformation of the Zygomatic Bone: Comparison between Virtual Surgical Planning and Standard Surgery with Review of the Literature

Antúnez-Conde

Cuéllar

Escobar

et al. 2021

JCM

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Intraosseous venous malformations affecting the zygomatic bone are infrequent. Primary reconstruction is usually accomplished with calvarial grafts, although the use of virtual surgical planning, cutting guides and patient-specific implants (PSI) have had a major development in recent years. A retrospective study was designed and implemented in patients diagnosed with intraosseous venous malformation during 2006–2021, and a review of the scientific literature was also performed to clarify diagnostic terms. Eight patients were treated, differentiating two groups according to the technique: four patients were treated through standard surgery with resection and primary reconstruction of the defect with calvarial graft, and four patients underwent resection and primary reconstruction through virtual surgical planning (VSP), cutting guides, STL models developed with CAD-CAM technology and PSI (titanium or Polyether-ether-ketone). In the group treated with standard surgery, 75% of the patients developed sequelae or morbidity associated with this technique. The operation time ranged from 175 min to 210 min (average 188.7 min), the length of hospital ranged from 4 days to 6 days (average 4.75 days) and the postoperative CT scan showed a defect surface coverage of 79.75%. The aesthetic results were “excellent” in 25% of the patients, “good” in 50% and “poor” in 25%. In the VSP group, 25% presented sequelae associated with surgical treatment. The operation time ranged from 99 min to 143 min (average 121 min), the length of hospital stay ranged from 1 to 2 days (average of 1.75 days) and 75% of the patients reported “excellent” results. Postoperative CT scan showed 100% coverage of the defect surface in the VSP group. The multi-stage implementation of virtual surgical planning with cutting guides, STL models and patient-specific implants increases the reconstructive accuracy in the treatment of patients diagnosed with intraosseous venous malformation of the zygomatic bone, reducing sequelae, operation time and average hospital stay, providing a better cover of the defect, and improving the precision of the reconstruction and the aesthetic results compared to standard technique.

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