Accuracy of Computer-Aided Design/Computer-Aided Manufacturing-Assisted Mandibular Reconstruction With a Fibula Free Flap

Geusens, Joris; Sun, Yi; Luebbers, Heinz-Theo; Bila, Michel; Darche, Vincent; Politis, Constantinus

doi:10.1097/scs.0000000000005704

Cited by 23 publications

(25 citation statements)

References 30 publications

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“…Another essential aspect raised by Numajiri et al is that this form of costeffective planning is done in the surgeon's time and is not outsourced to the osteosynthesis manufacturers and their clinical engineers as is usually the case (28). Geusens et al reported that they have employed a full-time clinical engineer, which could be another solution to the altruistic behavior of interested and motivated surgeons (21). According to Tang et al, the economic benefits and limitations associated with the application of virtual surgical planning must be weighed against patient outcomes (4).…”

Section: Discussionmentioning

confidence: 99%

“…The reason is again the heterogeneity of parameters. The majority of studies compared the preoperative virtual plan to the postoperative situation by measuring the fibula segment lengths (21,(29)(30)(31), point-to-point distances and angles (3,13,14), intercondylar distance (32), or intercoronoid distance (21) or by comparing interfragmentary gap distances (33). Numajiri et al analyzed an algorithm for the production of low-cost cutting guides designed and printed inhouse (28).…”

Section: Discussionmentioning

confidence: 99%

“…The digital workflow for the production of the in-house-planned and printed cutting and reconstruction guides complies with the general principles of CAD/CAM-assisted techniques as described elsewhere in detail (1,(19)(20)(21).…”

Section: Blender-based In-house Cad/cam Planningmentioning

confidence: 99%

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In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

et al. 2021

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BackgroundMandibular reconstruction is conventionally performed freehand, CAD/CAM-assisted, or by using partially adjustable resection aids. CAD/CAM-assisted reconstructions are usually done in cooperation with osteosynthesis manufacturers, which entails additional costs and longer lead time. The purpose of this study is to analyze an in-house, open-source software-based solution for virtual planning.Methods and MaterialsAll consecutive cases between January 2019 and April 2021 that underwent in-house, software-based (Blender) mandibular reconstruction with a free fibula flap (FFF) were included in this cross-sectional study. The pre- and postoperative Digital Imaging and Com munications in Medicine (DICOM) data were converted to standard tessellation language (STL) files. In addition to documenting general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time), conventional measurements and three-dimensional analysis methods (root mean square error [RMSE], mean surface distance [MSD], and Hausdorff distance [HD]) were used.ResultsTwenty consecutive cases were enrolled. Three-dimensional analysis of preoperative and virtually planned neomandibula models was associated with a median RMSE of 1.4 (0.4–7.2), MSD of 0.3 (-0.1–2.9), and HD of 0.7 (0.1–3.1). Three-dimensional comparison of preoperative and postoperative models showed a median RMSE of 2.2 (1.5–11.1), MSD of 0.5 (-0.6–6.1), and HD of 1.5 (1.1–6.5) and the differences were significantly different for RMSE (p < 0.001) and HD (p < 0.001). The difference was not significantly different for MSD (p = 0.554). Three-dimensional analysis of virtual and postoperative models had a median RMSE of 2.3 (1.3–10.7), MSD of -0.1 (-1.0–5.6), and HD of 1.7 (0.1–5.9).ConclusionsOpen-source software-based in-house planning is a feasible, inexpensive, and fast method that enables accurate reconstructions. Additionally, it is excellent for teaching purposes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

et al. 2021

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“…Using three‐dimensional (3D) printed reposition guide and metal bone plate for mandible reconstruction is getting more popular (Ciocca et al, 2012). Virtual planning combined improved 3D printing technology has proved to be time saving and increase the accuracy (Geusens et al, 2019). However, the cost of virtual planning and 3D printing is high, even not approved by the authorities yet in some countries, resin cutting guide may be an alternative way to improve the outline of the reconstructed mandible (Nuri et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Comparison of surgical outcomes between primary plate and fibular flap transfer for reconstruction of segmental mandibular defects

2021

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Purpose Although two ways of reconstruction have been reviewed for a long period, comparison of large sample size with nearly randomized patient selection is rare. Here, we compare the surgical outcomes of these two methods from two large medical institutes. Methods Totally 176 patients were included from two medical centers with different protocols, 62 patients from MacKay Hospital repair defects with fibula flaps using reconstruction plates. Also 114 patients from Kaohsiung ChangGung Hospital treat with reconstruction plates combine anterior lateral thigh flaps, in which 12 cases had secondary fibula flap after plate exposure. Electronic medical records were reviewed retrospectively. Short (3–12 months) and long‐term (>12 months) outcomes were evaluated. Results Short‐term evaluation revealed that the secondary fibula had a higher rate of vascular complications (33 vs. 6%, p = .02). Primary fibula had a higher risk of post reconstructive surgical debridement (60 vs. 40%, p = .018). Long‐term follow‐up revealed radiation therapy significantly worsened bone healing (p = .03). Primary fibula had a lower rate of screw loosening (14.0 vs. 40.3%, p = .002). Radiation therapy did not increase the plate exposure rate among the groups (33 vs. 27%, p = .389). Disease free survival showed no significant difference between two groups (53.1 ± 3.5 vs. 47.8 ± 2.8 months, p = .317). Conclusion Primary fibula reconstruction should be considered whenever possible to reduce the risk of late complications and simplifies the management after a potential plate exposure. Notably, radiation therapy apparently has no significant effect on plate exposure rate both in ALT or fibula groups.

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“…54 In addition to the apparent benefits of detailed 3D preoperative surgical planning, higher surgical precision and perioperative time saving is observed. [55][56][57][58] When CAD/CAM is used to produce patient-specific mandibular plates, the precision of the reconstruction is maximized. 59,60 One of the biggest advantages of CAD/CAMaided bony reconstruction is the reduction in flap ischemia time because of the ability to perform osteotomies "in situ" while the pedicle is still intact.…”

Section: Cad/cam Planningmentioning

confidence: 99%

The Iliac Crest Osteomuscular Flap for Bony Reconstruction: Beast or Beauty? A Reassessment of the Value and Donor Site Morbidity in the CAD/CAM Era

Hilven

Vranckx

2021

J Reconstr Microsurg

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Background The iliac crest bone flap (ICBF), based on the deep circumflex iliac artery, has a bad reputation regarding donor site morbidity. However, the ICBF has an ideal curvature and shape for occlusion-based hemimandibular reconstructions with rapid dental rehabilitation and for vertical class III maxillary reconstructions that require bony support and muscular bulk to fill cavities and to provide intraoral lining. Is this notorious donor site reputation still valid with modern flap procurement using computer aided design/computer aided manufacturing (CAD/CAM) and recipient-site closure techniques? Materials and Methods We performed a literature search of the public databases PubMed, Cochrane, Google Scholar, and Web of Science for papers using mesh keywords related to donor site morbidity of the ICBF. We report three illustrative case reports using our current protocols for oncologic bony resection and reconstruction, using in-house CAD/CAM and three-dimensional printing to procure a tight-fit ICBF and minimizing donor site morbidity. Results We found 191 articles in the PubMed database of which we considered 176 nonrelevant. Cochrane Library and Google Scholar database searches resulted in the inclusion of 11 additional papers. The second search resulted in 172 articles of which we used five after excluding nonrelevant papers. Accurate preoperative (CAD/CAM) planning, preservation of the anterior superior iliac spine (ASIS), and paying attention to thoroughly donor site closure make the ICBF a very valuable option for accurate maxillofacial reconstructions with very acceptable comorbidities. This corresponds with our clinical findings. Conclusion Dogma never is a good teacher; it remains elementary that routine “knowledge” is (re)questioned. Donor site morbidity of the ICBF is comparable to other bone flaps. The shape and bone stock of the ICBF is ideal and often may be first choice. In combination with CAD/CAM planning, the ICBF is an excellent option for specific maxillofacial reconstructions.

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Accuracy of Computer-Aided Design/Computer-Aided Manufacturing-Assisted Mandibular Reconstruction With a Fibula Free Flap

Cited by 23 publications

References 30 publications

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

Comparison of surgical outcomes between primary plate and fibular flap transfer for reconstruction of segmental mandibular defects

The Iliac Crest Osteomuscular Flap for Bony Reconstruction: Beast or Beauty? A Reassessment of the Value and Donor Site Morbidity in the CAD/CAM Era

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