Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps

Pucci, Resi; Weyh, Ashleigh; Smotherman, Carmen; Valentini, Virginia; Bunnell, Anthony; Fernandes, Rui

doi:10.1016/j.ijom.2020.02.018

Cited by 49 publications

(52 citation statements)

References 25 publications

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“…This can be achieved using customized prosthetics, soft tissue or osseous transfer, or a combination thereof. Over the past two decades, there has been a plethora of clinical series and meta‐analyses demonstrating the usefulness of VSP to improve mandibular reconstruction, particularly for larger and more complex defects 7,14 . While the application of VSP to maxillary reconstruction is gaining more traction, it has been studied much less rigorously than its mandibular counterpart.…”

Section: Discussionmentioning

confidence: 99%

Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions

et al. 2021

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Background This study virtually compares patient‐specific fibular and scapular reconstructions for maxillectomies. Methods Nine maxillectomy defects were created on 10 maxillas and virtually reconstructed with patient‐specific fibulas and scapulas. Reconstructions were compared for restoring midface cephalometrics, dental implantability, and pedicle length. Results Of 90 maxillectomy defects, the vertically oriented scapula provided improved orbital floor and maxillary height reconstructions (p < 0.001), albeit at the cost of dental implantability compared to the fibula (p < 0.001). In two defects crossing the midline, the fibula, allowing for more osteotomies, provided improved maxillary projection. In the remaining three defects crossing the midline, the horizontally oriented scapula was comparable to the fibula. Fibular and scapular reconstructions were amenable for dental implantation and had similar pedicle lengths, although favoring scapula in extensive defects. Conclusion Fibular and scapular reconstructions of maxillectomy defects provide unique strengths. This virtual analysis can guide a goal‐oriented reconstruction based on defect type and patient‐specific goals.

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Section: Discussionmentioning

confidence: 99%

Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions

et al. 2021

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“…Proper evaluation of the head and neck site is most commonly performed with computed tomography, which also is necessary for virtual surgical planning (VSP), which can increase accuracy and efficiency in the operating room (14). VSP can be utilized in many ways, but is often used to providing surgical Stereolithic models, cutting guides for both the resection site and fibula, pre-bent or custom hardware, and guides to place the dental implants.…”

Section: Pre-operative Preparationmentioning

confidence: 99%

Narrative review: fibula free flap, indications, tips, and pitfalls

Weyh¹,

Fernandes²

2021

Front Oral Maxillofac Med

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The fibula free flap is a reliable reconstruction option, also known as the "work horse" of mandibular reconstruction. Its advantages are its size and length, ability to utilize both hard and soft tissues, and its distance from the head and neck which allows for a two team approach. Pre operatively one must evaluate perfusion to the foot, as well as vasculature supplying the flap. Many adjuncts can facilitate easier harvest, inset, and monitoring. Virtual surgical planning, SPY angiography, and the WalterLorenzTM Surgical Assist Arm are all examples. Post operatively, by utilizing enhanced recovery after surgery protocols one can standardize care, which can produce more consistent results. Utilizing step down units, instead of the intensive care unit (ICU), can also help avoid common complications such as pneumonia and delirium, as well as reduce costs. Opioid use after surgery can be reduced by utilizing multimodal pain management strategies, including use of regional anesthesia blocks and indwelling catheters. By utilizing these techniques, we have found we are able to perform fibula free flap reconstruction more efficiently, with less staff, less complications, and are able to utilize less opioids post operatively. The fibula free flap continues to be extremely important for head and neck reconstruction, due to its reliability, versatility, and ability to place dental implants for total dental rehabilitation.

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“…Although the reconstruction with bone or composite flaps (associated with skin and/or muscle) represents the best surgical choice, dental rehabilitation finalizes the reconstructive result. The choice of the type of flap to use depends on many factors-bone gap extension, the complexity of the defect and the need to reconstruct even soft tissues [35]. For example, the fibula has a longer length and is usually preferred in the reconstruction of long mandible defects involving multiple segments [36].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Head and Neck Osteosarcoma—The Ongoing Challenge about Reconstruction and Dental Rehabilitation

Cassoni

Brauner

Pucci

et al. 2020

Cancers

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Head and Neck osteosarcoma is an uncommon disease. Hitherto, the treatment is surgical resection and survival is influenced by the presence of free margins. However, the dimension of the resection may represent a hurdle for an adequate Quality of Life (QOL). Maxillofacial district is a narrow space where the function, esthetics and patient’s relational skills fit together like the gears of a clock. The functional results depend on the type of reconstruction and prosthetic rehabilitation that are both important to guarantee a good aesthetic result and finally increase the patient’s self-esteem. This study aims to report our experience about head and neck (HN) osteosarcoma focusing the attention on reconstructive and dental-rehabilitative problems. It is a retrospective study all patients were surgically treated in our department. Subjects with histological diagnosis of HN osteosarcoma, treated between 2005 and 2017 were included. The demographic characteristics, surgical treatment, eventually secondary reconstruction and prosthetic rehabilitation, performed in the same department, have been collected. The QOL was assessed through the EORTC QLQ-H&N35 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35) questionnaire. Fifteen patients were enrolled, eight received a free flap microsurgical reconstruction. Dental rehabilitation was performed in five cases and a mobile prosthesis was always delivered. Eighteen implants were inserted in fibula bones for three patients; highly porous implants were used.

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Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps

Cited by 49 publications

References 25 publications

Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions

Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions

Narrative review: fibula free flap, indications, tips, and pitfalls

Head and Neck Osteosarcoma—The Ongoing Challenge about Reconstruction and Dental Rehabilitation

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