Applying Computer Techniques in Maxillofacial Reconstruction Using a Fibula Flap

Abstract

While the application of computer-assisted maxillofacial surgery becomes increasingly popular, the translation from virtual models and surgical plans to actual bedside maneuvers and the evaluation of the repeatability of virtual planning remain to be major challenges. The objective of this study was to experiment the technique of using a resin template as a messenger in maxillofacial reconstruction involving a fibula flap. Another aim was to find a quantitative and objective method to evaluate the repeatability of preoperative planning. Seven patients who underwent maxillary or mandibular reconstruction were included in this study. The mean age was 25 years, and the mean follow-up period was 18.7 months. Virtual planning was carried out before surgery. A resin template was made according to the virtual design of bone graft through rapid prototyping technique and served as a guide when surgeons shaped the fibula flap during surgery. The repeatability of the virtual plan was evaluated based on the matching percentage between the actual postoperative model and the computer-generated outcome. All patients demonstrated satisfactory clinical outcomes. The mean repeatability was 87.5% within 1 mm and 96.5% within 2 mm in isolated bone graft. It was 71.4% within 1 mm and 89.9% within 2 mm in reconstructed mandible or maxilla. These results demonstrated that a resin template based on virtual plan and rapid prototyping technique is a reliable messenger to translate from computer modeling to bedside surgical procedures. The repeatability of a virtual plan can be easily and quantitatively evaluated through our three-dimensional differential analysis method.

Computer-assisted Mandibular Reconstruction with Vascularized Iliac Crest Bone Graft

“…Resin templates rendering a virtual plan are reliable tools to transfer computer models to real-time surgery [8]. Currently, stereolithographic models of the desired iliac crest bone piece are being used intraoperatively to support surgery [9].…”

Mandibular Reconstruction with Vascularized Osseous Free Flaps: a Review of the Literature

“…This technique, using a model based on computer-aided design/computer-aided manufacturing and rapid prototyping, could provide a successful cosmetic and functional result. Meanwhile, Liu et al investigated the use of a computer-assisted resin template as a messenger in seven patients who needed maxillofacial reconstruction involving a fibula flap, and evaluated a quantitative and objective method for evaluating the repeatability of preoperative planning (Liu et al, 2009). The mean repeatability was 96.5% within 2 mm in isolated bone and 89.9% in the reconstructed mandible or maxilla.…”

Evolution and Trends in Reconstructive Facial Surgery: An Update

“…The advent of microsurgery significantly revolutionalized and increased the versatility of autologous tissue transfer in facial reconstruction [9]. Initial challenges such as limited options, multiple staging, and vascular insufficiency can now be readily overcome by moving distant tissues with their native blood supply (and/or nerves) from a donor site and anastomosing to corresponding structures within the recipient bed.…”

“…However, some authorities still believe that prosthesis is the last resort where the conditions for surgical reconstruction are not met. In fact, it is now thought that by employing three dimensional imaging and advanced technology in design and construction, prosthesis could remain a viable first treatment option in facial reconstruction [7,9].…”

“…Currently, images generated by 3D-rendition of the craniofacial complex are employed in a wide array of applications, including; (i) diagnosis and evaluation of extent of lesion [12,15], (ii) analysis of facial asymmetry [15,16], (iii) rapid prototyping for stereolithographic modeling [17], (iv) fabrication of customized implantable devices [18,19], (v) preoperative virtual surgery [5,9], (vi) generation and transfer of data for intraoperative navigation [20][21][22], (vii) presurgical assessment of potential recipient vessels for microvascular anastomosis near a resection site using 3D-CT angiogram [3], (viii) interactive discussion with patients for better understanding of the extent of disease and proposed surgery [10], and (ix) training of surgical residents in an educational environment [10]. By these applications, the surgeon is able to visualize the pathology in its entirety, assess its influence on the surrounding anatomy, determine the feasibility of resection, and concurrently plan the reconstruction of a defect.…”