Association between condylar position changes and functional outcomes after condylar reconstruction by free fibular flap

Tang, Qinchao; Li, Yixing; Chen, Yu; Chen, Xueru; Zhou, Zhuoqian; Huang, Wanqian; Liang, Feixin

doi:10.1007/s00784-020-03338-w

Cited by 14 publications

(12 citation statements)

References 36 publications

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“…But nevertheless, a derotation of the condylar head because of the cranial ramus rotation will be visible immediately. The functional sequalae is uncertain and needs further evaluation (37). A further prerequisite is the optimal design of ramus/collum resection guides.…”

Section: Limitations Pitfalls and Solutionsmentioning

confidence: 99%

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: Limitations Pitfalls and Solutionsmentioning

confidence: 99%

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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“…[19][20][21][22] Recently, there have been reports of condylar reconstruction integrating CPSSP in surgical care. [23][24][25][26] A critical review of those publications notes several differences between our protocol and some recommendations from these reports. First, we strongly advocate maintaining the native temporomandibular disk as a biologic spacer that allows for the reduced potential for ankylosis, as reported in some case series, and functional remodeling of the neo-condyle within the articulating fossa.…”

Section: Discussionmentioning

confidence: 99%

Vascularized Fibula TMJ Reconstruction: A Report of Five Cases featuring Computerized Patient-specific Surgical Planning

Powers

Breeze

Erdmann

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Mandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint because it requires precise bone graft alignment, or alloplastic materials, for complete restoration of joint function. The use of computerized patient-specific surgical planning (CPSSP) technology can aid in the anatomic reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study was to analyze clinical and functional outcomes after reconstruction of mandibular condyle defects using only a free fibula graft with the assistance of virtual surgery techniques. Methods: A retrospective review was performed to identify all patients who underwent mandibular reconstruction utilizing CPSSP with only a free fibula flap without any temporomandibular joint adjuncts after a hemimandibulectomy with total condylectomy. Results: From 2018 to 2021, five patients underwent reconstruction of mandibular defects involving the condyle with CPSSP technology and preservation of the native temporomandibular articulating disk. The average age was 62 years (range, 44–73 years). The average follow-up period was 29.2 months (range, 9–46 months). Flap survival was 100% (N = 5). The maximal interincisal opening range for all patients was 22–45 mm with no lateral deviation or subjective joint pain. No patients experienced progressive joint hypomobility or condylar migration. Conclusion: The use of CPSSP technology can aid in the anatomic reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise planning and intraoperative manipulation with optimal functional outcomes.

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“…6,7 In a study by Tang et al,4.7% of the post-operative patients experienced pain during chewing and mouth opening, while 7% were dissatisfied with the treatment outcomes. 8 The mandible may deviate toward the affected side during mouth opening. 9 In addition, the condylar range of motion (ROM) in tumour-affected mandibles was found to be greater than in healthy volunteers.…”

Section: Introductionmentioning

confidence: 99%

Prediction of jaw opening function after mandibular reconstruction using subject‐specific musculoskeletal modelling

Chen,

Wang,

Guo

et al. 2024

J of Oral Rehabilitation

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BackgroundMandibular reconstruction patients often suffer abnormalities in the mandibular kinematics. In silico simulations, such as musculoskeletal modelling, can be used to predict post‐operative mandibular kinematics. It is important to validate the mandibular musculoskeletal model and analyse the factors influencing its accuracy.ObjectivesTo investigate the jaw opening‐closing movements after mandibular reconstruction, as predicted by the subject‐specific musculoskeletal model, and the factors influencing its accuracy.MethodsTen mandibular reconstruction patients were enrolled in this study. Cone‐beam computed tomography images, mandibular movements, and surface electromyogram signals were recorded preoperatively. A subject‐specific mandibular musculoskeletal model was established to predict surgical outcomes using patient‐averaged muscle parameter changes as model inputs. Jaw bone geometry was replaced by surgical planning results, and the muscle insertion sites were registered based on the non‐rigid iterative closest point method. The predicted jaw kinematic data were validated based on 6‐month post‐operative measurements. Correlations between the prediction accuracy and patient characteristics (age, pathology and surgical scope) were further analysed.ResultsThe root mean square error (RMSE) for lower incisor displacement was 31.4%, and the error for peak magnitude of jaw opening was 4.9 mm. Age, post‐operative infection and radiotherapy influenced the prediction accuracy. The amount of masseter detachment showed little correlation with jaw opening.ConclusionThe mandibular musculoskeletal model successfully predicted short‐range jaw opening functions after mandibular reconstruction. It provides a novel surgical planning method to predict the risk of developing trismus.

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Association between condylar position changes and functional outcomes after condylar reconstruction by free fibular flap

Cited by 14 publications

References 36 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

Vascularized Fibula TMJ Reconstruction: A Report of Five Cases featuring Computerized Patient-specific Surgical Planning

Prediction of jaw opening function after mandibular reconstruction using subject‐specific musculoskeletal modelling

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