Computer-Assisted Surgery for Mandibular Reconstruction Using a Patient-Specific Titanium Mesh Tray and Particulate Cancellous Bone and Marrow

Abstract

Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computerassisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon's hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration * Corresponding author. S. Kondo et al. 86of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.

Titanium Alloy Implants with Lattice Structures for Mandibular Reconstruction

“…One design concept that has seen much interest in recent years is the patient-specific intraosseous mandibular implant, with either a cage or a crib structure, to fill the gap formed by mandibular segmentation surgery. This design concept has seen promising clinical results [ 199 , 200 , 201 , 202 , 203 ]. The intraosseous implant design comes with major advantages over the current standard of treatment.…”

Semi-automated digital workflow to design and evaluate patient-specific mandibular reconstruction implants

“…Clinical studies on customized metallic implant reconstructions using a cage (or crib) design with or without the insertion of bone grafts have shown promising results (Kondo et al, 2015;W. B. Lee et al, 2018; Y.W.…”