Improving the accuracy of mandibular reconstruction with vascularized iliac crest flap: Role of computer-assisted techniques

Zhang, Wenbo; Yu, Yanxin; Wang, Yang; Mao, Chi; Liu, Xiaojing; Guo, Chuanbin; Yu, Guang‐Yan; Peng, Xin

doi:10.1016/j.jcms.2016.08.014

Cited by 34 publications

(34 citation statements)

References 31 publications

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“…The use of custom cutting guides for this indication significantly reduce the length of time required for the surgical procedures [25], improves dental restoration, postoperative appearance [26] and appears to improve the accuracy of the reconstruction. Quality of mandibular reconstruction is all the more important as we use a fibular cutting guide and positioning guide [27].…”

Section: Resultsmentioning

confidence: 99%

Surgical benefit of mandibular morphometric analysis: A new tool to standardize mandibular reconstruction

et al. 2020

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Purpose The gold-standard for reconstruction of large mandibular defects is the use of free flaps of vascularized autologous bone with the fibula as the preferred donor site. The use of "custom cutting guides" for this indication is becoming increasingly prevalent. But cost of the procedure averages around 2,500 dollars per patient excluding treatment and entails selection criteria. We think it is possible to standardize mandibular reconstructions from an anatomical mean. The objective of this study was to perform a mandibular morphometric analysis in order to obtain a set of "mean" measurements, which can be used by all surgeons interested in mandibular reconstruction. Methods We performed a morphometric analysis consisting of three-dimensional mandibular reconstructions of 30 men and 30 women. Several reference points were set and defined to evaluate specific lengths and angles of interest. We conducted an intra and inter-sexual descriptive analysis of measurements obtained. Results We did not identify any major intra-sexual differences within each group. The gonial angle is more open in women and the measurements characterizing the basilar contour are more prominent in men. We did not identify any differences in alveolar region parameters. Conclusion The results of this study constitute a morphological tool for surgeons, from bone graft to free flap. These results also confirm us that the use of «custom cutting guides» for mandibular reconstruction may be excessive. It is pertinent to examine the value of "custom made" mandibular reconstructions since the differences observed are of the order of millimeters.

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Section: Resultsmentioning

confidence: 99%

Surgical benefit of mandibular morphometric analysis: A new tool to standardize mandibular reconstruction

et al. 2020

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“…For reconstruction of the mandible after a continuity resection and with extra‐intraoral communicating wounds, a free vascularised fibular flap is reported as the gold standard (Cordeiro, Disa, Hidalgo, & Hu, 1999). Several studies have reported an accurate and safe workflow for 3D VSP‐based fibula reconstruction of mandibular defects, occasionally in combination with a patient‐specific reconstruction plate (Essig et al., 2011; Roser et al., 2010; Schepers et al., 2015; Weijs et al., 2016; Weitz, Wolff, Kesting, & Nobis, 2018; Yang et al., 2019; Zhang et al., 2016). This paper critically reviews current methods for 3D VSP, leads for optimisation of the 3D VSP workflow and patient‐specific application of guides and implants.…”

Section: Introductionmentioning

confidence: 99%

Three‐dimensional virtual surgical planning in the oncologic treatment of the mandible

et al. 2020

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Objectives: In case of surgical removal of oral squamous cell carcinomas, a resection of mandibular bone is frequently part of the treatment. Nowadays, such resections frequently include the application of 3D virtual surgical planning (VSP) and guided surgery techniques. In this paper, current methods for 3D VSP leads for optimisation of the workflow, and patient-specific application of guides and implants are reviewed. Recent findings: Current methods for 3D VSP enable multi-modality fusion of images. This fusion of images is not restricted to a specific software package or workflow. New strategies for 3D VSP in Oral and Maxillofacial Surgery include finite element analysis, deep learning and advanced augmented reality techniques. These strategies aim to improve the treatment in terms of accuracy, predictability and safety. Conclusions: Application of the discussed novel technologies and strategies will improve the accuracy and safety of mandibular resection and reconstruction planning. Accurate, easy-to-use, safe and efficient three-dimensional VSP can be applied for every patient with malignancies needing resection of the mandible.

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“…This incision avoids facial scars, preserves the perioral musculature, and does not jeopardize the integrity of the facial nerve, providing optimal esthetic and functional results. 8 Several studies 4,7,[9][10][11][12] concerning mandibular reconstruction were focused on the assessment of the 3D accuracy of reconstruction with the pre-bent reconstruction plates. Until now, there is no study explored the effect of the surgical approach to ameloblastoma on the 3D position of the proximal segment after mandibular resection and reconstruction with a pre-bent reconstruction plate.…”

Section: Introductionmentioning

confidence: 99%

Three dimensional accuracy of mandibular reconstruction by pre-bent reconstruction plate using intra oral versus extra oral approaches following mandibular resection in patients with extensive ameloblastoma

Mohamed

2020

Egyptian Dental Journal

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Purpose: This prospective study aimed to compare the intraoral placement of the pre-bent reconstruction plate with that inserted via the extraoral approach, to evaluate their impact on the three-dimensional (3D) position of the proximal segment, after continuity resection of mandibular ameloblastoma.Patients and methods: Patients were divided into two equal groups. In group 1, the mandible was reconstructed with a pre-bent reconstruction plate via an intraoral approach. In group 2, an extraoral approach was used. The primary outcome variables were the need for intraoperative plate readjustment, the time needed for plate insertion, total operation time, difficulties encountered during surgery, and the postoperative stability of the proximal segment. Distances between corresponding anatomical landmarks on the mandibular angle and condyle (A-A`, B-B`, C-C`, B-C`) as well as the intercondylar angle (ICA) and B`XC angle, were measured. The difference between the pre-and postoperative measurements was used to evaluate the reconstruction accuracy. The results of the two groups were compared and analyzed by t-test.Results: Thirty patients were enrolled in this study. In group 1, four plates required minor readjustment. In group 2, only two cases required re-adaptation. The mean time for plate placement was 38 ± 5.8 and 27.5 ± 7.5 minutes in groups 1 and 2, respectively (p = 0.0001). The intraoral insertion of the pre-bent plates revealed a decrease in the linear measurements, resulting in mandibular compression. On contrary, the extraoral approach showed increase in the measurements, resulting in widening of the mandible. However, this width difference was statistically insignificant. Concerning the ICA and B`XC angle, no significant difference could be ascertained between the two groups. Conclusion:Intraoral approach is more conservative procedure, thereby achieving the best esthetic outcomes and resulting in a more accurate 3D mandibular reconstruction. This approach is considered the treatment of choice for resection and reconstruction of mandibular ameloblastoma. However, if the reconstruction plate cannot be inserted intraorally, then extraoral approach is advised.

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Improving the accuracy of mandibular reconstruction with vascularized iliac crest flap: Role of computer-assisted techniques

Cited by 34 publications

References 31 publications

Surgical benefit of mandibular morphometric analysis: A new tool to standardize mandibular reconstruction

Surgical benefit of mandibular morphometric analysis: A new tool to standardize mandibular reconstruction

Three‐dimensional virtual surgical planning in the oncologic treatment of the mandible

Three dimensional accuracy of mandibular reconstruction by pre-bent reconstruction plate using intra oral versus extra oral approaches following mandibular resection in patients with extensive ameloblastoma

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