Intraoperative Change in Defect Size during Maxillary Reconstruction Using Surgical Guides Created by CAD/CAM

Morita, Daiki; Numajiri, Toshiaki; Nakamura, Hiroko; Tsujiko, Shoko; Sowa, Yoshihiro; Yasuda, Makoto; Hirano, Shigeru

doi:10.1097/gox.0000000000001309

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…After screening the references for eligibility, 53 abstracts were selected and subsequently their full text was analyzed thoroughly. According to the inclusion and exclusion criteria, 12 studies were applicable to the purpose of this systematic review, describing a total of 67 maxillary reconstructions using CAS [ 8 , 11 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Figure 1 shows the PRISMA flowchart of the literature search and study selection process.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of Computer-Assisted Surgery in Maxillary Reconstruction: A Systematic Review

Baar

Schipper

Forouzanfar

et al. 2021

JCM

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Computer-assisted surgery (CAS) in maxillary reconstruction has proven its value regarding more predictable postoperative results. However, the accuracy evaluation methods differ between studies, and no meta-analysis has been performed yet. A systematic review was performed in the PubMed, Embase, and Cochrane Library databases, using a Patient, Intervention, Comparison and Outcome (PICO) method: (P) patients in need of maxillary reconstruction using free osteocutaneous tissue transfer, (I) reconstructed according to a virtual plan in CAS software, (C) compared to the actual postoperative result, and (O) postoperatively measured by a quantitative accuracy assessment) search strategy, and was reported according to the PRISMA statement. We reviewed all of the studies that quantitatively assessed the accuracy of maxillary reconstructions using CAS. Twelve studies matched the inclusion criteria, reporting 67 maxillary reconstructions. All of the included studies compared postoperative 3D models to preoperative 3D models (revised to the virtual plan). The postoperative accuracy measurements mainly focused on the position of the fibular bony segments. Only approximate comparisons of postoperative accuracy between studies were feasible because of small differences in the postoperative measurement methods; the accuracy of the bony segment positioning ranged between 0.44 mm and 7.8 mm, and between 2.90° and 6.96°. A postoperative evaluation guideline to create uniformity in evaluation methods needs to be considered so as to allow for valid comparisons of postoperative results and to facilitate meta-analyses in the future. With the proper validation of the postoperative results, future research might explore more definitive evidence regarding the management and superiority of CAS in maxillary and midface reconstruction.

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Section: Resultsmentioning

confidence: 99%

Accuracy of Computer-Assisted Surgery in Maxillary Reconstruction: A Systematic Review

Baar

Schipper

Forouzanfar

et al. 2021

JCM

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“…Nevertheless, these prior plans sometimes failed in practice because the preformed reconstruction plates and fibula segments could not be placed accurately due to the lack of anatomical markers. [ 13 ] Even worse, the reconstruction plate sometimes needed to be bent again during the operation, [ 14 ] which could prolong the operation and reduce its repairing effect. Therefore, in this study, we designed a variety of reconstruction guide templates to solve the above problems.…”

Section: Discussionmentioning

confidence: 99%

Application of optimized digital surgical guides in mandibular resection and reconstruction with vascularized fibula flaps

et al. 2020

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Rationale: Currently, digital surgical techniques have been widely used in the precise treatment of mandibular resection and reconstruction with fibula flaps. Utilizing these innovative techniques in surgical planning and hardware fabrication before surgery has shown to provide great help. However, it is difficult for even experienced surgeons to place the preformed reconstruction plate in the same position as its preoperative design, causing surgical results to differ from preoperative planning. This study aims to solve these acknowledged challenges by creating newly designed equipment. Patient concerns: Two patients suffering from long-term expansion of the mandible were admitted to our department. Case I was a 39-year-old female patient who was concerned about the disease in the middle of the mandible, Case II was a 45-year-old female patient who was concerned about the disease at the left mandibular angle and ramus region. Diagnoses: Two patients were diagnosed with the mandibular ameloblastoma based on computed tomography (CT) scan and pathological results. Interventions: Personalized 3-dimensional (3D) surgical guides were applied to 2 patients with mandibular ameloblastoma who underwent mandibular resection and reconstruction with vascularized fibula flaps using a specially optimized and designed reconstruction guide plate. Outcomes: We achieved precise mandibular repair with such a guide in full accordance with the preoperative plan and ensured the restoration of patient facial symmetry. Lessons: Optimized reconstruction guide template could accurately locate the preformed reconstruction plate. This component had the ability to ensure that the location of the actual reconstruction plates were highly consistent with preoperative designed models.

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“…Most osteotomies for maxillary reconstruction are completed on the lateral surface, though if multiple segments are required, the cuts may be in various planes. 3,15 Fig. 4.…”

Section: Osteotomy Optimizationmentioning

confidence: 99%

“…VSP is particularly useful in midface osseous reconstruction. 3,4,6,15,21 Maxillary access is difficult due to limited exposure constraining the reliable and accurate positioning of the final reconstruction. Furthermore, the maxilla's compact, boxy geometry exhibits more changes in shape over the same distance compared to the mandible, necessitating more osteotomies with smaller segments.…”

Section: Maxillary Reconstructionmentioning

confidence: 99%

Virtual Surgical Planning for Oncologic Mandibular and Maxillary Reconstruction

Myers

Nelson

Rosen³

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Virtual surgical planning (VSP) with computer-aided design and computer-aided modeling (CAD/CAM) enables the opportunity to provide personalized medicine in complex head and neck reconstruction. This innovative technology allows ablative and reconstructive surgeons to virtually create and manipulate three-dimensional anatomic models to plan both the resection and reconstruction of complicated maxillofacial defects. Studies demonstrate improvements in preoperative planning, operative efficiency and accuracy, and postoperative outcomes. VSP facilitates immediate dental implantation in selected patients, which can improve the likelihood of achieving dental restoration. This article outlines strategies for technique optimization as well as the applications, advantages and disadvantages of VSP in complex oncologic head and neck reconstruction.

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Intraoperative Change in Defect Size during Maxillary Reconstruction Using Surgical Guides Created by CAD/CAM

Abstract: Supplemental Digital Content is available in the text.

Cited by 5 publications

References 9 publications

Accuracy of Computer-Assisted Surgery in Maxillary Reconstruction: A Systematic Review

Accuracy of Computer-Assisted Surgery in Maxillary Reconstruction: A Systematic Review

Application of optimized digital surgical guides in mandibular resection and reconstruction with vascularized fibula flaps

Virtual Surgical Planning for Oncologic Mandibular and Maxillary Reconstruction

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