Navigation-guided fibula free flap for mandibular reconstruction: A proof of concept study

Pietruski, Piotr; Majak, Marcin; Świątek‐Najwer, Ewelina; Żuk, Magdalena; Popek, Michał; Mazurek, Maciej; Świecka, Marta; Jaworowski, Janusz

doi:10.1016/j.bjps.2019.01.026

Cited by 19 publications

(31 citation statements)

References 40 publications

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“…A). The CT scans of the phantom were acquired (Somatom Sensation 16; Siemens Medical Solutions, Erlangen, Germany), and the image data (512 × 512‐pixel dataset, 0.625‐mm slice thickness) was recorded as Digital Imaging and Communications in Medicine (DICOM) files exported to the MentorEye system (Wroclaw University of Technology, Wroclaw, Poland) . Then, seven virtual fibular osteotomies were designed using the surgery planning module of the system (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…During the early stage of the simulated FFF harvesting procedure, a navigation reference frame compatible with an optical tracking camera was mounted onto the anterior edge of the tibia using a transcutaneous approach. Then, virtual and actual positions of seven registration markers were registered with a tracked tip‐pointer . The registration was considered successful whenever a difference between the virtual and actual position of each marker was less than 2 mm.…”

Section: Methodsmentioning

confidence: 99%

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Supporting fibula free flap harvest with augmented reality: A proof‐of‐concept study

et al. 2019

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Objective: To analyze a novel navigation system utilizing augmented reality (AR) as a supporting method for fibula free flap (FFF) harvest and fabrication.Methods: A total of 126 simulated osteotomies supported with a cutting guide or one of two AR-based intraoperative navigation modules-simple AR (sAR) or navigated AR (nAR)-were carried out on 18 identical models of the fibula (42 osteotomies per method). After fusing postoperative computed tomography scans of the operated fibulas with the virtual surgical plan based on preoperative images, the objective outcomes-angular deviations from the planned osteotomy trajectory ( o ) and deviations of control points marked on the trajectory (mm)-were determined.Results: All analyzed methods provided similar accuracy of assisted osteotomies. The only significant difference referred to angular deviation in the sagittal plane, which was smaller after the cutting guide-assisted procedures than after the application of sAR and nAR (4.1 AE 2.29 vs. 5.08 AE 3.64 degrees, P = 0.031 and 4.1 AE 2.29 vs. 4.97 AE 2.91, P = 0.002, respectively). Mean deviation of control points after the cutting guide-assisted procedures was 2.76 AE 1.06 mm, as compared with 2.67 AE 1.09 mm for sAR and 2.95 AE 1.11 mm for nAR.Conclusion: Our study demonstrated that both novel AR-based methods provided similar accuracy of assisted harvesting and contouring of the FFF as the cutting guides. This fact, as well as the acceptability of the concept by clinicians, justify their further development and evaluation in preclinical settings.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Supporting fibula free flap harvest with augmented reality: A proof‐of‐concept study

et al. 2019

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“…Navigated resection and modeling of the flaps is considered as the next step in the evolution of computerassisted reconstruction of mandibular defects with possible more safe and accurate results. 42,43 The location of dental implant placement (mandible or maxilla) on implant failure was evaluated in literature with conflicting results. Schoen et al, 44 reported more failures in the maxilla while Pompa et al, 19 found no difference among arches.…”

Section: Flap Failuresmentioning

confidence: 99%

Dental implant‐based oral rehabilitation in patients reconstructed with free fibula flaps: Clinical study with a follow‐up 3 to 6 years

Göker

Baj

Bolzoni

et al. 2020

Clin Implant Dent Rel Res

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Background: Oral rehabilitation of patients after maxillofacial reconstructive surgery represents a challenge and stable prosthetic retention can be achieved with the use of dental implants.Purpose: This retrospective report aimed to evaluate implant-based oral rehabilitation following maxillofacial reconstruction with free fibula flaps.Materials and Methods: A total of 14 patients who had reconstruction with fibula flaps either by CAD/CAM or conventional surgery were included in this study. A total of 56 implants (40 in flaps, 16 in native bone) were evaluated. Follow-up after reconstructive surgery ranged between 3.25 and 6.3 years. Follow-up after implant surgery ranged between 1.5 and 3.8 years.Results: Overall survival rate was 85.7% in free fibula flaps and 85.6% in dental implants. Eight implants were lost in three patients and all of these failures were in dental implants inserted in free flaps. According to the results on patient basis, the implant survival was not influenced by any variable. Conclusions:The maxillofacial reconstruction with free fibula flap and oral rehabilitation with implant-supported prostheses after ablative surgery can be considered as an effective and safe procedure with successful aesthetic and functional outcomes.

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“…The CAD/CAM system with a navigation system facilitated the fabrication of a customized device for virtual resection and reconstruction procedure out of the operation field [30][31][32]. Using this method including the navigation system which positioned the bony segment of fibula free flap to the exact position will reconstruct the resected area adequately [19,33]. The CAD/CAM system also provided data to manufacture a customized plate to reposition the grafted bone efficiently; however, since customized plates were not legal in Korea at that time, the fibula bone was to be fixed by a conventional plate.…”

Section: Discussionmentioning

confidence: 99%

“…The pre-shaped segment and osteotomy guide were manufactured using a 3D printing system. The fibula bone was designed and cut using the osteotomy guide during operation, and the navigation system was used to enhance the accuracy of placement of the fibular graft [19]. The results of digital planning could be improved by the acquisition of intraoperative images as well as fusion with preoperative digital planning data by using navigation system.…”

Section: Methodsmentioning

confidence: 99%

Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap

Byun

Lim

Yang

et al. 2020

JCM

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Introduction. The objective of this study was to evaluate a surgical technique and to present the results of delayed reconstruction of palatomaxillary defects using fibula free flap (FFF). Methods. A review was conducted for nine patients who underwent palatomaxillary reconstruction using FFF. Primary disease, type of reconstruction, defect area, fibula segment length and number of osteotomies, radiotherapy, and implant installation after FFF reconstruction were analyzed. Results. All nine patients underwent delayed reconstruction. The fibula shaft was osteotomized into two segments in seven patients and three segments in one patient with bilateral Brown’s revised classification IV/d defect. One case was planned by using a computer-aided design computer-aided manufacturing (CAD/CAM) system with a navigation system. The mean length of the grafted fibula bone was 68.06 mm. Dental implant treatment was performed in six patients. Six patients received radiation therapy, and there were no specific complications related to the radiation therapy. In one case, the defect was reconstructed with FFF flow-through from a radial forearm free flap. Conclusion. This clinical study demonstrated that the fibula flap is an ideal donor-free flap in a palatomaxillary defect. Delayed reconstruction using an FFF can reduce the complication and failure rates.

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Navigation-guided fibula free flap for mandibular reconstruction: A proof of concept study

Cited by 19 publications

References 40 publications

Supporting fibula free flap harvest with augmented reality: A proof‐of‐concept study

Supporting fibula free flap harvest with augmented reality: A proof‐of‐concept study

Dental implant‐based oral rehabilitation in patients reconstructed with free fibula flaps: Clinical study with a follow‐up 3 to 6 years

Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap

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