Patient-specific implant modification for alloplastic bridging of mandibular segmental defects in head and neck surgery

Jehn, Philipp; Spalthoff, Simon; Korn, Philippe; Zeller, Alexander‐Nicolai; Dittmann, Jürgen; Zimmerer, Rüdiger; Tavassol, Frank; Gellrich, Nils‐Claudius

doi:10.1016/j.jcms.2020.01.018

Cited by 25 publications

(15 citation statements)

References 28 publications

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“…Another possibility for speeding up the planning process is to simplify patient-specific implants. However, this would negate the benefits of these implants, such as the reconstruction accuracy ( 12 , 17 – 20 ), and therefore, should not be considered.…”

Section: Discussionmentioning

confidence: 99%

“…HNSCC of the alveolar crest or mouth floor, for example, can lead to partial resection of the mandible. State of the art therapy of mandibular defects nowadays includes the use of patient-specific implants to reconstruct the mandible, with or without bone grafts ( 11 , 12 ). Patient-specific implants are usually planned through interactions between medical engineers and surgeons.…”

Section: Introductionmentioning

confidence: 99%

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Time is crucial in malignant tumor cases: Speeding up the process of patient-specific implant creation

et al. 2022

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PurposePatient-specific implants are commonly used to reconstruct lower jaw defects following surgical treatment for head and neck squamous cell carcinoma. The planning process of surgery is time-consuming and can delay the “time to surgery,” which should be as short as possible. Therefore, this study aimed to evaluate the planning process to speed up and identify any sources of problems.Patients and methodsIn this retrospective study, we enrolled patients who underwent continuous resection of the mandible in combination with reconstruction with a patient-specific implant between 2016 and 2021. The predictor variables were in-house training of the engineers and implant complexity (complex [with additional features] vs. less complex [resembling standard reconstruction plates]). The outcome variables were the duration of communication, message length, and the need for synchronous communication or modifications to the original design. Descriptive and univariate statistics were computed, and statistical significance was set at P < 0.05.ResultsThe data from 83 patients were included in this study. The mean duration of communication was 14.05 ± 13.58 days. The implant complexity and training status of the engineer had no statistically significant influence on the primary outcome variables. As for the secondary outcome variables, the implant complexity significantly influenced the chance that the planned operation had to be postponed (15/16 [93.75%] were complex cases, P = 0.001). The most frequent cause of problems in the planning process was an insufficient dataset, which was not dependent on the type of imaging.ConclusionsThe overall duration of the patient-specific implant creation process is too long to meet oncological requirements. Therefore, standardization of the planning process to accelerate implant creation is of utmost importance. In addition, a common standard imaging format (independent of the type of imaging) for oncological cases could eliminate all delays caused by insufficient datasets in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Time is crucial in malignant tumor cases: Speeding up the process of patient-specific implant creation

et al. 2022

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“…Preoperatively computed tomography angiography (CTA) [ 47 , 48 , 49 , 50 ] or magnetic resonance angiography (MRA) was performed in all cases to ensure three-vessel status to prevent postoperatively critical ischemia of the donor site leg [ 51 , 52 ]. In those cases, patients were excluded for FFF, and alternative reconstructive procedures, such as vascularized deep circumflex iliac artery flap (DCIA) [ 53 ], and a hand-bent or customized, patient-specific reconstruction plate [ 54 ] was used.…”

Section: Discussionmentioning

confidence: 99%

Impact of Planning Method (Conventional versus Virtual) on Time to Therapy Initiation and Resection Margins: A Retrospective Analysis of 104 Immediate Jaw Reconstructions

Knitschke

Bäcker

Schmermund

et al. 2021

Cancers

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Virtual surgical planning (VSP) and patient-specific implants are currently increasing for immediate jaw reconstruction after ablative oncologic surgery. This technique contributes to more accurate and efficient preoperative planning and shorter operation time. The present retrospective, single-center study analyzes the influence of time delay caused by VSP vs. conventional (non-VSP) reconstruction planning on the soft and hard tissue resection margins for necessary oncologic safety. A total number of 104 cases of immediate jaw reconstruction with free fibula flap are included in the present study. The selected method of reconstruction (conventionally, non-VSP: n = 63; digitally, VSP: n = 41) are analyzed in detail. The study reveals a statistically significant (p = 0.008) prolonged time to therapy initiation with a median of 42 days when the VSP method compared with non-VSP (31.0 days) is used. VSP did not significantly affect bony or soft tissue resection margin status. Apart from this observation, no significant differences concerning local tumor recurrence, lymph node, and distant metastases rates are found according to the reconstruction method, and affect soft or bone tissue resection margins. Thus, we conclude that VSP for immediate jaw reconstruction is safe for oncological purposes.

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“…Nach adjuvanter Therapie oder Rezidivfreiheit kanntypischerweise nach 12 Monatensekundär ein mikrovaskuläres Knochentransplantat zur autologen Unterkieferrekonstruktion aus Fibula, Skapula oder Beckenkamm herangezogen werden [27]. Das 2-zeitige Verfahren erlaubt eine knöcherne Nachresektion im Falle einer R1-Situation und bietet im Hinblick auf eine mögliche implantatprothetische Rehabilitation eine präzisere Umsetzung der Rekonstruktion durch virtuelle Planung und CAD-/ CAM-Implantate [28]. Darüber hinaus ist die Qualität des transplantierten Knochens höher, da dieser ohne vorherige Strahlenexposition in die Empfängerregion eingebracht wird.…”

Section: Mundhöhle Oropharynxunclassified

Weichgewebesarkome im Kopf-Hals-Bereich: Aktuelle Therapie – Teil 2

Dietz

Lethaus²,

Pirlich³

et al. 2022

Laryngorhinootologie

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Patient-specific implant modification for alloplastic bridging of mandibular segmental defects in head and neck surgery

Cited by 25 publications

References 28 publications

Time is crucial in malignant tumor cases: Speeding up the process of patient-specific implant creation

Time is crucial in malignant tumor cases: Speeding up the process of patient-specific implant creation

Impact of Planning Method (Conventional versus Virtual) on Time to Therapy Initiation and Resection Margins: A Retrospective Analysis of 104 Immediate Jaw Reconstructions

Weichgewebesarkome im Kopf-Hals-Bereich: Aktuelle Therapie – Teil 2

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