Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Reconstruction of Segmental Mandibular Defects

Abstract

Objectives The aim of the current study was to evaluate potential differences in the accuracy of mandibular reconstruction and long-term stability, with respect to different reconstructive procedures. Methods In total, 42 patients who had undergone primary segmental mandibular resection with immediate alloplastic reconstruction, with either manually pre-bent or patient-specific mandibular reconstruction plates (PSMRP), were included in this study. Mandibular dimensions, in terms of six clinically relevant distances (capitulum [most lateral points], capitulum [most medial points], incisura [most caudal points], mandibular foramina, coronoid process [most cranial points], dorsal tip of the mandible closest to the gonion point) determined from tomographic images, were compared prior to, and after surgery. Results Dimensional alterations were significantly more often found when conventionally bent titanium reconstruction plates were used. These occurred in the area of the coronoid process ( p = 0.014). Plate fractures were significantly ( p = 0.022) more often found within the manually pre-bent group than within the PSMRP group (17%/0%). Conclusion The results suggest that the use of PSMRP may prevent rotation of the proximal mandibular segment, thus avoiding functional impairment. In addition, the use of PSMRP may potentially enhance the long-term stability of alloplastic reconstructions.

Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction

“…A changed distance between the mandibular and the intercondylar angle after using intraoperatively bended plates was documented (51). This goes in line with previous research indicating that better three-dimensional precision is achieved when using PSI (1,16,31,44,51). Dimensional changes due to rotation errors of the resection parts are avoided by prescribing exact positioning in the preoperative planning aiming at restoring the physiological position (51).…”

“…The difference between the gonion (defined as point 6) experienced an average dimensional change of 1.52 mm (SD = 3.9) in the group of CR patients and differed significantly from the group PSI, which only showed average differences of -1.04 mm (SD = 4.9). Recent research identified additional dimensional changes in patients who were restored with CR (31). A changed distance between the mandibular and the intercondylar angle after using intraoperatively bended plates was documented (51).…”

“…The implant can be designed and shaped by the surgeon according to the defect size, shape, and morphology (22,23). By selecting the appropriate design method, manufacturing process, and implant material, it is possible to perform a precise surgical procedure and reduce complications (24)(25)(26)(27)(28)(29)(30)(31). The integration of this technology in the pre-and intraoperative workflow has simplified the production of cutting guides and has been shown to shorten the operation time and the length of stay and to improve osseus consolidation, symmetry, and morphology (10,29,32).…”

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

“…Neben der bereits genannten mikrovaskulären Weichgewebedeckung wird der ossäre Defekt temporär alloplastisch mit einer funktionsstabilen Osteosyntheseplatte oder einem patientenspezifischen CAD-/CAM-Titanimplantat rekonstruiert, welches mit einem temporären Kondylenkopf ausgestattet werden kann (▶ Abb. 2) [26].…”

Patient-Specific Surgical Implant Using Cavity-Filled Approach for Precise and Functional Mandible Reconstruction

“…Functional and aesthetic defects in the maxillofacial region occur primarily due to various ailments, such as tumor excision, trauma, malformation, jaw atrophy, and benign or malignant neoplasm [1,2]. Immediate reconstruction is the most effective way to achieve improved and long-term functional outcomes [3]. Recent advances in technology and innovations in the patient-specific implants and their treatment led to the minimization of surgical time and cost.…”