Preliminary clinic study on computer assisted mandibular reconstruction: the positive role of surgical navigation technique

Abstract

BackgroundThe objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery.MethodsEight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software.ResultsAll 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group.ConclusionsThe computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.

Low-cost Design and Manufacturing of Surgical Guides for Mandibular Reconstruction Using a Fibula

“…Other reports have noted that computer-simulated methods produce deviations less than 2 or 3 mm from the preoperative plans for mandibular reconstruction. 6 – 11 For osteotomies of the fibula, Hanasono and Skoracki 2 reported that the divided fibular segments had an average 2.4-mm difference in length from the initial plans.…”

Application of Combined Osteotomy and Reconstruction Pre-Bent Plate Position (CORPPP) Technology to Assist in the Precise Reconstruction of Segmental Mandibular Defects

“…Sometimes, even when the occlusal relation is well recovered, the position of the condyle can change considerably because of the anti-displacement or rotation that can occur when the remaining mandibular segments are short. [14][15][16] This situation is even more problematic when the condyle is included within the range of reconstruction, which can lead to reconstructed condyle dislocation in the glenoid fossa. The main reason for this phenomenon is that the spatial location of the remaining mandible changes after mandibular segmental resection…”

Navigation Guidance During Free Flap Mandibular Reconstruction

“…Our sample size estimate was determined based on previously published data. 16 Seven cadavers per group were required to provide an 80% power for detecting a 4.9-mm difference in mandible alignment at a 2-sided α = .05. Ten cadavers per group were used to increase the power of the study.…”