Secondary Maxillary and Orbital Floor Reconstruction With a Free Scapular Flap Using Cutting and Fixation Guides Created by Computer-Aided Design/Computer-Aided Manufacturing

Abstract

Computer-aided design/computer-aided manufacturing (CAD/CAM) guides are now widely used in maxillofacial reconstruction. However, there are few reports of CAD/CAM guides being used for scapular flaps. The authors performed the secondary maxillary and orbital floor reconstruction using a free latissimus dorsi muscle, cutaneous tissue, and scapular flap designed using CAD/CAM techniques in a 72-year-old man who had undergone partial maxillectomy four years previously. The patient had diplopia, the vertical dystopia of eye position, and a large oral-nasal-cutaneous fistula. After the operation, the authors confirmed that the deviation between the postoperative and preoperative planning three-dimensional images was less than 2 mm. Because scapular guides require 3 cutting surfaces, the shape of the scapular guide is more complex than that of a conventional fibular guide. In orbital floor reconstruction, the use of a CAM technique such as that used to manufacture the authors' fixation guide is as necessary for accurate, safe, and easy reconstruction as is preoperative CAD planning. The production of a fixation guide as well as a cutting guide is particularly useful because it is difficult to determine the angle for reconstructing the orbital floor by freehand techniques. In this case, the orbital floor was reconstructed based on a mirror image of the healthy side to avoid overcompression of the orbital tissue. Although the patient's vertical dystopia of eye position was improved, diplopia was not improved because, for greater safety, the authors did not plan overcorrection of the orbital volume.

Using a New Deep Learning Method for 3D Cephalometry in Patients With Hemifacial Microsomia

“…At present, computer-aided design/manufacturing (CAD/CAM) and virtual surgical planning (VSP) are widely used in craniomaxillofacial surgery 20 . Worldwide, few plastic surgeons use these techniques for automated 3D cephalometric measurements 21,22 . By using our automated 3D cephalometric tool, a more comprehensive morphological analysis of HFM patients can be performed, and the corresponding angle, length, and ration can be calculated by locating the landmarks, so that clinicians can more accurately grasp the patient's malformation problems, and thus more accurately design the surgical plan.…”

“…20 Worldwide, few plastic surgeons use these techniques for automated 3D cephalometric measurements. 21,22 By using our automated 3D cephalometric tool, a more comprehensive morphological analysis of HFM patients can be performed, and the corresponding angle, length, and ration can be calculated by locating the landmarks, so that clinicians can more accurately grasp the patient's malformation problems, and thus more accurately design the surgical plan. Our model could be combined with VSP and CAD/CAM technologies to enable more personalized surgical design for HFM patients.…”

Versatility of the subscapular system of flaps in head and neck oncologic reconstruction

“…In this light, thoughtful preoperative planning is crucial to optimize the correct in-setting for dental rehabilitation. The application of virtual surgical planning (VSP) has been recently described for several defects, including midface, mandible, and orbital floor [25][26][27]. VSP can be useful to plan the resection [28] and flap harvest osteotomies, and, in comparison to the free hand technique, is associated with better bone contouring, more precise flap insetting, and is particularly helpful if dental rehabilitation is planned [25,29].…”

Evaluation of virtual surgical planning and three‐dimensional configurations for reconstruction of maxillary defects using the fibula free flap

“…Today, VSP allows a variety of configurations to be operated with high accuracy. Recently, there are some reports of in‐house, surgeon designed VSP (Morita et al, 2017; Smithers et al, 2018).…”