Three-dimensional accuracy of mandibular reconstruction by patient-specific pre-bent reconstruction plates using an “in-house” 3D-printer

Naros, Andreas; Weise, Hannes; Tilsen, Felix; Hoefert, Sebastian; Naros, Georgios; Krimmel, Michael; Reinert, Siegmar; Polligkeit, Joachim

doi:10.1016/j.jcms.2018.05.047

Cited by 30 publications

(46 citation statements)

References 24 publications

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“…The highest overall recipient complication rate, though, was observed after the use of reconstruction plates. However, this observation might also be attributable to selection bias in this group, as seen in the study by Wei et al [36]. The plate group had the highest number of malignancies and, if required in accordance with the current guidelines [39], consecutive adjuvant radiation therapy.…”

Section: Impact Of Total Radiation Dosage On the Occurrence Of Complimentioning

confidence: 92%

“…Plate exposure is a severe complication that necessitates a critical review of the treatment plan, and a new operation including plate removal and secondary reconstruction [35]. Wei et al reported a plate exposure rate of 46.15% in a retrospective analysis of patients who had been reconstructed with a reconstruction plate and soft tissue free flap [36]. Their high incidence of plate exposure was probably due to patient selection, including only patients with recurrent carcinomas and stage IV tumours.…”

Section: Impact Of the Choice Of Reconstructive Technique On The Occumentioning

confidence: 99%

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Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

et al. 2020

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Objectives The purpose of this study was to evaluate the incidence of complications following mandibular reconstruction and to analyse possible contributing factors. Materials and methods Clinical data and computed tomography scans of all patients who needed a mandibular reconstruction with a reconstruction plate, free fibula flap (FFF) or iliac crest (DCIA) flap between August 2010 and August 2015 were retrospectively analysed. Results One hundred and ninety patients were enrolled, encompassing 77 reconstructions with reconstruction plate, 89 reconstructions with FFF and 24 reconstructions with DCIA flaps. Cutaneous perforation was most frequently detected in the plate subgroup within the early interval and overall (each p = 0.004). Low body mass index (BMI) and total radiation dosage were the most relevant risk factors for the development of analysed complications. Conclusions Microvascular bone flaps have overall less skin perforation than reconstruction plates. BMI and expected total radiation dosage have to be respected in choice of reconstructive technique. Clinical relevance A treatment algorithm for mandibular reconstructions on the basis of our results is presented.

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Section: Impact Of Total Radiation Dosage On the Occurrence Of Complimentioning

confidence: 92%

Section: Impact Of the Choice Of Reconstructive Technique On The Occumentioning

confidence: 99%

Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

et al. 2020

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“…On contrary, because of the limited accessibility of the intraoral approach, the plate insertion was considered more difficult, requiring more plate readjustment, which resulted in a longer plate placement time. Another reason for the need of plate readjustment in this study was that when the tumor had perforated or destroyed the buccal bone and reached a big size, the pre-bent plate could require further intraoperative readjustment, this explanation was also stated by Naros et al 12 However, this consumed time by the plate readjustment was outweighed by the reduced time required for making the intraoral incision. Similarly, the steps of the extraoral incision are considered a lengthy procedure, which consumed the time that was saved by the rapid plate placement without readjustment, resulting in an increase in the total operative time, which became comparable to that of the intraoral procedures with no significant difference.…”

Section: Discussionmentioning

confidence: 58%

“…According to Naros et al 12 , anatomical points, lines, and angles were identified and placed on the pre-and postoperative 3D images (Figure 2). The definitions of these anatomical landmarks are listed in Table 1.…”

Section: Ct Data Analysismentioning

confidence: 99%

“…This incision avoids facial scars, preserves the perioral musculature, and does not jeopardize the integrity of the facial nerve, providing optimal esthetic and functional results. 8 Several studies 4,7,[9][10][11][12] concerning mandibular reconstruction were focused on the assessment of the 3D accuracy of reconstruction with the pre-bent reconstruction plates. Until now, there is no study explored the effect of the surgical approach to ameloblastoma on the 3D position of the proximal segment after mandibular resection and reconstruction with a pre-bent reconstruction plate.…”

Section: Introductionmentioning

confidence: 99%

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Three dimensional accuracy of mandibular reconstruction by pre-bent reconstruction plate using intra oral versus extra oral approaches following mandibular resection in patients with extensive ameloblastoma

Mohamed

2020

Egyptian Dental Journal

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Purpose: This prospective study aimed to compare the intraoral placement of the pre-bent reconstruction plate with that inserted via the extraoral approach, to evaluate their impact on the three-dimensional (3D) position of the proximal segment, after continuity resection of mandibular ameloblastoma.Patients and methods: Patients were divided into two equal groups. In group 1, the mandible was reconstructed with a pre-bent reconstruction plate via an intraoral approach. In group 2, an extraoral approach was used. The primary outcome variables were the need for intraoperative plate readjustment, the time needed for plate insertion, total operation time, difficulties encountered during surgery, and the postoperative stability of the proximal segment. Distances between corresponding anatomical landmarks on the mandibular angle and condyle (A-A`, B-B`, C-C`, B-C`) as well as the intercondylar angle (ICA) and B`XC angle, were measured. The difference between the pre-and postoperative measurements was used to evaluate the reconstruction accuracy. The results of the two groups were compared and analyzed by t-test.Results: Thirty patients were enrolled in this study. In group 1, four plates required minor readjustment. In group 2, only two cases required re-adaptation. The mean time for plate placement was 38 ± 5.8 and 27.5 ± 7.5 minutes in groups 1 and 2, respectively (p = 0.0001). The intraoral insertion of the pre-bent plates revealed a decrease in the linear measurements, resulting in mandibular compression. On contrary, the extraoral approach showed increase in the measurements, resulting in widening of the mandible. However, this width difference was statistically insignificant. Concerning the ICA and B`XC angle, no significant difference could be ascertained between the two groups. Conclusion:Intraoral approach is more conservative procedure, thereby achieving the best esthetic outcomes and resulting in a more accurate 3D mandibular reconstruction. This approach is considered the treatment of choice for resection and reconstruction of mandibular ameloblastoma. However, if the reconstruction plate cannot be inserted intraorally, then extraoral approach is advised.

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Virtual planning and 3D‐printed guides for mandibular reconstruction: Factors impacting accuracy

Annino

Sethi

Hansen

et al. 2022

Laryngoscope Investig Oto

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Objectives: Examine accuracy and factors impacting accuracy for mandibular reconstruction with virtual surgical planning, 3D printed osteotomy guides and preoperatively bent mandibular reconstruction plate (VSP/3Dprinted-guide/plate). Method: Retrospective review of osseous-free-flap mandibular reconstructions with VSP/3Dprinted-guide/plate between January 2015 and July 2020 at a single academic medical center. Patient demographics, disease, and treatment variables were extracted. Accuracy was assessed by 3D-model-overlay with cephalometric and donor-bone segment length measurements. Multivariate analyses were performed to determine factors impacting cephalometric accuracy.Results: 60 cases met criteria: 41 (68%) cancer, 14 (23%) osteoradionecrosis (ORN), 5 (8%) secondary mandibular reconstruction. Thirteen cases (22%) were Brown class III or IV. Thirty-nine cases (65%) had ≥2 flap bone segments. Average donor-bone length was 82 mm (SD: 28). 3D-model-overlay accuracy demonstrated minimal deviation between planned and actual reconstruction: intercondylar distance = 2.10 mm (SD: 2.2); intergonial distance = 2.23 mm (SD: 1.9); anterior-posterior distance (APD) = 1.76 mm (SD: 1.5); gonial angle (GA) = 3.11 degrees (SD: 2.4). Mean change in donor-bone segment length inferiorly was 2.67 mm (SD: 2.6) and superiorly 3.27 mm (SD: 3.2). Higher number of donor-bone segments was associated with decreased accuracy in GA (p = .023) and longer donor-bone length was associated with decreased accuracy in APD (p = .031). Conclusion:To our knowledge this is the largest series assessing surgical accuracy of VSP/3Dprinted-guide/plate for osseous-free-flap mandibular reconstruction. We demonstrate highly accurate results, with increased number of donor-bone segments

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Three-dimensional accuracy of mandibular reconstruction by patient-specific pre-bent reconstruction plates using an “in-house” 3D-printer

Cited by 30 publications

References 24 publications

Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

Three dimensional accuracy of mandibular reconstruction by pre-bent reconstruction plate using intra oral versus extra oral approaches following mandibular resection in patients with extensive ameloblastoma

Virtual planning and 3D‐printed guides for mandibular reconstruction: Factors impacting accuracy

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