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Comparison of conventional and two methods of computer-assisted mandibular reconstruction planning techniques
191 Comparison of conventional and two methods of computer-assisted mandibular reconstruction planning techniques
The patients had a postoperative computed tomography scan to evaluate the accuracy of the reconstruction result. The findings of the study are discussed.
∗ ˇ J. Sebek , J. Mazánek, M. Molitor, J. Holakovsk´y, M. Vlk, ˇ M. Sipoˇs, V. Vlachopulos, N. Mahdian, R. Foltán
http://dx.doi.org/10.1016/j.ijom.2017.02.653
Institute of Medical Dentistry – Department of Oral and Maxillofacial Surgery, 1st Faculty of Medicine, Charles University in Prague, Czech Republic
Mandibular defects reconstruction with fibula flap and free fibula bone graft X.F. Shan ∗ , J. Liang, L. Zhang, Z.G. Cai
Resection of mandible is key treatment modality of squamous cell carcinoma infiltrating mandibular bone. Reconstruction of consequent defect with composite vascularised flaps is very demanding task in order to restore preoperative facial contour, normal function of temporomandibular joint and facilitate future prosthetic reconstruction. In our department we use different methods for planning reconstruction: free handed reconstruction (FH), based on pre-bending of plate on mandibular surface preoperatively and shaping bone on head surgical site after disconnection of pedicle, and two methods of computer-guided reconstruction—first with pre-bent plate (PP) on three-dimensional (3D) printed model of reconstruction designed in freeware and hand made cutting guides, second is ® DePuy Synthes TruMatch patient-specific plates for mandible (PSPM) with 3D printed cutting guides from Materialise company. These methods of reconstruction planning will be compared from perspective of operation time, precision of reconstruction on preoperative and postoperative computed tomography (CT), early and late sequelae occurrence and aesthetic and functional outcome. Defects were reconstructed using fibular free flap or with deep circumflex iliac artery flaps. Preoperative and postoperative CT scans were performed. They were compared and differences measured using Dolphin 3D software. Aesthetic and functional outcomes were compared using questionnaires and photography. Cohort of 18 patients, 6 patients was reconstructed with use of FH method, 6 with PP and 6 with PSPM. PSPM was most successful in restoring of shape of mandible, in aesthetic and functional aspect. FH and PP was less accurate in restoring the precise shape. However use of PP method reduced operation time significantly too.
Background and Objective: The vascularised free fibula flap has become the most popular reconstruction method for segmental mandibular defect because of adequate bone graft length and acceptance of dental implants. Because of the height discrepancy between the native mandible and transplanted fibula, it is difficult to wear conventional dentures or receive osseointegrated implants. The purpose of this study was to research if mandibular defect could be reconstructed with fibula flap and nonvascularised free fibula bone graft to get a better contour and high neo-alveolar bone. Methods: 17 patients received mandible reconstruction with fibula flap and free fibula bone graft. In the operation, fibula flap was used to reconstruct the mandible as the inferior portion or superior alveolar portion. The nonvascularised fibula bone was fixed to the fibula flap with titanium plate or screws to augment the height of fibula bone. The periosteum between vascularised and nonvascularised fibula was removed to get a better attachment between vascularised and nonvascularised fibula. Findings: The operation proceeded very smoothly in all 17 cases. The follow up time was 6 months to 24 months. All patients got a good appearance, and the bone height improved 5–15 mm compared with conventional one-strut type technique. Conclusions: It is a good choice to reconstruct mandibular defect with fibula flap and nonvascularised free fibula bone graft to get a better contour and high neo-alveolar bone.
http://dx.doi.org/10.1016/j.ijom.2017.02.652
Reconstruction of complex mandibular defects using titanium custom-made implants
Assessment of the accuracy of a three-dimensional modelling technique in maxillofacial reconstruction: a prospective study A.K. Shah ∗ , S. Nair, N. Vijay Bhagwan Mahaveer Jain Hospital, Bangalore, India The use of rapid prototyping three-dimensional (3D) models has revolutionised the way reconstruction of complex defects of the maxillofacial skeleton are planned. They help save time, and improve accuracy. Five patients who had 3D planning to plan their reconstruction were involved in this study. The defects ranged from mandible segmental defects, to mandible defects involving one condyle, to a complex midface defect.
Peking University School and Hospital of Stomatology, China
http://dx.doi.org/10.1016/j.ijom.2017.02.654
D. Shilo ∗ , O. Emodi, O. Blanc, A. Rachmiel Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel Background: Reconstructing mandibular deficiencies is challenging due to the unique anatomy and diversity of defects. In mandibular reconstruction, restoration of function, occlusion and aesthetics is the primary goal. Autografts are the gold standard for mandibular skeletal reconstruction. However autografts have few disadvantages, which led to the research of alloplastic materials. Development of computer-aided design/computer-aided manufacturing systems allows for precise preoperative planning and designing of patient specific implants preoperatively. Objective: Describe the use of patient specific implants for mandibular reconstruction. Methods: Three cases of mandibular bone reconstruction are presented. One patient following ablative surgery, one following traumatic avulsion injury and the third due to an extremely atrophic
The patients had a postoperative computed tomography scan to evaluate the accuracy of the reconstruction result. The findings of the study are discussed.
∗ ˇ J. Sebek , J. Mazánek, M. Molitor, J. Holakovsk´y, M. Vlk, ˇ M. Sipoˇs, V. Vlachopulos, N. Mahdian, R. Foltán
http://dx.doi.org/10.1016/j.ijom.2017.02.653
Institute of Medical Dentistry – Department of Oral and Maxillofacial Surgery, 1st Faculty of Medicine, Charles University in Prague, Czech Republic
Mandibular defects reconstruction with fibula flap and free fibula bone graft X.F. Shan ∗ , J. Liang, L. Zhang, Z.G. Cai
Resection of mandible is key treatment modality of squamous cell carcinoma infiltrating mandibular bone. Reconstruction of consequent defect with composite vascularised flaps is very demanding task in order to restore preoperative facial contour, normal function of temporomandibular joint and facilitate future prosthetic reconstruction. In our department we use different methods for planning reconstruction: free handed reconstruction (FH), based on pre-bending of plate on mandibular surface preoperatively and shaping bone on head surgical site after disconnection of pedicle, and two methods of computer-guided reconstruction—first with pre-bent plate (PP) on three-dimensional (3D) printed model of reconstruction designed in freeware and hand made cutting guides, second is ® DePuy Synthes TruMatch patient-specific plates for mandible (PSPM) with 3D printed cutting guides from Materialise company. These methods of reconstruction planning will be compared from perspective of operation time, precision of reconstruction on preoperative and postoperative computed tomography (CT), early and late sequelae occurrence and aesthetic and functional outcome. Defects were reconstructed using fibular free flap or with deep circumflex iliac artery flaps. Preoperative and postoperative CT scans were performed. They were compared and differences measured using Dolphin 3D software. Aesthetic and functional outcomes were compared using questionnaires and photography. Cohort of 18 patients, 6 patients was reconstructed with use of FH method, 6 with PP and 6 with PSPM. PSPM was most successful in restoring of shape of mandible, in aesthetic and functional aspect. FH and PP was less accurate in restoring the precise shape. However use of PP method reduced operation time significantly too.
Background and Objective: The vascularised free fibula flap has become the most popular reconstruction method for segmental mandibular defect because of adequate bone graft length and acceptance of dental implants. Because of the height discrepancy between the native mandible and transplanted fibula, it is difficult to wear conventional dentures or receive osseointegrated implants. The purpose of this study was to research if mandibular defect could be reconstructed with fibula flap and nonvascularised free fibula bone graft to get a better contour and high neo-alveolar bone. Methods: 17 patients received mandible reconstruction with fibula flap and free fibula bone graft. In the operation, fibula flap was used to reconstruct the mandible as the inferior portion or superior alveolar portion. The nonvascularised fibula bone was fixed to the fibula flap with titanium plate or screws to augment the height of fibula bone. The periosteum between vascularised and nonvascularised fibula was removed to get a better attachment between vascularised and nonvascularised fibula. Findings: The operation proceeded very smoothly in all 17 cases. The follow up time was 6 months to 24 months. All patients got a good appearance, and the bone height improved 5–15 mm compared with conventional one-strut type technique. Conclusions: It is a good choice to reconstruct mandibular defect with fibula flap and nonvascularised free fibula bone graft to get a better contour and high neo-alveolar bone.
http://dx.doi.org/10.1016/j.ijom.2017.02.652
Reconstruction of complex mandibular defects using titanium custom-made implants
Assessment of the accuracy of a three-dimensional modelling technique in maxillofacial reconstruction: a prospective study A.K. Shah ∗ , S. Nair, N. Vijay Bhagwan Mahaveer Jain Hospital, Bangalore, India The use of rapid prototyping three-dimensional (3D) models has revolutionised the way reconstruction of complex defects of the maxillofacial skeleton are planned. They help save time, and improve accuracy. Five patients who had 3D planning to plan their reconstruction were involved in this study. The defects ranged from mandible segmental defects, to mandible defects involving one condyle, to a complex midface defect.
Peking University School and Hospital of Stomatology, China
http://dx.doi.org/10.1016/j.ijom.2017.02.654
D. Shilo ∗ , O. Emodi, O. Blanc, A. Rachmiel Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel Background: Reconstructing mandibular deficiencies is challenging due to the unique anatomy and diversity of defects. In mandibular reconstruction, restoration of function, occlusion and aesthetics is the primary goal. Autografts are the gold standard for mandibular skeletal reconstruction. However autografts have few disadvantages, which led to the research of alloplastic materials. Development of computer-aided design/computer-aided manufacturing systems allows for precise preoperative planning and designing of patient specific implants preoperatively. Objective: Describe the use of patient specific implants for mandibular reconstruction. Methods: Three cases of mandibular bone reconstruction are presented. One patient following ablative surgery, one following traumatic avulsion injury and the third due to an extremely atrophic