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Use of silicone surgical guides and biomodels in jaw reconstruction
1246
21st ICOMS 2013—Abstracts: Oral Papers
The intra-operator digitization error was within 0.4 mm. Lip purse and maximal smile animation showed the least amount of change in magnitude (0.2 mm) following surgery, speed difference was least for maximal smile animation (−0.1 mm/s). Motion similarity was found to be highest for lip purse animation (0.77). The study confirmed that the surgery did influence the dynamics of facial animations and Di4D capture system can be regarded as a feasible objective tool for assessing the impact of surgical interventions on facial soft tissue movements. A larger sample and multicenter investigations can improve the understanding of how various surgical procedures affect the dynamics of facial animation. http://dx.doi.org/10.1016/j.ijom.2013.07.256 T12. Facial Reconstructive Surgery T12.OR001 New trends in mandibular reconstruction A. Abdel Fattah Mahmoud 1,∗ , M. Ashraf Abdel Fattah Mahmoud 2 1
Al Azhar University, Egypt Hear and Speech Institute-General Authority for Hospitals and Educational Institutions, Egypt
2
Reconstruction of maxillo-facial defects creates a challenge for oral and maxillo-facial surgeons. It requires basic knowledge of anatomy and thorough skills for harvesting osseous and soft tissue to reconstruct the defective area. Aim: To select and compare between different approaches for mandibular reconstruction. Patients and methods: A total number of thirty patients of different age groups complaining of different mandibular lesions were selected for resection and reconstruction of their defects either simultaneously or delayed after thorough investigations. The reconstruction will depend on many factors which include size, site of the defect, age and medical status of the patient, nature of the donor and recipient site. Results: Immediate reconstruction is preferred than delayed one if it is feasible. In children preservation of the periostium is mandatory for self bone regeneration without harvesting bone graft. Micro-vascular bone grafting is the golden standard for reconstructing large bone defects while non vascularized iliac crest bone grafting is suitable for mild to moderate bone defects. Recommendations: Rehabilitation of the reconstructed patient is mandatory as soon as possible for preserving bone, contour and facial symmetry by inserting dental implants with bridges or over dentures. http://dx.doi.org/10.1016/j.ijom.2013.07.257 T12.OR002 Correction of post mandibular resection-reconstruction defects using stereolithographic model technology M. Ahmed ∗ , N. Askar, M. Hakam Faculty of Oral & Dental Medicine, Cairo University, Egypt Introduction: Reconstruction aims to achieve adequate form and function to maintain proper aesthetics and symmetry of the face. Mandibular reconstruction poses a challenge to the surgeon due to its complicated geometry, muscle attachment, the form and position of condyles in the glenoid fossa, and occlusion.
Aim: To address the efficacy of Stereolithographic model technology in precise adaptation of reconstruction plate with reasonable symmetry, decreasing surgical time and plate handling intra-operatively thus preserving hardware strength. Material and methods: 10 patients selected, three cases of segmental mandibular resection and three of disarticulation resection without reconstruction plate nor bone grafting. Another Two cases were presented with exposed reconstruction plate and two with poorly contoured fibula grafting leading to significant dissatisfactory symmetry. Pre-operative OPG and multislice CT scan were performed for all patients. Computer-guided virtual surgical planning was prepared from the CT scan image of DICOM-format, where the affected segment was subtracted and then reformatted with a mirror image from the contralateral normal side. Prebending of the reconstruction plate was done on the prefabricated model and transferred to the surgical field. Immediate replacement of the condylar segment was done with costochondral graft. Post-operative assessment was performed immediately and six months to evaluate the inter-incisal mouth opening, occlusion, facial symmetry, and condylar or graft position in the glenoid fossa. Results: Clinical results showed no complications in all patients except one patient who developed submandibular. There was no open bite, normal range of mouth opening and mandibular movements, and the occlusion and facial form was restored. Radiographic results showed normal position of the replaced condyle in the glenoid fossa. Conclusion: Use of virtual surgical planning and stereolithographic model remarkably decrease surgical time, blood loss, exposure to general anaesthesia, shorter wound exposure with reasonable mandibular symmetry. http://dx.doi.org/10.1016/j.ijom.2013.07.258 T12.OR003 Use of silicone surgical guides and biomodels in jaw reconstruction D. Alcocer 1,∗ , F. Loyola 1 , H. Perez 2 , N. Aranda 2 1 2
Hospital Dr. Sótero Del Río, Chile Maxillofacial Surgery Resident, Chile
Background and objectives: Introduce a novel working protocol for jaw reconstructive surgery using silicone guides elaborated on biomodels for resective and reconstructive treatments. Methods: In 8 patients undergoing resective surgery for mandibular pathology biomodels were made. Resections were planned in accordance with clinical and CT examinations on the biomodels. After preplating, silicone surgical guides were elaborated to register the craniomaxillo mandibular relationship (CMMR) and also to record the positions of the plates on the remaining bone. During surgery, after the tumoral resection, plates were installed according to the planned position in the biomodel, away from the lesion to prevent seeding, using the silicone guides previously elaborated. Results: The use of silicone guides on mandibular resection surgery allowed keeping a more accurate CMMR and an asymptomatic TMJ after surgery. The silicone guides were easily adapted and there was a decrease of the surgical time. Conclusions: According to our experience, using silicone surgical guides elaborated on biomodels is an excellent resource for studying, planning of the surgery and subsequent reconstruction,
21st ICOMS 2013—Abstracts: Oral Papers
1247
considerably decreasing the surgery time and improving the final predictability. Key words: biomodel; surgical guide; mandible; reconstruction
T12.OR005
http://dx.doi.org/10.1016/j.ijom.2013.07.259
Hospital of Specialties, Rabat, Morocco
T12.OR004
The defects of the face are often complex and extensive whose the aetiology is essentially malignant. They constitute a challenge to which is frequently confronted the Maxillofacial surgeon. Reconstructive surgery is always the solution where morphological and functional rehabilitation of the face involves many autoplasties. Indeed the restoration of the defect by autologous tissue is the ideal solution in condition to respect the basic principles of aesthetic units and subunits of the face. The indications are based on the criteria of location of the defect, size and quality of local tissues, but also on age, general condition and the aetiology of the defect. The progress of musculocutaneous flaps and particularly microvascular transplants have changed radically the data of the surgery of the face. We present here some procedures of repair according to different regions of the face affected by emphasizing the principles of reconstructive surgery of the face.
Mandibular reconstruction in benign tumours using nonvascularized grafts—our treatment protocol J.P. Alister 1,∗ , R. Fari˜na 2,3,4 , F. Uribe 1 , S. Valladares 3 , M. Barreda 2,3,4 1
Oral and Maxillofacial Surgery Department, Universidad De La Frontera, Temuco, Chile 2 Oral and Maxillofacial Surgery Department, Universidad de Chile, Santiago, Chile 3 Oral and Maxillofacial Surgery Department, Hospital del Salvador, Santiago, Chile 4 Oral and Maxillofacial Surgery Department, Hospital San Borja Arriarán, Santiago, Chile Mandible reconstruction involves a great challenge for Maxillofacial surgeons. Nowadays, the surgical procedures are more predictable returning function and a successful aesthetic outcome as soon as possible. Work and social insertion of these patients who are treated with resective and reconstructive surgery is accomplished in a shorter period of time and have better outcomes. Actually the microvascular free flap technique is the gold standard treatment in reconstruction. However the technical difficulty of the microsurgical reconstruction, the absence of trained surgeons and the limited amount of bone for the later dental implant placement are the disadvantages in relation to the non-vascularized grafts (Iliac Crest). This is a retrospective study of 9 patients, 5 men and 4 women with an average of age of 34 years (15–52 years). The diagnoses were; Ameloblastoma (N = 3), Ossyfing Fibroma (N = 2), Mixoma (N = 3) and Sclerosing Osteomyelitis (N = 1). Tooth extractions were made 6 weeks previous to resection. Hemimandibulectomy and reconstruction at same surgical time were performed in each patient. All the procedures were carried out using an extraoral approach avoiding oral contact. Locking plates previously shaped using stereolithographic models were used. Mandibular segment was reconstructed with Iliac Crest blocks. Ninety percent of the patients maintained sufficient amount of bone that allowed a dental implant treatment. One case (Sclerosing Osteomyelitis) presented 50% bone resorption of the iliac crest graft due to communication with oral cavity. Non-vascularized grafts (Iliac Crest) are less complex and require less time in relation to vascular grafts. Also they contribute a great amount of bone in wide and height to place dental implants properly. To improve the final outcome is important to avoid graft overloading and the communication with the oral cavity.Key words: mandibular reconstruction; tumour resection; nonvascularized grafts http://dx.doi.org/10.1016/j.ijom.2013.07.260
Repair procedures of large defects of the face H. Benhalima
http://dx.doi.org/10.1016/j.ijom.2013.07.261 T12.OR006 Palatal and nasal reconstruction in cocaine related syndrome C. Bescós Atín ∗ , J. Pamias Romero, M. Sáez Barba, A. de Pablo García-Cuenca Hospital Vall D’Hebrón, Department of Oral And Maxillofacial Surgery, Spain Background and objectives: Cocaine consumption can induce centrofacial midline necrosis producing complex defects which require difficult reconstructive combined techniques. Our objective is to describe and discuss the reconstructive possibilities for palatal and nasal defects produced by this aetiology. Materials and methods: A retrospective review was done of the cases treated by our Department which developed centrofacial midline defects due to cocaine consumption. We describe the anatomical defects and the reconstructive methods performed. Results: A total of 6 patients were treated. All cases developed palatal defects with oronasal communication, and 3 patients had combined nasal deformity. For the nasal defects either local pedicled flaps or grafts were used. For the 6 palatal defects 5 free flaps were used (2 radial forearms, 2 ALTs and 1 anterolateral arm). The remaining palatal defect was treated using a bilateral FAMM flap, which failed, and an ALT was performed. Conclusion: Reconstruction of central midfacial defects developed by cocaine consumption can be challenging. The combination of free flaps, pedicled flaps and grafts can be used to reconstruct defects which are usually located in the hard palate but can also involve the nose and soft palate. Key words: cocaine; nasal deformity; oronasal communication; reconstruction http://dx.doi.org/10.1016/j.ijom.2013.07.262
21st ICOMS 2013—Abstracts: Oral Papers
The intra-operator digitization error was within 0.4 mm. Lip purse and maximal smile animation showed the least amount of change in magnitude (0.2 mm) following surgery, speed difference was least for maximal smile animation (−0.1 mm/s). Motion similarity was found to be highest for lip purse animation (0.77). The study confirmed that the surgery did influence the dynamics of facial animations and Di4D capture system can be regarded as a feasible objective tool for assessing the impact of surgical interventions on facial soft tissue movements. A larger sample and multicenter investigations can improve the understanding of how various surgical procedures affect the dynamics of facial animation. http://dx.doi.org/10.1016/j.ijom.2013.07.256 T12. Facial Reconstructive Surgery T12.OR001 New trends in mandibular reconstruction A. Abdel Fattah Mahmoud 1,∗ , M. Ashraf Abdel Fattah Mahmoud 2 1
Al Azhar University, Egypt Hear and Speech Institute-General Authority for Hospitals and Educational Institutions, Egypt
2
Reconstruction of maxillo-facial defects creates a challenge for oral and maxillo-facial surgeons. It requires basic knowledge of anatomy and thorough skills for harvesting osseous and soft tissue to reconstruct the defective area. Aim: To select and compare between different approaches for mandibular reconstruction. Patients and methods: A total number of thirty patients of different age groups complaining of different mandibular lesions were selected for resection and reconstruction of their defects either simultaneously or delayed after thorough investigations. The reconstruction will depend on many factors which include size, site of the defect, age and medical status of the patient, nature of the donor and recipient site. Results: Immediate reconstruction is preferred than delayed one if it is feasible. In children preservation of the periostium is mandatory for self bone regeneration without harvesting bone graft. Micro-vascular bone grafting is the golden standard for reconstructing large bone defects while non vascularized iliac crest bone grafting is suitable for mild to moderate bone defects. Recommendations: Rehabilitation of the reconstructed patient is mandatory as soon as possible for preserving bone, contour and facial symmetry by inserting dental implants with bridges or over dentures. http://dx.doi.org/10.1016/j.ijom.2013.07.257 T12.OR002 Correction of post mandibular resection-reconstruction defects using stereolithographic model technology M. Ahmed ∗ , N. Askar, M. Hakam Faculty of Oral & Dental Medicine, Cairo University, Egypt Introduction: Reconstruction aims to achieve adequate form and function to maintain proper aesthetics and symmetry of the face. Mandibular reconstruction poses a challenge to the surgeon due to its complicated geometry, muscle attachment, the form and position of condyles in the glenoid fossa, and occlusion.
Aim: To address the efficacy of Stereolithographic model technology in precise adaptation of reconstruction plate with reasonable symmetry, decreasing surgical time and plate handling intra-operatively thus preserving hardware strength. Material and methods: 10 patients selected, three cases of segmental mandibular resection and three of disarticulation resection without reconstruction plate nor bone grafting. Another Two cases were presented with exposed reconstruction plate and two with poorly contoured fibula grafting leading to significant dissatisfactory symmetry. Pre-operative OPG and multislice CT scan were performed for all patients. Computer-guided virtual surgical planning was prepared from the CT scan image of DICOM-format, where the affected segment was subtracted and then reformatted with a mirror image from the contralateral normal side. Prebending of the reconstruction plate was done on the prefabricated model and transferred to the surgical field. Immediate replacement of the condylar segment was done with costochondral graft. Post-operative assessment was performed immediately and six months to evaluate the inter-incisal mouth opening, occlusion, facial symmetry, and condylar or graft position in the glenoid fossa. Results: Clinical results showed no complications in all patients except one patient who developed submandibular. There was no open bite, normal range of mouth opening and mandibular movements, and the occlusion and facial form was restored. Radiographic results showed normal position of the replaced condyle in the glenoid fossa. Conclusion: Use of virtual surgical planning and stereolithographic model remarkably decrease surgical time, blood loss, exposure to general anaesthesia, shorter wound exposure with reasonable mandibular symmetry. http://dx.doi.org/10.1016/j.ijom.2013.07.258 T12.OR003 Use of silicone surgical guides and biomodels in jaw reconstruction D. Alcocer 1,∗ , F. Loyola 1 , H. Perez 2 , N. Aranda 2 1 2
Hospital Dr. Sótero Del Río, Chile Maxillofacial Surgery Resident, Chile
Background and objectives: Introduce a novel working protocol for jaw reconstructive surgery using silicone guides elaborated on biomodels for resective and reconstructive treatments. Methods: In 8 patients undergoing resective surgery for mandibular pathology biomodels were made. Resections were planned in accordance with clinical and CT examinations on the biomodels. After preplating, silicone surgical guides were elaborated to register the craniomaxillo mandibular relationship (CMMR) and also to record the positions of the plates on the remaining bone. During surgery, after the tumoral resection, plates were installed according to the planned position in the biomodel, away from the lesion to prevent seeding, using the silicone guides previously elaborated. Results: The use of silicone guides on mandibular resection surgery allowed keeping a more accurate CMMR and an asymptomatic TMJ after surgery. The silicone guides were easily adapted and there was a decrease of the surgical time. Conclusions: According to our experience, using silicone surgical guides elaborated on biomodels is an excellent resource for studying, planning of the surgery and subsequent reconstruction,
21st ICOMS 2013—Abstracts: Oral Papers
1247
considerably decreasing the surgery time and improving the final predictability. Key words: biomodel; surgical guide; mandible; reconstruction
T12.OR005
http://dx.doi.org/10.1016/j.ijom.2013.07.259
Hospital of Specialties, Rabat, Morocco
T12.OR004
The defects of the face are often complex and extensive whose the aetiology is essentially malignant. They constitute a challenge to which is frequently confronted the Maxillofacial surgeon. Reconstructive surgery is always the solution where morphological and functional rehabilitation of the face involves many autoplasties. Indeed the restoration of the defect by autologous tissue is the ideal solution in condition to respect the basic principles of aesthetic units and subunits of the face. The indications are based on the criteria of location of the defect, size and quality of local tissues, but also on age, general condition and the aetiology of the defect. The progress of musculocutaneous flaps and particularly microvascular transplants have changed radically the data of the surgery of the face. We present here some procedures of repair according to different regions of the face affected by emphasizing the principles of reconstructive surgery of the face.
Mandibular reconstruction in benign tumours using nonvascularized grafts—our treatment protocol J.P. Alister 1,∗ , R. Fari˜na 2,3,4 , F. Uribe 1 , S. Valladares 3 , M. Barreda 2,3,4 1
Oral and Maxillofacial Surgery Department, Universidad De La Frontera, Temuco, Chile 2 Oral and Maxillofacial Surgery Department, Universidad de Chile, Santiago, Chile 3 Oral and Maxillofacial Surgery Department, Hospital del Salvador, Santiago, Chile 4 Oral and Maxillofacial Surgery Department, Hospital San Borja Arriarán, Santiago, Chile Mandible reconstruction involves a great challenge for Maxillofacial surgeons. Nowadays, the surgical procedures are more predictable returning function and a successful aesthetic outcome as soon as possible. Work and social insertion of these patients who are treated with resective and reconstructive surgery is accomplished in a shorter period of time and have better outcomes. Actually the microvascular free flap technique is the gold standard treatment in reconstruction. However the technical difficulty of the microsurgical reconstruction, the absence of trained surgeons and the limited amount of bone for the later dental implant placement are the disadvantages in relation to the non-vascularized grafts (Iliac Crest). This is a retrospective study of 9 patients, 5 men and 4 women with an average of age of 34 years (15–52 years). The diagnoses were; Ameloblastoma (N = 3), Ossyfing Fibroma (N = 2), Mixoma (N = 3) and Sclerosing Osteomyelitis (N = 1). Tooth extractions were made 6 weeks previous to resection. Hemimandibulectomy and reconstruction at same surgical time were performed in each patient. All the procedures were carried out using an extraoral approach avoiding oral contact. Locking plates previously shaped using stereolithographic models were used. Mandibular segment was reconstructed with Iliac Crest blocks. Ninety percent of the patients maintained sufficient amount of bone that allowed a dental implant treatment. One case (Sclerosing Osteomyelitis) presented 50% bone resorption of the iliac crest graft due to communication with oral cavity. Non-vascularized grafts (Iliac Crest) are less complex and require less time in relation to vascular grafts. Also they contribute a great amount of bone in wide and height to place dental implants properly. To improve the final outcome is important to avoid graft overloading and the communication with the oral cavity.Key words: mandibular reconstruction; tumour resection; nonvascularized grafts http://dx.doi.org/10.1016/j.ijom.2013.07.260
Repair procedures of large defects of the face H. Benhalima
http://dx.doi.org/10.1016/j.ijom.2013.07.261 T12.OR006 Palatal and nasal reconstruction in cocaine related syndrome C. Bescós Atín ∗ , J. Pamias Romero, M. Sáez Barba, A. de Pablo García-Cuenca Hospital Vall D’Hebrón, Department of Oral And Maxillofacial Surgery, Spain Background and objectives: Cocaine consumption can induce centrofacial midline necrosis producing complex defects which require difficult reconstructive combined techniques. Our objective is to describe and discuss the reconstructive possibilities for palatal and nasal defects produced by this aetiology. Materials and methods: A retrospective review was done of the cases treated by our Department which developed centrofacial midline defects due to cocaine consumption. We describe the anatomical defects and the reconstructive methods performed. Results: A total of 6 patients were treated. All cases developed palatal defects with oronasal communication, and 3 patients had combined nasal deformity. For the nasal defects either local pedicled flaps or grafts were used. For the 6 palatal defects 5 free flaps were used (2 radial forearms, 2 ALTs and 1 anterolateral arm). The remaining palatal defect was treated using a bilateral FAMM flap, which failed, and an ALT was performed. Conclusion: Reconstruction of central midfacial defects developed by cocaine consumption can be challenging. The combination of free flaps, pedicled flaps and grafts can be used to reconstruct defects which are usually located in the hard palate but can also involve the nose and soft palate. Key words: cocaine; nasal deformity; oronasal communication; reconstruction http://dx.doi.org/10.1016/j.ijom.2013.07.262