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Evaluation of Effective Condyle Positioning Assisted by 3D Surgical Guide in Mandibular Reconstruction Using Osteocutaneous Free Flap.

ABSTRACT: In the present study, the reproducibility and postoperative stability of a 3D printed surgical guide were evaluated in mandibular reconstruction with an osteocutaneous free flap (OCFF), including a fibular free flap (FFF) and deep circumflex iliac artery free flap (DCIA). Fifteen patients were enrolled, and a 3D surgical guide was fabricated by simulation surgery using preoperative (T0) Computed tomography (CT) images. Mandibular reconstruction was performed with OCFF using the 3D surgical guide. Postoperative CTs were taken immediately, 1 week (T1), and 6 months (T2) after surgery, to evaluate the reproducibility of the 3D surgical guide and condyle stability. Error of the 3D surgical guide ranged from 0.85 to 2.56 mm. There were no differences in reproducibility according to flap type. Condylar error and error at mandible midpoint were significantly different in FFF. However, there was no difference in DCIA error between the condyle and mandible midpoint. Regarding condyle stability 6 months after surgery, condyles moved more than 2 mm (up to 2.85 mm) in FFF, whereas there were no significant movement in DCIA. Careful intraoperative flap fixation and closed postoperative observation should be considered for stable clinical outcome, especially in the case of FFF.

SUBMITTER: Kim SR

PROVIDER: S-EPMC7287575 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Evaluation of Effective Condyle Positioning Assisted by 3D Surgical Guide in Mandibular Reconstruction Using Osteocutaneous Free Flap.

Kim Seong Ryoung SR Jang Sam S Ahn Kang-Min KM Lee Jee-Ho JH

Materials (Basel, Switzerland) 20200519 10

In the present study, the reproducibility and postoperative stability of a 3D printed surgical guide were evaluated in mandibular reconstruction with an osteocutaneous free flap (OCFF), including a fibular free flap (FFF) and deep circumflex iliac artery free flap (DCIA). Fifteen patients were enrolled, and a 3D surgical guide was fabricated by simulation surgery using preoperative (T0) Computed tomography (CT) images. Mandibular reconstruction was performed with OCFF using the 3D surgical guide ...[more]

PMID: 32438671

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Project description:BackgroundReconstruction of mandibular defects following ablative surgery remains a challenge even for experienced surgeons. Virtual planning and guided surgery, including computer-aided design/computer-aided manufacturing (CAD/CAM), afford optimized ways by which to plan complex surgery. This study aimed to evaluate and compare aesthetic outcome and surgical efficiency of free fibular flap (FFF) with and without CAD/CAM customized osteotomy guide (COG) for reconstruction of onco-surgical mandibular defects.MethodsTwenty-two patients indicated for segmental mandibulectomy were randomly assigned to either CAD/CAM with COG group or that without COG- Model based reconstruction (MB group) at a 1:1 ratio. Aesthetic outcomes were evaluated by means of morphometric assessment and comparison for each differential area (DAr) and angle (DAn) in the affected side to the contralateral side of the mandible using computerized digital imaging analysis (CDIA) based on the post-operative 3D CT-scan. Subjective evaluation was performed using the Visual Analogue Scale (VAS) and Patient's Satisfaction Score (PSS). Surgical efficiency was a secondary outcome and evaluated as total operative time and ischemia time.ResultsThe mean sagittal DAr was significantly lower in the COG group (277.28 ± 127.05 vs. 398.67 ± 139.10 mm2, P = 0.045). Although there was an improvement in the axial DAr (147.61 ± 55.42 vs. 183.68 ± 72.85 mm2), the difference was not statistically significant (P = 0.206). The mean differences (Δ) in both sagittal and coronal DAn were significantly lower in the COG group than in the MB group (6.11 ± 3.46 and 1.77 ± 1.12° vs. 9.53 ± 4.17 and 3.44 ± 2.34°), respectively. There were no statistically significant differences in the axial DAn between the two groups (P = 0.386). The PSS was significantly higher in the COG group, reflecting better aesthetic satisfaction than in the MB group (P = 0.041). The total operation and ischemia time were significantly shorter in favor of the COG group with a mean of (562.91 ± 51.22, 97.55 ± 16.80 min vs. 663.55 ± 53.43, 172.45 ± 21.87 min), respectively.ConclusionThe CAD/CAM with COG is more reliable and highly valuable in enhancing aesthetic outcomes and surgical efficiency of mandibular reconstruction by FFF compared to that without COG (MB reconstruction).Trial registrationThis trial was registered at ClinicalTrials.gov .Registration numberNCT03757273. Registration date: 28/11/2018.

Dataset Information

Evaluation of Effective Condyle Positioning Assisted by 3D Surgical Guide in Mandibular Reconstruction Using Osteocutaneous Free Flap.

Publications

Evaluation of Effective Condyle Positioning Assisted by 3D Surgical Guide in Mandibular Reconstruction Using Osteocutaneous Free Flap.

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