Dataset Information

A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction.

ABSTRACT:

Objectives

Although computer-assisted surgery using fibula flap has been widely applied for oncologic jaw reconstruction in recent years, the inaccurate positioning of the fibula harvest guide brings sliding and rotational errors, which leads to compromised accuracy in simultaneous implant placement and dental rehabilitation. This study aimed to develop a novel three-dimensional (3D)-printed patient-specific fibula malleolus cap to increase oncologic reconstruction accuracy.

Methods

In this prospective comparative study with a recent historical control cohort, patients in need of oncologic jaw reconstruction with fibula free flaps were recruited. In the study group, the fibula was harvested with the guide of the malleolus cap, whereas in the control group, without the malleolus cap. Deviations of location and angulation of distal fibula osteotomies, jaw reconstruction segments, and simultaneous dental implants were compared.

Results

Twenty patients were recruited, with 10 in each arm. The application of the malleolus cap significantly reduced the deviations in locations and angles of distal fibula osteotomies, from 9.5 to 4.1 mm and 25.3° to 8.7°. For the simultaneous dental implants placed in the fibula flaps, there was a significant increase in the accuracy of implant platform locations (the average deviation from 3.2 to 1.3 mm), apex locations (from 3.8 to 1.5 mm), and angles (from 11.3° to 4.6°). No significant difference was detected in the accuracy of fibula reconstruction segments.

Conclusions

We developed a novel fibula malleolus cap to overcome the sliding and rotational errors during fibula flap harvesting for oncologic jaw reconstruction, with increased accuracy in simultaneous dental implants. This is a step forward to achieve a satisfactory functional outcome of jaw reconstruction with dental rehabilitation.

SUBMITTER: Pu JJ

PROVIDER: S-EPMC8767155 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction.

Pu Jingya Jane JJ Choi Wing Shan WS Yeung Wai Kan WK Yang Wei-Fa WF Zhu Wang-Yong WY Su Yu-Xiong YX

Frontiers in oncology 20220105

<h4>Objectives</h4>Although computer-assisted surgery using fibula flap has been widely applied for oncologic jaw reconstruction in recent years, the inaccurate positioning of the fibula harvest guide brings sliding and rotational errors, which leads to compromised accuracy in simultaneous implant placement and dental rehabilitation. This study aimed to develop a novel three-dimensional (3D)-printed patient-specific fibula malleolus cap to increase oncologic reconstruction accuracy.<h4>Methods</ ...[more]

PMID: 35070962

Similar Datasets

Project description:Introduction There is currently no consensus as to the comparative complication profiles of mini-plate (MP) and reconstruction bar (RB) osseous fixation in fibula flap mandibular reconstruction. The aim of this study is to compare complication rates associated with the use of MP versus RB fixation for vascularized fibula free flap (FFF) reconstruction of oncologic mandibular defects in an effort to better guide hardware utilization and pre-operative virtual surgical planning methods. Methods A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, and Cochrane Library databases were queried to identify studies related to FFF-based mandibular reconstruction with either MP or RB fixation. Primary endpoints of interest were plate complications, wound infection, mal- or non-union, and total flap loss. Complication rates were calculated as weighted proportions and compared via Fisher's exact testing. Results Sixteen studies met inclusion criteria, which examined 1,513 patients. Only three studies directly compared MP fixation with RB fixation. MP fixation was used in 828 (54.7%) cases and RB fixation in 685 (45.3%) cases. MP fixation demonstrated greater rates of plate-related complications (32.5% versus 18.8%, p < 0.01, respectively), fistula formation (15.8% versus 4.7%, p = 0.04), total flap loss (9.4% versus 4.7%, p = 0.02), partial flap loss (20.6% versus 6.1%, p < 0.01), and re-operation for vascular compromise (13.3% versus 4.0%, p < 0.01). Rates of infection, mal-union/non-union, and wound dehiscence were similar across both groups. Conclusion Our results suggest that MP use may be associated with higher rates of plate-related complications. Though limited by outcome reporting heterogeneity, this review can serve as a template for future investigations evaluating the safety profiles of MP and RB fixation in head and neck surgery.

Project description:BackgroundDue to the special anatomy morphology and physiological function of the mandible, it has always become a challenge to accurately reconstruct the mandibular defect in maxillofacial surgery. Digital three dimensions (3D) printing surgical guide, as the effective method for individual and accurate surgery, is a hotspot of clinical research at present. In this study, 3D printing PLA surgical guide plate was applied to reconstruct the mandibular defect with fibula flap, its clinical effect and accuracy were evaluated, which aimed to improve the accurate reconstruction of mandibular defects.MethodsAfter sterilization, the dimension deformation of the PLA standard specimen were measured. Eighteen patients diagnose with mandibular tumor were collected as observation objects. Then partial mandible resection and simultaneous mandible reconstruction with fibula graft were implemented according to the computer-aided design plan. The clinical effects of 3D printing PLA guide plates application were evaluated by facial contours, occlusal stability and chewing function. Through registering the postoperative computed images reconstruction with preoperative designed shape, the reconstruction accuracy was evaluated by detecting the maximum difference including the distance between lateral convex point of the condyles, the distance between medial convex point of the condyles and the horizontal contained angle between long axis of the condyles.ResultsAfter high temperature steam sterilization, the curvature of the PLA specimen with 100% filling rate and 4.8 mm thickness were the smallest and their dimension deformation had no statistical significance (P>0.05). The minimally deformed 3D printing PLA guide plate were smoothly placed in the right place during the operation. After surgery, the face was symmetrical, the occlusal relationship was restored well and no deviation of the mandibular movement were found. The spiral computed tomography (SCT) scanning showed that the distance between lateral/medial convex points of the condyle and the horizontal contained angle were 128.34±8.68 mm, 88.69±6.75 mm and 145.87°±12.01°. Compared with preoperative design, the maximum deviation of the actual postoperative registration was 1.67±0.63, and the difference was not statistically significant (P>0.05).ConclusionsThe application of 3D printing PLA guide plate in the segmental section and reconstruction of the mandible can effectively simplify the operation, and better reconstruct the continuity of the mandible. The surgical accuracy can fully meet clinical needs with relatively low prices.

Project description:IntroductionFunctional and cosmetic defects in maxillofacial region are caused by various ailments like trauma, neoplasm, developmental, infections and iatrogenic causes. Reconstruction of these defects with free flaps remains the gold standard but demerits like need for surgical expertise and equipment, prolonged duration of surgery, compliance of the patient and increased cost are associated with microvascular reconstruction. Hence reconstruction with nonvascular bone grafts can be considered when defect is nonirradiated and <9 cm and with sufficient soft tissue cover available.PurposeTo retrospectively evaluate clinical, radiological outcome and complications encountered with mandibular reconstruction using non vascular fibula graft.Patients and methodsThis retrospective study included 7 patients who were treated in the Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, AP between 2011 and 2013 with histologically proven benign osteolytic lesions of mandible that require a segmental mandibulectomy and primary reconstruction using autogenous non-vascularised fibular graft. The clinical case records of the patients and personal patient assessment forms (Quality of Life Assessment Forms) were analysed. They were recalled every 3rd, 6th and 9th month after surgery for evaluation of clinical, radiological outcome of the graft and complications occurring at recipient and donor sites.ResultsIn all the 7 patients, the lower border continuity was maintained except in one where the graft was dislodged. Tongue movements in all the patients were unrestricted. Jaw movements were affected in cases of ramus defects with slight deviation to operated side and reduced mouth opening. Radiological observations revealed no significant changes in 3 months except for slight reduction in graft height. The radioopaque bridging with continuity of lower border of mandible was noticed in 6th month indicating the take of the graft. This was achieved in every case except in one where the graft was lost due to dislodged reconstruction plate. In 9th month the edges of the graft i.e., graft to native mandible junction showed more resorption (3 mm) especially where there is >2 mm of gap. Whereas increase in height of graft in other areas especially in graft to graft junction was seen. Significant graft resorption was seen in two cases. There were no major complications associated with the donor site.ConclusionAvascular fibula graft although a second choice to vascularised fibula, is a favourable option for mandible defects of 6-10 cm under optimum conditions especially in developing countries where financial and/or surgical resources are limited. An attempt for primary reconstruction with this is never futile as it prevents aesthetic deformity even in the event of failure and thus makes secondary reconstruction easy. However in order to confirm the results a prospective study with large scale of patients is necessary.

Dataset Information

A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction.

Objectives

Methods

Results

Conclusions

Publications

A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets