Template based segmental mandibulectomy with nerve preservation and patient-specific PEEK plate reconstruction in a dog

Abstract

A 7-year-old French Bulldog presented with an acanthomatous ameloblastoma affecting approximately 30% of the right mandibular body. We utilized a patient-specific 3D-printed surgical template to perform lateral fenestration of the mandible and elevation of the inferior alveolar nerve (IAN), facilitating nerve preservation during subsequent segmental mandibulectomy. The resulting critical-sized bone defect was anatomically stabilized using a patient-specific polyetheretherketone (PEEK) bridging plate. The recovery process was uneventful, with maintained occlusion and orofacial sensitivity.

Similar to cases in humans with ameloblastoma, preserving orofacial sensitivity through the preservation of the inferior alveolar nerve seems feasible in dogs. Consequently, potential negative consequences of permanent regional denervation, which are unavoidable in traditional mandibulectomy, can be avoided. Bridging the ostectomy with a PEEK plate, offering advantages such as radiolucency, absence of imaging artifacts, and a modulus of elasticity similar to bone, proved to be functional in this canine patient, with no signs of complications observed up to the latest follow-up at 6 months.

Zusammenfassung

Eine 7-jährige französische Bulldogge wurde aufgrund eines akanthomatösen Ameloblastoms, welches ca. 30% des rechten Unterkieferasts einnahm, vorgestellt. Unter Verwendung einer patientenspezifischen 3D gedruckten chirurgischen Schablone wurde die Mandibula laterale fenestriert und der Nervus alveolaris inferior (IAN) angehoben, sodass der Nerv während der anschließenden Mandibulektomie erhalten wurde. Der resultierende Knochendefekt wurde mittels einer patientenspezifischen PEEK-Überbrückungsplatte (PEEK: Polyether-Ether-Keton) anatomisch stabilisiert. Der Genesungsprozess verlief komplikationslos mit Erhalt der Okklusion und der orofazialen Sensitivität.

Vergleichbar zu Fällen in der Humanmedizin scheint der Erhalt der orofazialen Sensitivität durch Schonung des IAN auch beim Hund möglich. Dadurch können potenziell negative Konsequenzen durch permanente Denervation, wie sie bei traditioneller Mandibulektomie unvermeidlich sind, verhindert werden. Die Überbrückung der Ostektomie, die mittels PEEK-Platte Vorteile wie Radioluszenz, das Fehlen von Bildgebungsartefakten und ein dem Knochen vergleichbares Elastizitätsmodul bietet, erwies sich als funktional bei diesem Patienten, ohne Anzeichen von Komplikationen bis zum Zeitpunkt der letzten Untersuchung 6 Monate postoperativ.

Keywords

Ameloblastoma - PSI - mandibular reconstruction - inferior alveolar nerve - 3D printing

Schlüsselwörter

Ameloblastom - PSI - Kieferrekonstruktion - Nervus alveolaris inferior - 3D-Druck

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