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J Reconstr Microsurg 2012; 28(06): 395-404
DOI: 10.1055/s-0032-1315762
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Computer-Aided Stereolithography for Presurgical Planning in Fibula Free Tissue Reconstruction of the Mandible

Jill Sink
1   Department of Oral and Maxillofacial Surgery, University of Minnesota, Minneapolis, Minnesota
,
David Hamlar
2   Department of Otolaryngology, University of Minnesota, Minneapolis
,
Deepak Kademani
1   Department of Oral and Maxillofacial Surgery, University of Minnesota, Minneapolis, Minnesota
,
Samir S. Khariwala
2   Department of Otolaryngology, University of Minnesota, Minneapolis
› Institutsangaben
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Publikationsverlauf

30. Oktober 2011

21. März 2012

Publikationsdatum:
18. Juni 2012 (online)

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Abstract

Introduction Computer-aided imaging has facilitated presurgical modeling for free tissue mandibular reconstruction. The purpose of this study is to illustrate the utility of preoperative virtual surgical planning in fibula reconstruction of the mandible.

Methods Eight patients, age 17 to 72 years, treated between November 2009 and January 2011 were reviewed. Each required segmental resection and reconstruction of the mandible and were managed with presurgical virtual planning.

Results Our series includes five cases of squamous cell carcinoma (SCCA), one case of osteoradionecrosis (ORN), one leiomyosarcoma, and one odontogenic myxoma. All patients underwent a segmental resection of the mandible 5 to 14 cm in size (average 8 cm). In each case, prefabricated guides for segmental mandibulectomy and fibula osteotomy were employed and resulted in simplification of bony inset and reduced need for “fine tuning” of fibula segments.

Conclusions Virtual surgical planning fosters multidisciplinary communication and provides accurate presurgical planning. This allows seamless reconstruction in patients requiring mandibular reconstruction via fibula free tissue transfer. The combination of mandibular and fibular cutting guides and templates allows for a precise and efficient surgical reconstruction. In our experience, this technology is most useful in the reconstruction of large mandibular defects requiring large reconstruction plates and multiple fibular osteotomies.

Keywords

fibula - free flap - mandibular reconstruction - modeling
 

  • References

  • 1 Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989; 84: 71-79
    Google Scholar
  • 2 Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-year follow-up study. Plast Reconstr Surg 2002; 110: 438-449 , discussion 450–451
    CrossrefPubMedGoogle Scholar
  • 3 Hirsch DL, Garfein ES, Christensen AM, Weimer KA, Saddeh PB, Levine JP. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg 2009; 67: 2115-2122
    CrossrefPubMedGoogle Scholar
  • 4 Roser SM, Ramachandra S, Blair H , et al. The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results. J Oral Maxillofac Surg 2010; 68: 2824-2832
    CrossrefPubMedGoogle Scholar
  • 5 Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Otolaryngol Head Neck Surg 1991; 117: 733-744
    CrossrefPubMedGoogle Scholar
  • 6 BuSaba NY, Schaumberg DA. Predictors of prolonged length of stay after major elective head and neck surgery. Laryngoscope 2007; 117: 1756-1763
    CrossrefPubMedGoogle Scholar
  • 7 Eckardt A, Swennen GR. Virtual planning of composite mandibular reconstruction with free fibula bone graft. J Craniofac Surg 2005; 16: 1137-1140
    CrossrefPubMedGoogle Scholar
  • 8 Liu XJ, Gui L, Mao C, Peng X, Yu GY. Applying computer techniques in maxillofacial reconstruction using a fibula flap: a messenger and an evaluation method. J Craniofac Surg 2009; 20: 372-377
    CrossrefPubMedGoogle Scholar
  • 9 Leiggener C, Messo E, Thor A, Zeilhofer HF, Hirsch JM. A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular reconstruction with free fibula osseous flaps. Int J Oral Maxillofac Surg 2009; 38: 187-192
    CrossrefPubMedGoogle Scholar
  • 10 Sharaf B, Levine JP, Hirsch DL, Bastidas JA, Schiff BA, Garfein ES. Importance of computer-aided design and manufacturing technology in the multidisciplinary approach to head and neck reconstruction. J Craniofac Surg 2010; 21: 1277-1280
    CrossrefPubMedGoogle Scholar
  • 11 Macario A. What does one minute of operating room time cost?. J Clin Anesth 2010; 22: 233-236
    CrossrefPubMedGoogle Scholar
  • 12 Chang SY, Huang JJ, Tsao CK , et al. Does ischemia time affect the outcome of free fibula flaps for head and neck reconstruction? A review of 116 cases. Plast Reconstr Surg 2010; 126: 1988-1995
    CrossrefPubMedGoogle Scholar
  • 13 González-García R, Naval-Gías L, Rodríguez-Campo FJ, Muñoz-Guerra MF, Sastre-Pérez J. Vascularized free fibular flap for the reconstruction of mandibular defects: clinical experience in 42 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: 191-202
    CrossrefPubMedGoogle Scholar