Accuracy of the surgical execution of virtually planned deep circumflex iliac artery flaps and their appropriateness for masticatory rehabilitation.
Humans
Male
Female
Middle Aged
Surgical Flaps
/ blood supply
Iliac Artery
/ surgery
Aged
Adult
Surgery, Computer-Assisted
/ methods
Imaging, Three-Dimensional
Plastic Surgery Procedures
/ methods
Mandibular Neoplasms
/ surgery
Retrospective Studies
Mandibular Reconstruction
/ methods
Mastication
/ physiology
Treatment Outcome
Computer-aided design
DCIA
Deep circumflex iliac artery flap
Free flaps
Virtual surgery planning
Journal
Head & face medicine
ISSN: 1746-160X
Titre abrégé: Head Face Med
Pays: England
ID NLM: 101245792
Informations de publication
Date de publication:
13 Aug 2024
13 Aug 2024
Historique:
received:
05
01
2024
accepted:
06
08
2024
medline:
13
8
2024
pubmed:
13
8
2024
entrez:
12
8
2024
Statut:
epublish
Résumé
Tumorous diseases of the jaw demand effective treatments, often involving continuity resection of the jaw. Reconstruction via microvascular bone flaps, like deep circumflex iliac artery flaps (DCIA), is standard. Computer aided planning (CAD) enhances accuracy in reconstruction using patient-specific CT images to create three-dimensional (3D) models. Data on the accuracy of CAD-planned DCIA flaps is scarce. Moreover, the data on accuracy should be combined with data on the exact positioning of the implants for well-fitting dental prosthetics. This study focuses on CAD-planned DCIA flaps accuracy and proper positioning for prosthetic rehabilitation. Patients post-mandible resection with CAD-planned DCIA flap reconstruction were evaluated. Postoperative radiograph-derived 3D models were aligned with 3D models from the CAD plans for osteotomy position, angle, and flap volume comparison. To evaluate the DCIA flap's suitability for prosthetic dental rehabilitation, a plane was created in the support zone and crestal in the middle of the DCIA flap. The lower jaw was rotated to close the mouth and the distance between the two planes was measured. 20 patients (12 males, 8 females) were included. Mean defect size was 73.28 ± 4.87 mm; 11 L defects, 9 LC defects. Planned vs. actual DCIA transplant volume difference was 3.814 ± 3.856 cm³ (p = 0.2223). The deviation from the planned angle was significantly larger at the dorsal osteotomy than at the ventral (p = 0.035). Linear differences between the planned DCIA transplant and the actual DCIA transplant were 1.294 ± 1.197 mm for the ventral osteotomy and 2.680 ± 3.449 mm for the dorsal (p = 0.1078). The difference between the dental axis and the middle of the DCIA transplant ranged from 0.2 mm to 14.8 mm. The mean lateral difference was 2.695 ± 3.667 mm in the region of the first premolar. The CAD-planned DCIA flap is a solution for reconstructing the mandible. CAD planning results in an accurate reconstruction enabling dental implant placement and dental prosthetics.
Sections du résumé
BACKGROUND
BACKGROUND
Tumorous diseases of the jaw demand effective treatments, often involving continuity resection of the jaw. Reconstruction via microvascular bone flaps, like deep circumflex iliac artery flaps (DCIA), is standard. Computer aided planning (CAD) enhances accuracy in reconstruction using patient-specific CT images to create three-dimensional (3D) models. Data on the accuracy of CAD-planned DCIA flaps is scarce. Moreover, the data on accuracy should be combined with data on the exact positioning of the implants for well-fitting dental prosthetics. This study focuses on CAD-planned DCIA flaps accuracy and proper positioning for prosthetic rehabilitation.
METHODS
METHODS
Patients post-mandible resection with CAD-planned DCIA flap reconstruction were evaluated. Postoperative radiograph-derived 3D models were aligned with 3D models from the CAD plans for osteotomy position, angle, and flap volume comparison. To evaluate the DCIA flap's suitability for prosthetic dental rehabilitation, a plane was created in the support zone and crestal in the middle of the DCIA flap. The lower jaw was rotated to close the mouth and the distance between the two planes was measured.
RESULTS
RESULTS
20 patients (12 males, 8 females) were included. Mean defect size was 73.28 ± 4.87 mm; 11 L defects, 9 LC defects. Planned vs. actual DCIA transplant volume difference was 3.814 ± 3.856 cm³ (p = 0.2223). The deviation from the planned angle was significantly larger at the dorsal osteotomy than at the ventral (p = 0.035). Linear differences between the planned DCIA transplant and the actual DCIA transplant were 1.294 ± 1.197 mm for the ventral osteotomy and 2.680 ± 3.449 mm for the dorsal (p = 0.1078). The difference between the dental axis and the middle of the DCIA transplant ranged from 0.2 mm to 14.8 mm. The mean lateral difference was 2.695 ± 3.667 mm in the region of the first premolar.
CONCLUSION
CONCLUSIONS
The CAD-planned DCIA flap is a solution for reconstructing the mandible. CAD planning results in an accurate reconstruction enabling dental implant placement and dental prosthetics.
Identifiants
pubmed: 39135061
doi: 10.1186/s13005-024-00444-y
pii: 10.1186/s13005-024-00444-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
42Informations de copyright
© 2024. The Author(s).
Références
Davudov MM, Harirchi I, Arabkheradmand A, Garajei A, Mahmudzadeh H, Shirkhoda M, et al. Evaluation of quality of life in patients with oral cancer after mandibular resection: comparing no reconstruction, reconstruction with plate, and reconstruction with flap. Medicine. 2019;98(41):e17431.
doi: 10.1097/MD.0000000000017431
pubmed: 31593097
pmcid: 6799791
Chandu A, Smith AC, Rogers SN. Health-related quality of life in oral cancer: a review. J oral Maxillofacial Surgery: Official J Am Association Oral Maxillofacial Surg. 2006;64(3):495–502.
doi: 10.1016/j.joms.2005.11.028
Lonie S, Herle P, Paddle A, Pradhan N, Birch T, Shayan R. Mandibular reconstruction: meta-analysis of iliac- versus fibula-free flaps. ANZ J Surg. 2016;86(5):337–42.
doi: 10.1111/ans.13274
pubmed: 26331293
Willinger K, Guevara-Rojas G, Cede J, Schicho K, Stamm T, Klug C. Comparison of feasibility, time consumption and costs of three virtual planning systems for surgical correction of midfacial deficiency. Maxillofac Plast Reconstr Surg. 2021;43(1):2.
doi: 10.1186/s40902-020-00284-1
pubmed: 33411020
pmcid: 7790928
Modabber A, Ayoub N, Mohlhenrich SC, Goloborodko E, Sonmez TT, Ghassemi M, et al. The accuracy of computer-assisted primary mandibular reconstruction with vascularized bone flaps: iliac crest bone flap versus osteomyocutaneous fibula flap. Med Devices. 2014;7:211–7.
doi: 10.2147/MDER.S62698
Modabber A, Gerressen M, Ayoub N, Elvers D, Stromps JP, Riediger D, et al. Computer-assisted zygoma reconstruction with vascularized iliac crest bone graft. Int J Med Rob Comput Assist Surg. 2013;9(4):497–502.
doi: 10.1002/rcs.1557
Modabber A, Peters F, Raith S, Ayoub N, Hölzle F. Virtuelle Planung Komplexer mikrovaskulärer knöcherner Rekonstruktionen in Der MKG-Chirurgie. Der MKG-Chirurg. 2017;10(4):272–83.
doi: 10.1007/s12285-017-0120-7
Bartier S, Mazzaschi O, Benichou L, Sauvaget E. Computer-assisted versus traditional technique in fibular free-flap mandibular reconstruction: a CT symmetry study. Eur Ann Otorhinolaryngol Head Neck Dis. 2021;138(1):23–7.
doi: 10.1016/j.anorl.2020.06.011
pubmed: 32620425
Elsharabasy IM, Elhafez H, Ahmed SAE, Ayad WM. Evaluation of the Accuracy of three-dimensional virtual Surgical Planning for Reconstruction of Mandibular defects using free Fibular flap. J Craniofac Surg. 2020;31(4):950–5.
doi: 10.1097/SCS.0000000000006280
pubmed: 32149975
Geusens J, Sun Y, Luebbers HT, Bila M, Darche V, Politis C. Accuracy of computer-aided Design/Computer-Aided Manufacturing-assisted Mandibular Reconstruction with a Fibula Free Flap. J Craniofac Surg. 2019;30(8):2319–23.
doi: 10.1097/SCS.0000000000005704
pubmed: 31261320
Goormans F, Sun Y, Bila M, Schoenaers J, Geusens J, Lübbers HT, et al. Accuracy of computer-assisted mandibular reconstructions with free fibula flap: results of a single-center series. Oral Oncol. 2019;97:69–75.
doi: 10.1016/j.oraloncology.2019.07.022
pubmed: 31430641
Powcharoen W, Yang WF, Yan Li K, Zhu W, Su YX. Computer-assisted versus conventional freehand Mandibular Reconstruction with Fibula Free Flap: a systematic review and Meta-analysis. Plast Reconstr Surg. 2019;144(6):1417–28.
doi: 10.1097/PRS.0000000000006261
pubmed: 31764662
Sweed AH, Bolzoni AR, Kadubiec A, Beltramini GA, Cherchi A, Baj A. Factors influencing CAD/CAM accuracy in fibula free flap mandibular reconstruction. Acta Otorhinolaryngol Ital. 2020;40(2):138–43.
doi: 10.14639/0392-100X-N0400
pubmed: 32469008
pmcid: 7256912
Eichner K. Uber Eine Gruppeneinteilung Der Lückengebisse für die Prothetik. Dtsch Zahnarztliche Zeitschriff. 1955;10:1831–4.
Jewer DD, Boyd JB, Manktelow RT, Zuker RM, Rosen IB, Gullane PJ, et al. Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plast Reconstr Surg. 1989;84(3):391–403. discussion 4–5.
doi: 10.1097/00006534-198909000-00001
pubmed: 2762397
Kansy K, Mueller AA, Mücke T, Koersgen F, Wolff KD, Zeilhofer HF, et al. A worldwide comparison of the management of surgical treatment of advanced oral cancer. J Craniomaxillofac Surg. 2018;46(3):511–20.
doi: 10.1016/j.jcms.2017.12.031
pubmed: 29395993
Mavrogenis AF, Igoumenou VG, Ignatiadis I, Mourouzis K, Rallis G, Spyridonos SG. Microsurgical reconstruction of complex oromandibular defects: an update. Injury. 2019;50(Suppl 5):S117–22.
doi: 10.1016/j.injury.2019.10.061
pubmed: 31732121
Ristow O, Otto S, Troeltzsch M, Hohlweg-Majert B, Pautke C. Treatment perspectives for medication-related osteonecrosis of the jaw (MRONJ). J Craniomaxillofac Surg. 2015;43(2):290–3.
doi: 10.1016/j.jcms.2014.11.014
pubmed: 25541255
Becker ST, Menzebach M, Küchler T, Hertrampf K, Wenz HJ, Wiltfang J. Quality of life in oral cancer patients–effects of mandible resection and socio-cultural aspects. J Craniomaxillofac Surg. 2012;40(1):24–7.
doi: 10.1016/j.jcms.2011.01.021
pubmed: 21514171
Head C, Alam D, Sercarz JA, Lee JT, Rawnsley JD, Berke GS, et al. Microvascular flap reconstruction of the mandible: a comparison of bone grafts and bridging plates for restoration of mandibular continuity. Otolaryngol Head Neck Surg. 2003;129(1):48–54.
doi: 10.1016/S0194-59980300480-7
pubmed: 12869916
Sato N, Koyama S, Mito T, Izumita K, Ishiko R, Yamauchi K, et al. Changes in oral health-related quality of life after oral rehabilitation with dental implants in patients following mandibular tumor resection. J Oral Sci. 2019;61(3):406–11.
doi: 10.2334/josnusd.18-0234
pubmed: 31341120
Disa JJ, Cordeiro PG. Mandible reconstruction with microvascular surgery. Semin Surg Oncol. 2000;19(3):226–34.
doi: 10.1002/1098-2388(200010/11)19:3<226::AID-SSU4>3.0.CO;2-N
pubmed: 11135479
Makiguchi T, Yokoo S, Hashikawa K, Miyazaki H, Terashi H. Evaluation of bone height of the free fibula flap in mandible reconstruction. J Craniofac Surg. 2015;26(3):673–6.
doi: 10.1097/SCS.0000000000001509
pubmed: 25915680
Wolff K-D, Hölzle F. Raising of microvascular flaps: a systematic approach. Berlin: Springer; 2018.
doi: 10.1007/978-3-319-53670-5
van Baar GJC, Forouzanfar T, Liberton N, Winters HAH, Leusink FKJ. Accuracy of computer-assisted surgery in mandibular reconstruction: a systematic review. Oral Oncol. 2018;84:52–60.
doi: 10.1016/j.oraloncology.2018.07.004
pubmed: 30115476
Shu DL, Liu XZ, Guo B, Ran W, Liao X, Zhang YY. Accuracy of using computer-aided rapid prototyping templates for mandible reconstruction with an iliac crest graft. World J Surg Oncol. 2014;12:190.
doi: 10.1186/1477-7819-12-190
pubmed: 24957053
pmcid: 4101797
Ayoub N, Ghassemi A, Rana M, Gerressen M, Riediger D, Holzle F, et al. Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial. Trials. 2014;15:114.
doi: 10.1186/1745-6215-15-114
pubmed: 24716651
pmcid: 3998950
Zhang WB, Yu Y, Wang Y, Mao C, Liu XJ, Guo CB, et al. Improving the accuracy of mandibular reconstruction with vascularized iliac crest flap: role of computer-assisted techniques. J Craniomaxillofac Surg. 2016;44(11):1819–27.
doi: 10.1016/j.jcms.2016.08.014
pubmed: 27713054
Anne-Gaëlle B, Samuel S, Julie B, Renaud L, Pierre B. Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions. Oral Oncol. 2011;47(12):1099–104.
doi: 10.1016/j.oraloncology.2011.07.016
pubmed: 21873106
Wilkman T, Apajalahti S, Wilkman E, Törnwall J, Lassus P. A comparison of bone resorption over time: an analysis of the free Scapular, Iliac Crest, and Fibular Microvascular flaps in Mandibular Reconstruction. J oral Maxillofacial Surgery: Official J Am Association Oral Maxillofacial Surg. 2017;75(3):616–21.
doi: 10.1016/j.joms.2016.09.009
Kniha K, Möhlhenrich SC, Foldenauer AC, Peters F, Ayoub N, Goloborodko E, et al. Evaluation of bone resorption in fibula and deep circumflex iliac artery flaps following dental implantation: a three-year follow-up study. J Craniomaxillofac Surg. 2017;45(4):474–8.
doi: 10.1016/j.jcms.2017.01.014
pubmed: 28258918