Frank Wilde1, Henning Hanken2, Florian Probst3, Alexander Schramm4, Max Heiland2, Carl-Peter Cornelius3. 1. Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany. frank.wilde@extern.uni-ulm.de. 2. Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University Hospital of Munich, Munich, Germany. 4. Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
Abstract
PURPOSE: For the new generation of mandibular reconstruction, patient-specific mandible reconstruction plates (PSMPs) have been developed which are milled from titanium after preoperative computer planning using CAD/CAM procedures. Resection margins and plate position are determined by surgical guides. In addition, length and shape of the plate and the number and angulation of the screw holes can be planned. METHODS: 30 patients received such PSMP. Indication ranged from stabilization osteosynthesis, single alloplastic stand-alone reconstruction to microvascular reconstructions. Time for planning, fit of surgical guides and plates, pre-/postoperative occlusion, radiological position of the temporo mandibular joint and complications were recorded. RESULTS: The median time for online planning was 35 min. The results concerning fit and handling of the PSMP and the surgical guides were mainly very positive. In six cases, the plan had to be adapted to the intraoperative clinical needs. The postoperative position of the condyles in the temporo mandibular fossae was regular in 28 cases. The evaluation of the occlusion was not representative due to not clearly identifiable occlusion in 2/3 of the cases. Nevertheless, complications like postoperative extraoral plate exposure, infection, graft and flap necrosis or difficulties to position the guides or the plate during surgery occurred. CONCLUSIONS: Mandibular reconstruction with PSMP offers a broad range of opportunities and benefits compared with standard procedures and can be recommended for all kind of mandibular reconstructions. It is not yet foreseeable whether PSMP will in future become routine clinical practice for mandibular reconstruction or will be confined to selected isolated cases.
PURPOSE: For the new generation of mandibular reconstruction, patient-specific mandible reconstruction plates (PSMPs) have been developed which are milled from titanium after preoperative computer planning using CAD/CAM procedures. Resection margins and plate position are determined by surgical guides. In addition, length and shape of the plate and the number and angulation of the screw holes can be planned. METHODS: 30 patients received such PSMP. Indication ranged from stabilization osteosynthesis, single alloplastic stand-alone reconstruction to microvascular reconstructions. Time for planning, fit of surgical guides and plates, pre-/postoperative occlusion, radiological position of the temporo mandibular joint and complications were recorded. RESULTS: The median time for online planning was 35 min. The results concerning fit and handling of the PSMP and the surgical guides were mainly very positive. In six cases, the plan had to be adapted to the intraoperative clinical needs. The postoperative position of the condyles in the temporo mandibular fossae was regular in 28 cases. The evaluation of the occlusion was not representative due to not clearly identifiable occlusion in 2/3 of the cases. Nevertheless, complications like postoperative extraoral plate exposure, infection, graft and flap necrosis or difficulties to position the guides or the plate during surgery occurred. CONCLUSIONS: Mandibular reconstruction with PSMP offers a broad range of opportunities and benefits compared with standard procedures and can be recommended for all kind of mandibular reconstructions. It is not yet foreseeable whether PSMP will in future become routine clinical practice for mandibular reconstruction or will be confined to selected isolated cases.
Authors: Marc Anton Fuessinger; Steffen Schwarz; Carl-Peter Cornelius; Marc Christian Metzger; Edward Ellis; Florian Probst; Wiebke Semper-Hogg; Mathieu Gass; Stefan Schlager Journal: Int J Comput Assist Radiol Surg Date: 2017-10-28 Impact factor: 2.924
Authors: Jan J Lang; Mirjam Bastian; Peter Foehr; Michael Seebach; Jochen Weitz; Constantin von Deimling; Benedikt J Schwaiger; Carina M Micheler; Nikolas J Wilhelm; Christian U Grosse; Marco Kesting; Rainer Burgkart Journal: PLoS One Date: 2021-06-08 Impact factor: 3.240