Toshiaki Numajiri1, Daiki Morita2, Hiroko Nakamura2, Shoko Tsujiko3, Ryo Yamochi4, Yoshihiro Sowa5, Kenichiro Toyoda6, Takahiro Tsujikawa7, Akihito Arai7, Makoto Yasuda8, Shigeru Hirano9. 1. Department Head and Associate Professor, Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: prs-bin@koto.kpu-m.ac.jp. 2. Resident, Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 3. Intern, Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 4. Assistant Professor, Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 5. Lecturer, Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 6. Department Head, Otorhinolaryngology, Kyoto City Hospital, Kyoto, Japan. 7. Assistant Professor, Department of Otorhinolaryngology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 8. Lecturer, Department of Otorhinolaryngology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 9. Department Head and Professor, Department of Otorhinolaryngology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Abstract
PURPOSE: Computer-assisted design (CAD) and computer-aided manufacturing (CAM) techniques are in widespread use for maxillofacial reconstruction. However, CAD/CAM surgical guides are commercially available only in limited areas. To use this technology in areas where these commercial guides are not available, the authors developed a CAD/CAM technique in which all processes are performed by the surgeon (in-house approach). The authors describe their experience and the characteristics of their in-house CAD/CAM reconstruction of the maxilla. PATIENTS AND METHODS: This was a retrospective study of maxillary reconstruction with a free osteocutaneous flap. Free CAD software was used for virtual surgery and to design the cutting guides (maxilla and fibula), which were printed by a 3-dimensional printer. After the model surgery and pre-bending of the titanium plates, the actual reconstructions were performed. The authors compared the clinical information, preoperative plan, and postoperative reconstruction data. The reconstruction was judged as accurate if more than 80% of the reconstructed points were within a deviation of 2 mm. RESULTS: Although on-site adjustment was necessary in particular cases, all 4 reconstructions were judged as accurate. In total, 3 days were needed before the surgery for planning, printing, and pre-bending of plates. The average ischemic time was 134 minutes (flap suturing and bone fixation, 70 minutes; vascular anastomoses, 64 minutes). The mean deviation after reconstruction was 0.44 mm (standard deviation, 0.97). The deviations were 67.8% for 1 mm, 93.8% for 2 mm, and 98.6% for 3 mm. The disadvantages of the regular use of CAD/CAM reconstruction are the intraoperative changes in defect size and local tissue scarring. CONCLUSION: Good accuracy was obtained for CAD/CAM-guided reconstructions based on an in-house approach. The theoretical advantage of computer simulation contributes to the accuracy. An in-house approach could be an option for maxillary reconstruction.
PURPOSE: Computer-assisted design (CAD) and computer-aided manufacturing (CAM) techniques are in widespread use for maxillofacial reconstruction. However, CAD/CAM surgical guides are commercially available only in limited areas. To use this technology in areas where these commercial guides are not available, the authors developed a CAD/CAM technique in which all processes are performed by the surgeon (in-house approach). The authors describe their experience and the characteristics of their in-house CAD/CAM reconstruction of the maxilla. PATIENTS AND METHODS: This was a retrospective study of maxillary reconstruction with a free osteocutaneous flap. Free CAD software was used for virtual surgery and to design the cutting guides (maxilla and fibula), which were printed by a 3-dimensional printer. After the model surgery and pre-bending of the titanium plates, the actual reconstructions were performed. The authors compared the clinical information, preoperative plan, and postoperative reconstruction data. The reconstruction was judged as accurate if more than 80% of the reconstructed points were within a deviation of 2 mm. RESULTS: Although on-site adjustment was necessary in particular cases, all 4 reconstructions were judged as accurate. In total, 3 days were needed before the surgery for planning, printing, and pre-bending of plates. The average ischemic time was 134 minutes (flap suturing and bone fixation, 70 minutes; vascular anastomoses, 64 minutes). The mean deviation after reconstruction was 0.44 mm (standard deviation, 0.97). The deviations were 67.8% for 1 mm, 93.8% for 2 mm, and 98.6% for 3 mm. The disadvantages of the regular use of CAD/CAM reconstruction are the intraoperative changes in defect size and local tissue scarring. CONCLUSION: Good accuracy was obtained for CAD/CAM-guided reconstructions based on an in-house approach. The theoretical advantage of computer simulation contributes to the accuracy. An in-house approach could be an option for maxillary reconstruction.
Authors: Jose Luís Cebrián Carretero; José Luis Del Castillo Pardo de Vera; Néstor Montesdeoca García; Pablo Garrido Martínez; Marta María Pampín Martínez; Iñigo Aragón Niño; Ignacio Navarro Cuéllar; Carlos Navarro Cuéllar Journal: J Clin Med Date: 2022-08-06 Impact factor: 4.964
Authors: Gustaaf J C van Baar; Kitty Schipper; Tymour Forouzanfar; Lars Leeuwrik; Henri A H Winters; Angela Ridwan-Pramana; Frank K J Leusink Journal: J Clin Med Date: 2021-03-16 Impact factor: 4.241