George Kokosis1, Edward H Davidson2, Rachel Pedreira3, Alexandra Macmillan4, Amir H Dorafshar5. 1. Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2. Assistant Professor, Division of Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY. 3. Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. 4. Medical Student, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 5. Associate Professor, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: adorafs1@jhmi.edu.
Abstract
PURPOSE: Virtual surgical planning (VSP) with subsequent computer-aided design and manufacturing have proved efficacious in improving the efficiency and outcomes of a plethora of surgical modalities, including mandibular reconstruction and orthognathic surgery. PATIENTS AND METHODS: Five patients underwent complex mandibular reconstruction after traumatic injury using VSP from July 2016 to August 2017 at our institution. The Johns Hopkins University Hospital institutional review board approved the present study. The patient's occlusion was restored virtually, and a milled 2.0-mm plate was created that would bridge the defect with the patient in occlusion. RESULTS: Appropriate occlusion was confirmed using postoperative computed tomography. No patient developed any adverse outcomes, except for a minor dehiscence of the intraoral incision in 1 patient that was treated with local wound care. The average interval from the injury to custom plate availability was approximately 7 days. CONCLUSIONS: The utility of this technology in acute complex mandibular trauma can overcome the challenges of traditional treatment. Custom patient-specific prebent and milled plates permit the use of a lower profile and therefore less palpable hardware, can guide reduction, avoid the need for plate bending, and obviate the need for an extraoral incision.
PURPOSE: Virtual surgical planning (VSP) with subsequent computer-aided design and manufacturing have proved efficacious in improving the efficiency and outcomes of a plethora of surgical modalities, including mandibular reconstruction and orthognathic surgery. PATIENTS AND METHODS: Five patients underwent complex mandibular reconstruction after traumatic injury using VSP from July 2016 to August 2017 at our institution. The Johns Hopkins University Hospital institutional review board approved the present study. The patient's occlusion was restored virtually, and a milled 2.0-mm plate was created that would bridge the defect with the patient in occlusion. RESULTS: Appropriate occlusion was confirmed using postoperative computed tomography. No patient developed any adverse outcomes, except for a minor dehiscence of the intraoral incision in 1 patient that was treated with local wound care. The average interval from the injury to custom plate availability was approximately 7 days. CONCLUSIONS: The utility of this technology in acute complex mandibular trauma can overcome the challenges of traditional treatment. Custom patient-specific prebent and milled plates permit the use of a lower profile and therefore less palpable hardware, can guide reduction, avoid the need for plate bending, and obviate the need for an extraoral incision.
Authors: Sean A Knudson; Kristopher M Day; Patrick Kelley; Pablo Padilla; Ian X Collier; Steven Henry; Raymond Harshbarger; Patrick Combs Journal: Craniomaxillofac Trauma Reconstr Date: 2021-06-21
Authors: Johanna Nilsson; Fredrik Nysjö; Ingela Nyström; Johan Kämpe; Andreas Thor Journal: Int J Comput Assist Radiol Surg Date: 2021-04-27 Impact factor: 2.924