Justine Moe1, Jessica Foss2, Rachel Herster3, Corey Powell4, Joseph Helman5, Brent B Ward6, Kyle VanKoevering7. 1. Assistant Professor and Residency Program Director, Oral and Maxillofacial Surgery Associate Director, Oncology/Microvascular Surgery Fellowship, University of Michigan, Ann Arbor, MI. Electronic address: jusmoe@med.umich.edu. 2. Student, University of Michigan, Ann Arbor, MI. 3. Student, College of Engineering, University of Michigan, Ann Arbor, MI. 4. Consulting for Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, MI. 5. Former C. J. Lyons Endowed Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Michigan, Retired, Ann Arbor, MI. 6. Section Head, Chair, and Associate Professor, Oral and Maxillofacial Surgery Director, Oncology/Microvascular Surgery Fellowship, University of Michigan, Ann Arbor, MI. 7. Assistant Professor, Department of Otolaryngology, University of Michigan, Ann Arbor, MI.
Abstract
PURPOSE: In-house computer-aided surgical design and computer-aided manufacturing (CAD/CAM) can be used in oral and maxillofacial surgery for virtual surgical planning and 3-dimensional printing of patient-specific models. The purpose of this study was to measure the cost and accuracy of an in-house CAD/CAM workflow for maxillofacial free flap reconstruction. MATERIALS AND METHODS: A retrospective cohort study of patients undergoing mandibular resection and free flap reconstruction was performed between July 2017 and March 2018 in which in-house CAD/CAM was used. The predictor variable was the in-house CAD/CAM workflow. The outcome variables were in-house workflow cost, as measured by the material expenses, and accuracy, as measured by comparative distance, osteotomy angle, and surfaced overlay measurements and the root mean square (RMS) between the preoperative virtual reconstructive plan and the postoperative computed tomography scan. Additional variables evaluated were time required for in-house CAD/CAM workflow, and clinical and radiographic outcomes. RESULTS: In-house CAD/CAM was used for 26 patients undergoing mandibular resection for benign or malignant disease and free flap reconstruction with fibula (n = 24) or scapula free flap (n = 2). Overall flap success rate was 95%. The mean in-house workflow cost per case was $3.87 USD. There were no significant differences between the mean comparative distance and osteotomy angle measurements between the planned and actual mandibular reconstructions with an RMS ranging from 5.11 to 9.00 mm for distance measurements and 17.41° for the osteotomy angle measurements. The mean surface overlay difference was 1.90 mm with an RMS of 3.72 mm. CONCLUSIONS: The in-house CAD/CAM workflow is a low cost and accurate option for maxillofacial free flap reconstruction. The in-house workflow should be considered as an alternative to current practices using proprietary systems in select cases.
PURPOSE: In-house computer-aided surgical design and computer-aided manufacturing (CAD/CAM) can be used in oral and maxillofacial surgery for virtual surgical planning and 3-dimensional printing of patient-specific models. The purpose of this study was to measure the cost and accuracy of an in-house CAD/CAM workflow for maxillofacial free flap reconstruction. MATERIALS AND METHODS: A retrospective cohort study of patients undergoing mandibular resection and free flap reconstruction was performed between July 2017 and March 2018 in which in-house CAD/CAM was used. The predictor variable was the in-house CAD/CAM workflow. The outcome variables were in-house workflow cost, as measured by the material expenses, and accuracy, as measured by comparative distance, osteotomy angle, and surfaced overlay measurements and the root mean square (RMS) between the preoperative virtual reconstructive plan and the postoperative computed tomography scan. Additional variables evaluated were time required for in-house CAD/CAM workflow, and clinical and radiographic outcomes. RESULTS: In-house CAD/CAM was used for 26 patients undergoing mandibular resection for benign or malignant disease and free flap reconstruction with fibula (n = 24) or scapula free flap (n = 2). Overall flap success rate was 95%. The mean in-house workflow cost per case was $3.87 USD. There were no significant differences between the mean comparative distance and osteotomy angle measurements between the planned and actual mandibular reconstructions with an RMS ranging from 5.11 to 9.00 mm for distance measurements and 17.41° for the osteotomy angle measurements. The mean surface overlay difference was 1.90 mm with an RMS of 3.72 mm. CONCLUSIONS: The in-house CAD/CAM workflow is a low cost and accurate option for maxillofacial free flap reconstruction. The in-house workflow should be considered as an alternative to current practices using proprietary systems in select cases.
Authors: Alexander-N Zeller; Elisabeth Goetze; Daniel G E Thiem; Alexander K Bartella; Lukas Seifert; Fabian M Beiglboeck; Juliane Kröplin; Jürgen Hoffmann; Andreas Pabst Journal: Oral Maxillofac Surg Date: 2022-08-22
Authors: Lucas M Ritschl; Paul Kilbertus; Florian D Grill; Matthias Schwarz; Jochen Weitz; Markus Nieberler; Klaus-Dietrich Wolff; Andreas M Fichter Journal: Front Oncol Date: 2021-09-24 Impact factor: 6.244