Sean A Knudson1, Kristopher M Day1,2,3, Patrick Kelley1,2,3, Pablo Padilla4, Ian X Collier3, Steven Henry2,3, Raymond Harshbarger1,2,3, Patrick Combs1,2,3. 1. Division of Craniofacial and Pediatric Plastic Surgery, Dell Children's Medical Center, The University of Texas at Austin, Austin, TX, USA. 2. Department of Plastic Surgery, Dell Seton Medical Center, The University of Texas at Austin, Austin, TX, USA. 3. Dell Medical School, The University of Texas at Austin, Austin, TX, USA. 4. Department of Plastic Surgery, University of Texas Medical Branch at Galveston, Galveston, TX, USA.
Abstract
Study Design: Retrospective case series; systematic review. Objective: It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods: A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results: Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions: Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.
Study Design: Retrospective case series; systematic review. Objective: It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods: A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results: Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions: Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.
Authors: George Kokosis; Edward H Davidson; Rachel Pedreira; Alexandra Macmillan; Amir H Dorafshar Journal: J Oral Maxillofac Surg Date: 2017-12-13 Impact factor: 1.895
Authors: Michael R Zachar; Carl Labella; Christopher P Kittle; Pamela Brown Baer; Robert G Hale; Rodney K Chan Journal: J Oral Maxillofac Surg Date: 2013-01-23 Impact factor: 1.895
Authors: Constantin Stuehmer; Harald Essig; Alexander Schramm; Martin Rücker; André Eckardt; Nils-Claudius Gellrich Journal: Oral Maxillofac Surg Date: 2008-12