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Digital Surgical Planning for Mandibular Reconstruction With Free Fibula Flap: Is the Accuracy Affected by the Number of Compromised Mandibular Segments?
Aura Cardona
Industrias Médicas Sampedro. Medellín, Colombia
Corresponding Author
License:
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Background: Reconstructive mandibular surgery using free fibular flap in patients with defects due to oncologic resections aims to restore the lost functionality and appearance. Digital surgical planning (DSP) aids in designing the procedure through three-dimensional (3D) visualization of the anatomical defect, flap positioning, and contour restoration. Some studies have explored the DSP for assistance with mandibular reconstructions; however, most are limited in sample size and geographic region where these resources are available. Here we present a step-by-step DSP and the results obtained in a cohort of patients analyzed according to the number of compromised mandibular segments.
Methods: We retrospectively analyzed 90 procedures in which DSP was applied, from patients who underwent oncologic mandibulectomy and reconstruction using a free fibula flap from 2012 to 2019. Customized cutting guides and implants were used in all patients. Clínical data was obtained from medical records and information concerning the DSP from company archives. Ethics committee approval was obtained.
Results: patient's median age was 60 years; 52% were women. The most common tumor was squamous cell carcinoma in 49.4%. The medians of the mandibular defect volume and the length of the whole fibula flap were 12.24 cm3 and 9.24 cm. More than one mandibular segment was compromised in 44% of the patients. The median surgical and flap ischemia times were 380 and 76 minutes, respectively. In 95.5% cases, excellent bone apposition was achieved; four cases required minor intraoperative adjustments. Median follow-up was 14 months, and the complication rate was 18.9%. Satisfactory functional and aesthetic results were achieved in more than 60 and 70% of the cases. There were no differences in those outcomes according to the number of mandibular segments resected and reconstructed.
Conclusion: The digitally planned mandibular reconstructive procedures showed highly satisfactory results. The technology facilitated the completion of procedures without deviating from the surgical plan or requiring onsite adjustments. The latter indicated the high accuracy of the surgical plan. The customized cutting guides and plates optimized the surgical precision and times for a low complication rate and adequate overall results independently of the number of compromised mandibular segments and procedure's complexity.
Keywords
Computer-Aided Design, Printing, Three-Dimensional, Models, Anatomic, acrylonitrile-butadiene-styrene, Sterilization, Dimensional Measurement Accuracy
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CURRENT STATUS: Under Revision
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Posted 12 Jan, 2021
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Editorial decision: Major revision
On 15 Feb, 2021
Review #2 received
Received 24 Jan, 2021
Review #1 received
Received 20 Jan, 2021
Reviewer #2 agreed
On 13 Jan, 2021
Reviewer #1 agreed
On 10 Jan, 2021
Reviewers invited
Invitations sent on 08 Jan, 2021
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On 02 Jan, 2021
Editor invited
On 02 Jan, 2021
First submitted
On 27 Dec, 2020
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This preprint is under consideration at 3D Printing in Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Digital Surgical Planning for Mandibular Reconstruction With Free Fibula Flap: Is the Accuracy Affected by the Number of Compromised Mandibular Segments?
Aura Cardona
Industrias Médicas Sampedro. Medellín, Colombia
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 12 Jan, 2021
No community comments so far
Editorial decision: Major revision
On 15 Feb, 2021
Review #2 received
Received 24 Jan, 2021
Review #1 received
Received 20 Jan, 2021
Reviewer #2 agreed
On 13 Jan, 2021
Reviewer #1 agreed
On 10 Jan, 2021
Reviewers invited
Invitations sent on 08 Jan, 2021
Editor assigned
On 02 Jan, 2021
Submission checks complete
On 02 Jan, 2021
Editor invited
On 02 Jan, 2021
First submitted
On 27 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Reconstructive mandibular surgery using free fibular flap in patients with defects due to oncologic resections aims to restore the lost functionality and appearance. Digital surgical planning (DSP) aids in designing the procedure through three-dimensional (3D) visualization of the anatomical defect, flap positioning, and contour restoration. Some studies have explored the DSP for assistance with mandibular reconstructions; however, most are limited in sample size and geographic region where these resources are available. Here we present a step-by-step DSP and the results obtained in a cohort of patients analyzed according to the number of compromised mandibular segments.
Methods: We retrospectively analyzed 90 procedures in which DSP was applied, from patients who underwent oncologic mandibulectomy and reconstruction using a free fibula flap from 2012 to 2019. Customized cutting guides and implants were used in all patients. Clínical data was obtained from medical records and information concerning the DSP from company archives. Ethics committee approval was obtained.
Results: patient's median age was 60 years; 52% were women. The most common tumor was squamous cell carcinoma in 49.4%. The medians of the mandibular defect volume and the length of the whole fibula flap were 12.24 cm3 and 9.24 cm. More than one mandibular segment was compromised in 44% of the patients. The median surgical and flap ischemia times were 380 and 76 minutes, respectively. In 95.5% cases, excellent bone apposition was achieved; four cases required minor intraoperative adjustments. Median follow-up was 14 months, and the complication rate was 18.9%. Satisfactory functional and aesthetic results were achieved in more than 60 and 70% of the cases. There were no differences in those outcomes according to the number of mandibular segments resected and reconstructed.
Conclusion: The digitally planned mandibular reconstructive procedures showed highly satisfactory results. The technology facilitated the completion of procedures without deviating from the surgical plan or requiring onsite adjustments. The latter indicated the high accuracy of the surgical plan. The customized cutting guides and plates optimized the surgical precision and times for a low complication rate and adequate overall results independently of the number of compromised mandibular segments and procedure's complexity.
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