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Computer-assisted versus traditional freehand technique for mandibular reconstruction with free vascularized fibular flap: A matched-pair study

  • Hongyang Ma
    Affiliations
    OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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  • Sohaib Shujaat
    Affiliations
    OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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  • Michel Bila
    Affiliations
    OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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  • Yi Sun
    Affiliations
    OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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  • Jan Vranckx
    Affiliations
    Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospitals Leuven, Leuven, Belgium
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  • Constantinus Politis
    Affiliations
    OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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  • Reinhilde Jacobs
    Correspondence
    Corresponding author.
    Affiliations
    OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium

    Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Published:April 21, 2021DOI:https://doi.org/10.1016/j.bjps.2021.03.121

      Summary

      Objectives

      This study aimed to perform a surgery-related and patient-related outcome analysis of a case-matched series of patients treated with computer-assisted surgery (CAS) and traditional freehand surgery.

      Methods

      A total of 153 patients who underwent mandibular reconstruction by VFF were included from Jan 1999 to Dec 2019. The mandibular resection and reconstruction were performed by four experienced oral and maxillofacial surgeons. Reasons for reconstruction were oncologic, osteoradionecrosis, trauma, and osteoporosis. All the patients were followed up postoperatively for at least 1 year. Eighteen pairs were formed with the matched cohort consisting of a total of 36 patients who underwent primary mandibular reconstruction without additional combined flaps. The surgery-related and patient-related continuous and categorical parameters were assessed in both groups.

      Results

      The average operation time and bleeding volume in the CAS group were less than those in the non-CAS group. Additionally, both hospitalization and ICU days were lower in the CAS group without any significant difference. The only significant finding related to surgical parameters was observed for the ischemia time, which was lower in the CAS group.

      Conclusions

      Computer-assisted surgery indicated improved efficiency considering reduced ischemia time, operation time, and length of hospital stay with lower early complications than that of conventional surgical procedures. It can thus be considered as an optimized alternative to the freehand approach.

      Keywords

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      References

        • Brown JS
        • Lowe D
        • Kanatas A
        • Schache A.
        Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years.
        Br J Oral Maxillofac Surg. 2017; 55: 113-126
        • Hidalgo DA.
        Fibula free flap: a new method of mandible reconstruction.
        Plast Reconstr Surg. 1989; 84: 71-79
        • Virgin FW
        • Iseli TA
        • Iseli CE
        • et al.
        Functional outcomes of fibula and osteocutaneous forearm free flap reconstruction for segmental mandibular defects.
        Laryngoscope. 2010; 120: 663-667
        • Posnick JC
        • Egolum N
        • Tremont TJ.
        Primary Mandibular Deficiency Dentofacial Deformities: Occlusion and Facial Aesthetic Surgical Outcomes.
        J Oral Maxillofac Surg. 2018; 76 (e1-09 e15): 2209
        • Anne-Gaelle B
        • Samuel S
        • Julie B
        • Renaud L
        • Pierre B
        Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions.
        Oral Oncol. 2011; 47: 1099-1104
        • Powcharoen W
        • Yang WF
        • Yan Li K
        • Zhu W
        • Su YX
        Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap: A Systematic Review and Meta-Analysis.
        Plast Reconstr Surg. 2019; 144: 1417-1428
        • Hallermann W
        • Olsen S
        • Bardyn T
        • et al.
        A new method for computer-aided operation planning for extensive mandibular reconstruction.
        Plast Reconstr Surg. 2006; 117: 2431-2437
        • Chan A
        • Sambrook P
        • Munn Z
        • Boase S.
        Effectiveness of computer-assisted virtual planning, cutting guides and pre-engineered plates on outcomes in mandible fibular free flap reconstructions over traditional freehand techniques: a systematic review protocol.
        JBI Database System Rev Implement Rep. 2019;
        • Alfouzan AF.
        Review of surgical resection and reconstruction in head and neck cancer. Traditional versus current concepts.
        Saudi Med J. 2018; 39: 971-980
        • Nilsson J
        • Hindocha N
        • Thor A.
        Time matters - Differences between computer-assisted surgery and conventional planning in cranio-maxillofacial surgery: A systematic review and meta-analysis.
        Journal of Cranio-Maxillofacial Surgery. 2020; 48: 132-140
        • Mahendru S
        • Jain R
        • Aggarwal A
        • et al.
        CAD-CAM vs conventional technique for mandibular reconstruction with free fibula flap: A comparison of outcomes.
        Surg Oncol. 2020; 34: 284-291
        • Brown JS
        • Barry C
        • Ho M
        • Shaw R.
        A new classification for mandibular defects after oncological resection.
        Lancet Oncol. 2016; 17: e23-e30
        • Rodby KA
        • Turin S
        • Jacobs RJ
        • et al.
        Advances in oncologic head and neck reconstruction: systematic review and future considerations of virtual surgical planning and computer aided design/computer aided modeling.
        J Plast Reconstr Aesthet Surg. 2014; 67: 1171-1185
        • Nemeth D
        • Zaleczna L
        • Huremovic A
        • et al.
        Importance of chewing, saliva, and swallowing function in patients with advanced oral cancer undergoing preoperative chemoradiotherapy: a prospective study of quality of life.
        Int J Oral Maxillofac Surg. 2017; 46: 1229-1236
        • Lignon J
        • Guerlain J
        • Bozec A
        • et al.
        Multicentre evaluation of the interest in planned surgery for mandibular reconstruction with fibula free flap: a retrospective cohort study.
        Eur Arch Otorhinolaryngol. 2021; : 1-7
        • Modabber A
        • Legros C
        • Rana M
        • et al.
        Evaluation of computer-assisted jaw reconstruction with free vascularized fibular flap compared to conventional surgery: a clinical pilot study.
        Int J Med Robot. 2012; 8: 215-220
        • Mazzola F
        • Smithers F
        • Cheng K
        • et al.
        Time and cost-analysis of virtual surgical planning for head and neck reconstruction: A matched pair analysis.
        Oral Oncol. 2020; 100104491
        • Weitz J
        • Bauer FJ
        • Hapfelmeier A
        • et al.
        Accuracy of mandibular reconstruction by three-dimensional guided vascularised fibular free flap after segmental mandibulectomy.
        Br J Oral Maxillofac Surg. 2016; 54: 506-510
        • Seruya M
        • Fisher M
        • Rodriguez ED.
        Computer-assisted versus conventional free fibula flap technique for craniofacial reconstruction: an outcomes comparison.
        Plast Reconstr Surg. 2013; 132: 1219-1228
        • Hwang B-Y
        • Lee J-Y
        • Jung J
        • et al.
        Computer-Assisted Preoperative Simulations and 3D Printed Surgical Guides Enable Safe and Less-Invasive Mandibular Segmental Resection.
        Tailor-Made Mandibular Resection. 2020; 10: 1325
        • Ren WH
        • Gao L
        • Li SM
        • et al.
        Virtual Planning and 3D printing modeling for mandibular reconstruction with fibula free flap.
        Medicina Oral Patologia Oral Y Cirugia Bucal. 2018; 23: E359-EE66
        • Bouchet B
        • Raoul G
        • Julieron B
        • Wojcik T.
        Functional and morphologic outcomes of CAD/CAM-assisted versus conventional microvascular fibular free flap reconstruction of the mandible: A retrospective study of 25 cases.
        J Stomatol Oral Maxillofac Surg. 2018; 119: 455-460
        • Deek NFA
        • Wei Fu-Chan
        Computer-assisted surgery for segmental mandibular reconstruction with the osteoseptocutaneous fibula flap: can we instigate ideological and technological reforms?.
        J Plastic Reconstructive Surgery. 2016; 137: 963-970
        • Dupret-Bories A
        • Vergez S
        • Meresse T
        • Brouillet F
        • Bertrand G.
        Contribution of 3D printing to mandibular reconstruction after cancer.
        Eur Ann Otorhinolaryngol Head Neck Dis. 2018; 135: 133-136