J Reconstr Microsurg 2017; 33(04): 281-291
DOI: 10.1055/s-0036-1597823
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Functional Outcome of CAD/CAM-Assisted versus Conventional Microvascular, Fibular Free Flap Reconstruction of the Mandible: A Retrospective Study of 30 Cases

Lucas M. Ritschl
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
,
Thomas Mücke
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
,
Andreas Fichter
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
,
Florian D. Güll
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
,
Christopher Schmid
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
,
Jean Marc Pho Duc
2   Department of Prosthodontics, Dental School of the Ludwig-Maximilians, University of Munich, Germany
,
Marco R. Kesting
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
,
Klaus-Dietrich Wolff
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
,
Denys J. Loeffelbein
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

05. Oktober 2016

16. November 2016

Publikationsdatum:
18. Januar 2017 (online)

Abstract

Background Different advantages of virtually planned and guided mandibular reconstructions have been described. Functional analyses and comparisons with conventionally reconstructed patients.

Methods We retrospectively analyzed 30 cases of mandibular reconstructions that involved virtually planned or conventional microvascular, fibular free flaps that occurred between April 2011 and December 2014 at a single center. The results were also compared with a healthy cohort of 30 participants. Axiographic measurements were performed postoperatively, and uni- and multivariate regressions analyses were performed to determine the association between possible predictor variables on functional outcome.

Results Operation time, hospital stay, number of osteotomies, incidence of postoperative temporomandibular joint pain, noise, and tension did not differ significantly between the conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) groups (each p > 0.05). Mouth opening and protrusion and laterotrusion also did not differ significantly (each p > 0.05) but were significantly reduced compared with the healthy group. Univariate analysis showed a significant influence of postoperative irradiation on mouth opening and laterotrusion in the conventional group (p = 0.047 and p = 0.028). In addition, multivariate analysis showed a significant influence of indication and number of osteotomies on laterotrusion (p = 0.005 and p = 0.043). Uni and multivariate analyses revealed a significant influence of indication, preoperative irradiation, and number of osteotomies on protrusion and mouth opening in the CAD/CAM group (p = 0.016, p = 0.044, and p = 0.028).

Conclusion CAD/CAM-assisted reconstructions of the mandible give comparable functional results with those of the conventional technique, but no functional superiority has been established. Nevertheless, the integration of virtual planning and guided surgery is definitely of significant value but should be indicated individually case by case.

 
  • References

  • 1 Tarsitano A, Ciocca L, Scotti R, Marchetti C. Morphological results of customized microvascular mandibular reconstruction: a comparative study. J Craniomaxillofac Surg 2016; 44 (6) 697-702
  • 2 Weitz J, Bauer FJ, Hapfelmeier A, Rohleder NH, Wolff KD, Kesting MR. Accuracy of mandibular reconstruction by three-dimensional guided vascularised fibular free flap after segmental mandibulectomy. Br J Oral Maxillofac Surg 2016; 54 (5) 506-510
  • 3 Sieira Gil R, Roig AM, Obispo CA, Morla A, Pagès CM, Perez JL. Surgical planning and microvascular reconstruction of the mandible with a fibular flap using computer-aided design, rapid prototype modelling, and precontoured titanium reconstruction plates: a prospective study. Br J Oral Maxillofac Surg 2015; 53 (1) 49-53
  • 4 Avraham T, Franco P, Brecht LE , et al. Functional outcomes of virtually planned free fibula flap reconstruction of the mandible. Plast Reconstr Surg 2014; 134 (4) 628e-634e
  • 5 Hanken H, Schablowsky C, Smeets R , et al. Virtual planning of complex head and neck reconstruction results in satisfactory match between real outcomes and virtual models. Clin Oral Investig 2015; 19 (3) 647-656
  • 6 Moro A, Cannas R, Boniello R, Gasparini G, Pelo S. Techniques on modeling the vascularized free fibula flap in mandibular reconstruction. J Craniofac Surg 2009; 20 (5) 1571-1573
  • 7 Wolff K-D, Bootz F, Beck J , et al. AWMF-Leitlinie. Mundhöhlenkarzinom, Diagnostik und Therapie. In: Leitlinienprogramm Onkologie: Deutsche Krebsgesellschaft, Deutsche Krebshilfe. Germany: AWMF; 2012
  • 8 Koerdt S, Röckl J, Rommel N, Mücke T, Wolff KD, Kesting MR. Lymph node management in the treatment of oral cancer: analysis of a standardized approach. J Craniomaxillofac Surg 2016; 44 (10) 1737-1742
  • 9 Mücke T, Rohleder NH, Rau A , et al. The value of perioperative antibiotics on the success of oral free flap reconstructions. Microsurgery 2015; 35 (7) 507-511
  • 10 Mücke T, Ritschl LM, Roth M , et al. Predictors of free flap loss in the head and neck region: a four-year retrospective study with 451 microvascular transplants at a single centre. J Craniomaxillofac Surg 2016; 44 (9) 1292-1298
  • 11 Brown JS, Barry C, Ho M, Shaw R. A new classification for mandibular defects after oncological resection. Lancet Oncol 2016; 17 (1) e23-e30
  • 12 Stirling Craig E, Yuhasz M, Shah A , et al. Simulated surgery and cutting guides enhance spatial positioning in free fibular mandibular reconstruction. Microsurgery 2015; 35 (1) 29-33
  • 13 Schepers RH, Kraeima J, Vissink A , et al. Accuracy of secondary maxillofacial reconstruction with prefabricated fibula grafts using 3D planning and guided reconstruction. J Craniomaxillofac Surg 2016; 44 (4) 392-399
  • 14 Wang YY, Zhang HQ, Fan S , et al. Mandibular reconstruction with the vascularized fibula flap: comparison of virtual planning surgery and conventional surgery. Int J Oral Maxillofac Surg 2016; 45 (11) 1400-1405
  • 15 Matros E, Albornoz CR, Rensberger M, Weimer K, Garfein ES. Computer-assisted design and computer-assisted modeling technique optimization and advantages over traditional methods of osseous flap reconstruction. J Reconstr Microsurg 2014; 30 (5) 289-296
  • 16 Kääriäinen M, Kuuskeri M, Gremoutis G, Kuokkanen H, Miettinen A, Laranne J. Utilization of three-dimensional computer-aided preoperative virtual planning and manufacturing in maxillary and mandibular reconstruction with a microvascular fibula flap. J Reconstr Microsurg 2016; 32 (2) 137-141
  • 17 Wolff KD, Ervens J, Herzog K, Hoffmeister B. Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects. J Craniomaxillofac Surg 1996; 24 (6) 330-338
  • 18 Matros E, Santamaria E, Cordeiro PG. Standardized templates for shaping the fibula free flap in mandible reconstruction. J Reconstr Microsurg 2013; 29 (9) 619-622
  • 19 Wu CC, Lin PY, Chew KY, Kuo YR. Free tissue transfers in head and neck reconstruction: complications, outcomes and strategies for management of flap failure: analysis of 2019 flaps in single institute. Microsurgery 2014; 34 (5) 339-344
  • 20 Lee M, Chin RY, Eslick GD, Sritharan N, Paramaesvaran S. Outcomes of microvascular free flap reconstruction for mandibular osteoradionecrosis: a systematic review. J Craniomaxillofac Surg 2015; 43 (10) 2026-2033
  • 21 Lodders JN, Schulten EA, de Visscher JG, Forouzanfar T, Karagozoglu KH. Complications and risk after mandibular reconstruction with fibular free flaps in patients with oral squamous cell carcinoma: a retrospective cohort study. J Reconstr Microsurg 2016; 32 (6) 455-463
  • 22 Zhang C, Sun J, Zhu H , et al. Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps. Int J Oral Maxillofac Surg 2015; 44 (6) 675-684
  • 23 Pohlenz P, Klatt J, Schön G, Blessmann M, Li L, Schmelzle R. Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg 2012; 41 (6) 739-743
  • 24 Kucur C, Durmus K, Uysal IO , et al. Management of complications and compromised free flaps following major head and neck surgery. Eur Arch Otorhinolaryngol 2016; 273 (1) 209-213
  • 25 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 (4) 663-667
  • 26 Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-year follow-up study. Plast Reconstr Surg 2002; 110 (2) 438-449 , discussion 450–451
  • 27 Seikaly H, Maharaj M, Rieger J, Harris J. Functional outcomes after primary mandibular resection and reconstruction with the fibular free flap. J Otolaryngol 2005; 34 (1) 25-28
  • 28 Wetzels JW, Merkx MA, de Haan AF, Koole R, Speksnijder CM. Maximum mouth opening and trismus in 143 patients treated for oral cancer: a 1-year prospective study. Head Neck 2014; 36 (12) 1754-1762
  • 29 Lee R, Slevin N, Musgrove B, Swindell R, Molassiotis A. Prediction of post-treatment trismus in head and neck cancer patients. Br J Oral Maxillofac Surg 2012; 50 (4) 328-332
  • 30 Scherpenhuizen A, van Waes AM, Janssen LM, Van Cann EM, Stegeman I. The effect of exercise therapy in head and neck cancer patients in the treatment of radiotherapy-induced trismus: a systematic review. Oral Oncol 2015; 51 (8) 745-750
  • 31 Steiner F, Evans J, Marsh R , et al. Mouth opening and trismus in patients undergoing curative treatment for head and neck cancer. Int J Oral Maxillofac Surg 2015; 44 (3) 292-296
  • 32 Hassanein KA, Musgrove BT, Bradbury E. Functional status of patients with oral cancer and its relation to style of coping, social support and psychological status. Br J Oral Maxillofac Surg 2001; 39 (5) 340-345
  • 33 Mücke T, Rau A, Weitz J , et al. Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions. Oral Oncol 2012; 48 (4) 367-371
  • 34 Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery 2009; 29 (1) 1-7
  • 35 Koerdt S, Steinstraesser L, Stoeckelhuber M , et al. Radiotherapy for oral cancer decreases the cutaneous expression of host defence peptides. J Craniomaxillofac Surg 2016; 44 (7) 882-889
  • 36 Tarsitano A, Battaglia S, Crimi S, Ciocca L, Scotti R, Marchetti C. Is a computer-assisted design and computer-assisted manufacturing method for mandibular reconstruction economically viable?. J Craniomaxillofac Surg 2016; 44 (7) 795-799