Mandible reconstruction with free fibula flaps: Accuracy of a cost-effective modified semicomputer-assisted surgery compared with computer-assisted surgery - A retrospective study |
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| Institution: | 1. Department of Oral and Maxillofacial and Facial Plastic Surgery, Martin-Luther-University Halle-Wittenberg (Head: Prof. Dr. Dr. S. Otto), Ernst-Grube-Straße 40, 06120, Halle, Germany;2. Professor Emeritus of the Department of Oral and Maxillofacial and Facial Plastic Surgery, Martin-Luther-University Halle-Wittenberg, 06193, Petersberg, Germany;1. Dept. Maxillofacial Surgery, Head and Neck Cancer Centre, University and University Hospital of Lübeck, Lübeck, Germany;2. Dept. of Pathology, University and University Hospital of Lübeck, Lübeck, Germany;1. Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy;2. Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy;3. Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy;4. Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy;1. Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France;2. University of François Rabelais, School of Medicine, Tours, France;3. Department of Neurosurgery, Bretonneau Hospital, University Hospital Center of Tours, Tours, France;4. Reference Center for Rare Craniostenose and Craniofacial Malformations CRANIOST, France;1. Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Maximiliansplatz 3, 91054, Erlangen, Germany;2. Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Glueckstrasse 11, 91054, Erlangen, Germany;1. Unit of Maxillofacial and Plastic Surgery, APHP, Necker-Enfants Malades, 149 Rue de Sèvres, Paris, 75015, France;2. Unit of Maxillofacial Surgery, APHP Pitié-Salpetrière Hospital, Pierre et Marie Curie University, Sorbonne University, Paris, 75013, France;3. Department of Head and Neck Surgical Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, 94800, France;4. Department of Pathology, APHP, Necker Enfants Malades, 149 Rue de Sèvres, Paris, 75015, France;5. University Paris Descartes, 12 Rue de l''École de Médecine, 75006, Paris, France;6. Department of Biostatistics, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, 94800, France;7. Radiation Oncology Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, 94800, France;8. Department of Pediatric Radiology, APHP, Necker Enfants Malades, 149 Rue de Sèvres, Paris, 75015, France;9. Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, 94800, France;10. Department of Radiology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, 94800, France;11. Unit of Otolaryngology and Head and Neck Surgery, APHP, Necker Enfants Malades, 149 Rue de Sèvres, Paris, 75015, France;12. Methodology and Biostatistics Unit, Centre Oscar Lambret, 3 Rue Frederic Combemale, Lille, 59000, France;13. CESP, INSERM, Paris-Sud, Paris-Saclay University, Villejuif, 94805, France;14. Department of Clinical Studies, Unicancer, 101 Rue de Tolbiac, 75654, 13 Paris cedex, France;15. Department of Oncology for Children and Adolescents, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, 94800, France |
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| Abstract: | A new individualized, cost-effective, modified semi-computer-assisted surgery (MSCAS) concept for free fibular flap mandibular reconstruction is reported and compared with the computer-assisted surgery (CAS) concept.Patients were divided into two groups and retrospectively reviewed. In the MSCAS and CAS groups, intraoperative guides were created using computer-aided design with manual fabrication and computer-aided design and manufacturing, respectively. Differences in specific linear and angular parameters on pre- and postoperative computed tomography scans were calculated for morphometric comparison, and clinical parameters and efficiency were analysed.ResultsEighteen patients (CAS, 7; MSCAS, 11), were included. The morphometric comparison showed no significant differences between the groups. The mean deviation of the mandibular ramus length, body length, width 1 and width 2 was 0.82 ± 0.29 mm, 1.84 ± 0.43 mm, 1.89 ± 0.61 mm and 1.45 ± 0.61 mm in the CAS group versus 1.56 ± 0.54 mm, 1.72 ± 0.33 mm, 2.24 ± 0.55 mm and 2.36 ± 0.50 mm in the MSCAS group (p = 0.7804, p = 0.9997, p = 0.9814 and p = 0.6334). The mean deviation of the sagittal, axial and coronal mandibular angles was 1.56 ± 0.48°, 1.93 ± 0.50° and 2.15 ± 0.72° in the CAS group versus 2.19 ± 0.35°, 1.86 ± 0.35° and 1.94 ± 0.55° in the MSCAS group (p = 0.7594, p = 0.9996 and p = 0.9871). There were no significant differences in clinical parameters, efficiency or postoperative complications between the groups.ConclusionThe accuracy and operative efficiency of the MSCAS concept are comparable to those of the more expensive CAS concept. Therefore, in times of increasing clinical costs, this concept might be an adequate and inexpensive alternative to preoperative CAS. |
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| Keywords: | Computer-assisted surgery Modified semi-computer-assisted surgery Free fibular flap Mandibular reconstruction Accuracy Efficiency |
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