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open access
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ISSN : 0376-4672
The purpose of this study is to compare and evaluate the methods through computer-assisted simulation surgery and surgical guide production in mandibular reconstruction using the fibula and the existing traditional method. From February 2021 to July 2022, 10 patients who underwent segmental mandibulectomy at our hos pital for two years were evaluated for operation time and reconstruction time. 10 patients underwent segmental mandibulectomy and reconstruction using a surgical guide prepared in advance through 3D analysis. In addi tion, we compared and analyzed 5 patients who had undergone surgery by the conventional method. In segmen tal mandibulectomy using a surgical guide, the average operating time was 443.50 minutes with the standard deviation (SD): 88.696, and the average reconstruction time was 64.90 minutes with the standard deviation: 11.377. The average operation time using the conventional method was 517.00 minutes with the standard devia tion (SD): 83.86, the average reconstruction time 77.80 minutes with the standard deviation (SD): 8.075. When the average operation time was compared, the p-value was 0.148, which was not statistically significant. In the comparison of the average reconstruction times, the p-value was 0.0425, which was statistically significant. In conclusion, it was found that in the case of mandibular reconstruction using the fibula, the operation time was shortened along with the decrease of the time in the reconstruction. The operation time in the conventional method was longer than that of the surgical guide method.
1. Miles, B.A.; Goldstein, D.P.; Gilbert, R.W.; Gullane, P.J. Mandible reconstruction. Curr Opin Otolaryngol Head Neck Surg 2010, 18, 317-322.
2. Cohen, A.; Laviv, A.; Berman, P.; Nashef, R.; Abu-Tair, J. Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009, 108, 661-666.
3. Lopez-Arcas, J.M.; Arias, J.; Del Castillo, J.L.; Burgueno, M.; Navarro, I.; Moran, M.J.; Chamorro, M.; Martorell, V. The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience. J Oral Maxillofac Surg 2010, 68, 2377-2384.
4. Choi, E.C.; Kim, E.S.; Suh, K.S.; Hong, W.P.; Lee, H.B.; sung, J.M. Mandibular reconstruction using free fibular osteocutanueous flap. Korean J Otolaryngol 1996, 39, 103-110.
5. Ferri, J.; Piot, B.; Ruhin, B.; Mercier, J. Advantages and limitations of the fibula free flap in mandibular reconstruction. J Oral Maxillofac Surg 1997, 55, 440-448.
6. Yoo, S.-I.; Ahn, K.-M. Reconstruction of oral cancer patients. The journal of Korean Dental Association 2010, 48, 607-614.
7. Liu, X.J.; Gui, L.; Mao, C.; Peng, X.; Yu, G.Y. Applying computer techniques in maxillofacial reconstruction using a fibula flap: a messenger and an evaluation method. J Craniofac Surg 2009, 20, 372-377.
8. Lethaus, B.; Kessler, P.; Boeckman, R.; Poort, L.J.; Tolba, R. Reconstruction of a maxillary defect with a fibula graft and titanium mesh using CAD/CAM techniques. Head Face Med 2010, 6, 16-19.
9. Kraeima, J.; Dorgelo, B.; Gulbitti, H.A.; Steenbakkers, R.; Schepman, K.P.; Roodenburg, J.L.N.; Spijkervet, F.K.L.; Schepers, R.H.; Witjes, M.J.H. Multi-modality 3D mandibular resection planning in head and neck cancer using CT and MRI data fusion: A clinical series. Oral Oncol 2018, 81, 22-28.
10. Dai, J.; Wang, X.; Dong, Y.; Yu, H.; Yang, D.; Shen, G. Two- and three-dimensional models for the visualization of jaw tumors based on CT-MRI image fusion. J Carniofac Surg 2012, 23, 502-508.
11. Weitz, J.; Bauer, F.J.; Hapfelmeier, A.; Rohleder, N.H.; Wolff, K.D.;Kesting, M.R. Accuracy of mandibular reconstruction by threedimensional guided vascularised fibular free flap after segmental mandibulectomy. Br J Oral Maxillofac Surg 2016, 54, 506-510.
12. Succo, G.; Berrone, M.; Battiston, B.; Tos, P.; Goia, F.; Appendino, P.; Crosetti, E. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning. Eur Arch Otorhinolaryngol 2015, 272, 1491-1501.
13. Ren, W.; Gao, L.; Li, S.; Chen, C.; Li, F.; Wang, Q.; Zhi, Y.; Song, J.;Dou, Z.; Xue, L.; et al. Virtual Planning and 3D printing modeling for mandibular reconstruction with fibula free flap. Med Oral Patol Oral Cir Bucal 2018, 23, 359-366.
14. Stirling Craig, E.; Yuhasz, M.; Shah, A.; Blumberg, J.; Salomon, J.;Lowlicht, R.; Fusi, S.; Steinbacher, D.M. Simulated surgery and cutting guides enhance spatial positioning in free fibular mandibular reconstruction. Microsurgery 2015, 35, 29-33.
15. Adolphs, N.; Haberl, E.J.; Liu, W.; Keeve, E.; Menneking, H.; Hoffmeister, B. Virtual planning for craniomaxillofacial surgery--7 years of experience. J Craniomaxillofac Surg 2014, 42, 289-295.
16. Hwang, B.-Y.; Lee, J.-Y.; Jing, J.; Ohe, J.-Y.; Eun, Y.-G.; Lee, Y.;Lee, J.-W. Computer-Assisted Preoperative Simulations and 3D Printed Surgical Guides Enable Safe and Less-Invasive Mandibular Segmental Resection: Tailor-Made Mandibular Resection. Applied Sciences 2020, 10, 1325-1334.
17. Geusens, J.; Sun, Y.; Luebbers, H.T.; Bila, M.; Darche, V.; Politis, C. Accuracy of Computer-Aided Design/Computer-Aided Manufacturing-Assisted Mandibular Reconstruction With a Fibula Free Flap. J Craniofac Surg 2019, 30, 2319-2323.
18. Sweed, A.H.; Bolzoni, A.R.; Kadubiec, A.; Beltramini, G.A.; Cherchi, A.; Baj, A. Factors influencing CAD/CAM accuracy in fibula free flap mandibular reconstruction. Acta Otorhinolaryngol Ital 2020, 40, 138-143.
19. Lim, S.H.; Kim, M.K.; Kang, S.H. Precision of fibula positioning guide in mandibular reconstruction with a fibula graft. Head Face Med 2016, 12, 7-16.
20. Zeller, A.N.; Neuhaus, M.T.; Weissbach, L.V.M.; Rana, M.; Dhawan, A.; Eckstein, F.M.; Gellrich, N.C.; Zimmerer, R.M. Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Reconstruction of Segmental Mandibular Defects. J Maxillofac Oral Surg 2020, 19, 609-615.