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. 2011 Oct 3:3:45.
doi: 10.1186/1758-3284-3-45.

Pre-operative planning for mandibular reconstruction - a full digital planning workflow resulting in a patient specific reconstruction

Harald Essig #  1 , Majeed Rana #  1 , Horst Kokemueller  1 , Constantin von See  1 , Martin Ruecker  1 , Frank Tavassol  1 , Nils-Claudius Gellrich  1
Affiliations

Pre-operative planning for mandibular reconstruction - a full digital planning workflow resulting in a patient specific reconstruction

Harald Essig et al. Head Neck Oncol. .

Abstract

Objectives: Reconstruction of large mandiblular defects following ablative oncologic surgery could be done by using vascularized bone transfer or, more often, primarily with simultaneous or delayed bone grafting, using load bearing reconstruction plates. Bending of these reconstruction plates is typically directed along the outer contour of the original mandible. Simultaneously or in a second operation vascularized or non-vascularized bone is fixed to the reconstruction plate. However, the prosthodontic-driven backward planning to ease bony reconstruction of the mandible in terms of dental rehabilitation using implant-retained overdentures might be an eligible solution. The purpose of this work was to develop, establish and clinically evaluate a novel 3D planning procedure for mandibular reconstruction.

Materials and methods: Three patients with tumors involving the mandible, which included squamous cell carcinoma in the floor of the mouth and keratocystic odontogenic tumor, were treated surgically by hemimandibulectomy.

Results: In primary alloplastic mandible reconstruction, shape and size of the reconstruction plate could be predefined and prebent prior to surgery.

Clinical relevance: This study provides modern treatment strategies for mandibular reconstruction.

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Figures

Figure 1
Figure 1
CT scan showing an extended mandibular lesion (keratocystic odontogenic tumor). Swelling of the mandible makes conventionally bending prior to resection difficult (A, B). By Computer assisted pre-operative planning by mirroring of the unaffected left side (template C, D; mirrored template E, F) a stereolithographic model (G) could be printed and a reconstruction plate could be bended prior to surgery.
Figure 2
Figure 2
Panorex X-ray Case 1 - after secondary reconstruction of the mandible.
Figure 3
Figure 3
Even in edentulous patients with severe atrophy of the mandible (A), Computer assisted planning is possible due to the autosegmentation (B) provided by the iPlan 3.0 software (BrainLAB®).
Figure 4
Figure 4
Patient with squamous cell carcinoma facing subtotale mandibulectomy (A). Conventional bending of the reconstruction plate could be simulated (B). Virtual planning of the mandible by autosegmentation (similar to Figure 3) shows the conventional relation and position between plate and favored mandible reconstruction (C, D). Conventional bending of the plate follows the outer contour of the original mandible.
Figure 5
Figure 5
Pre-operative planning allows prior to surgery a prosthetic-driven "backward planning". Even in iliac crest bone transplants reconstruction size is limited. The position of future implants with their requirements of adequate bony lining is considered (A) and simulated with different hollow cylinders. Distance between conventional position of reconstruction plates (visualized by the red plate) aligned by the original outer contour is demonstrated in two different planes (B, C).
Figure 6
Figure 6
Modified neomandible (green, A) respects the future implant position (B) and guides the new position of the reconstruction plate (green plate, C). The new position is mostly lingual bound (D, E).
See this image and copyright information in PMC

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