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Case Reports
. 2017 Jun;37(3):195-200.
doi: 10.14639/0392-100X-1250.

Design of a customised bridging mandibular prosthesis for complex reconstruction: a pilot study

A Tarsitano  1 , S Battaglia  1 , A Sandi  2 , C Marchetti  1
Affiliations
Case Reports

Design of a customised bridging mandibular prosthesis for complex reconstruction: a pilot study

A Tarsitano et al. Acta Otorhinolaryngol Ital. 2017 Jun.

Abstract
in English, Italian

The gold standard for mandibular reconstruction is universally recognised and consists of the replacement of the bony part of the mandible with a bony microvascular free flap supported by a reconstructive plate. Although this procedure is feasible and reproducible in most patients, at times poor oncological prognosis or poor performance status force surgeons to consider other reconstructive solutions. In these cases, the main alternative in reconstructing a mandibular defect is represented by bridging plates combined with soft tissue flaps. However, repairing a mandibular defect with a reconstructive plate only can lead to a series of diverse complications. The most frequent complications reported are rupture and oral exposure of the plate. In this paper, we describe a new method for mandibular reconstruction using a customised bridging mandibular prosthesis (CBMP) without bone free flap.

La ricostruzione mandibolare è attualmente effettuata mediante il trasferimento di lembi liberi rivascolarizzati di tessuto osseo, supportati da placche di osteosintesi. Sebbene questa procedura sia generalmente efficace e riproducibile, talvolta la scarsa prognosi oncologica o le condizioni cliniche scadenti del paziente costringono il chirurgo a considerare alternative ricostruttive. In tali casi, la principale possibilità è rappresentata dall’utilizzo di placche ricostruttive ‘a ponte’, associate a lembi liberi di tessuti molli. Comunque la ricostruzione così concepita espone a un significativo rischio di sviluppare complicanze di vario genere. Le più frequenti complicanze sono rappresentate dalla rottura e dall’esposizione della placca. In questo articolo descriviamo un nuovo metodo ricostruttivo mandibolare, che si avvale di una protesi mandibolare customizzata, senza lembo libero osseo.

Keywords: Bridging plate; Computer-aided design; Computer-aided manufacturing; Mandibular reconstruction; Prosthesis; Reconstructive surgery.

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Figures

Fig. 1.
Fig. 1.
Clinical view of reconstructive plate exposure. A: facial appearance. B: intra-oral exposure.
Fig. 2.
Fig. 2.
3D model of CT showing bilateral rami anti-version and rotation without condyle displacement.
Fig. 3.
Fig. 3.
Superimposition of native mandible (yellow) and post-resection (green) CT-scan data showing mandibular rami displacement.
Fig. 4.
Fig. 4.
Computer-assisted design of CBMP. CBMP is designed on the internal (lingual) bone surface of the native mandible. A: inferior view. B: anterior view. C: left view.
Fig. 5.
Fig. 5.
Computer-assisted design of CBMP. Two retention titanium structures were designed on each plate-end side in order to increase hardware stability (red arrow). Twelve holes were provided on the anterior part (blue arrow). These should allow the surgeon to position the anterior digastric and genioglossus muscles on the prosthetic chin. The part of the prosthesis corresponding to the mandibular body has some grooves in order to fix the mylohyoid muscles (green arrow).
Fig. 6.
Fig. 6.
Computer-assisted design of drilling guides: they were designed to fit on the previously placed reconstructive plate.
Fig. 7.
Fig. 7.
Intra-operative image showing drilling guides positioning. A: right plate side exposition; B: right drilling guide positioning on the plate; C: left plate side exposition; D: left drilling guide positioning on the plate.
Fig. 8.
Fig. 8.
Intra-operative images showing CBMP positioning. Note the nice fitting of the customised implant to the mandible. A: right view; B: left view; C: inferior view.
Fig. 9.
Fig. 9.
Intra-oral image showing good soft tissue healing without signs of implant exposure.
Fig. 10.
Fig. 10.
Post-operative accuracy evaluation. A: virtual planning; B: post-operative 3D CT-scan; C: superimposition of the virtual planning with the postoperative CT scan. D-E: error grade colour map. It provides a direct impression of the concordance between the pre-operative design and the post-operative position of the mandibular rami. F-G: CT-scan concordance between virtual planning (red line) and post-operative situation (coronal view).
See this image and copyright information in PMC

References

    1. Lonie S, Herle P, Paddle A, et al. Mandibular reconstruction: meta-analysis of iliac-versus fibula-free flaps. ANZ J Surg. 2016;86:337–342. - PubMed
    1. Kokosis G, Schmitz R, Powers DB, et al. Mandibular reconstruction using the free vascularized fibula graft: an overview of different modifications. Arch Plast Surg. 2016;43:3–9. - PMC - PubMed
    1. Moubayed SP, L'Heureux-Lebeau B, Christopoulos A, et al. Osteocutaneous free flaps for mandibular reconstruction: systematic review of their frequency of use and a preliminary quality of life comparison. J Laryngol Otol. 2014;128:1034–1043. - PubMed
    1. Poli T, Ferrari S, Bianchi B, et al. Primary oromandibular reconstruction using free flaps and thorp plates in cancer patients: a 5-year experience. Head Neck. 2003;25:15–23. - PubMed
    1. Okura M, Isomura ET, Iida S, et al. Long-term outcome and factors influencing bridging plates for mandibular reconstruction. Oral Oncol. 2005;41:791–798. - PubMed

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