Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Reconstruction of Segmental Mandibular Defects

Overview

Journal J Maxillofac Oral Surg

Date 2020 Oct 19

PMID 33071511

Citations 9

Authors

A N Zeller

M T Neuhaus

L V M Weissbach

M Rana

A Dhawan

F M Eckstein

N C Gellrich

R M Zimmerer

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of the current study was to evaluate potential differences in the accuracy of mandibular reconstruction and long-term stability, with respect to different reconstructive procedures.

Methods: In total, 42 patients who had undergone primary segmental mandibular resection with immediate alloplastic reconstruction, with either manually pre-bent or patient-specific mandibular reconstruction plates (PSMRP), were included in this study. Mandibular dimensions, in terms of six clinically relevant distances (capitulum [most lateral points], capitulum [most medial points], incisura [most caudal points], mandibular foramina, coronoid process [most cranial points], dorsal tip of the mandible closest to the gonion point) determined from tomographic images, were compared prior to, and after surgery.

Results: Dimensional alterations were significantly more often found when conventionally bent titanium reconstruction plates were used. These occurred in the area of the coronoid process ( = 0.014). Plate fractures were significantly ( = 0.022) more often found within the manually pre-bent group than within the PSMRP group (17%/0%).

Conclusion: The results suggest that the use of PSMRP may prevent rotation of the proximal mandibular segment, thus avoiding functional impairment. In addition, the use of PSMRP may potentially enhance the long-term stability of alloplastic reconstructions.

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References

Wilde F, Winter K, Kletsch K, Lorenz K, Schramm A . Mandible reconstruction using patient-specific pre-bent reconstruction plates: comparison of standard and transfer key methods. Int J Comput Assist Radiol Surg. 2014; 10(2):129-40. DOI: 10.1007/s11548-014-1065-1. View

Schepers R, Raghoebar G, Vissink A, Stenekes M, Kraeima J, Roodenburg J . Accuracy of fibula reconstruction using patient-specific CAD/CAM reconstruction plates and dental implants: A new modality for functional reconstruction of mandibular defects. J Craniomaxillofac Surg. 2015; 43(5):649-57. DOI: 10.1016/j.jcms.2015.03.015. View

Cascone P, Di Paolo C, Leonardi R, Pedulla E . Temporomandibular disorders and orthognathic surgery. J Craniofac Surg. 2008; 19(3):687-92. DOI: 10.1097/SCS.0b013e3180c31962. View

Parthasarathy J . 3D modeling, custom implants and its future perspectives in craniofacial surgery. Ann Maxillofac Surg. 2014; 4(1):9-18. PMC: 4073471. DOI: 10.4103/2231-0746.133065. View

Gutwald R, Jaeger R, Lambers F . Customized mandibular reconstruction plates improve mechanical performance in a mandibular reconstruction model. Comput Methods Biomech Biomed Engin. 2016; 20(4):426-435. PMC: 5359746. DOI: 10.1080/10255842.2016.1240788. View

Ferreira J, Zagalo C, Oliveira M, Correia A, Reis A . Mandible reconstruction: History, state of the art and persistent problems. Prosthet Orthot Int. 2014; 39(3):182-9. DOI: 10.1177/0309364613520032. View

LYON L, SARNAT B . LIMITED OPENING OF THE MOUTH CAUSED BY ENLARGED CORONOID PROCESSES: REPORT OF CASE. J Am Dent Assoc. 1963; 67:644-50. DOI: 10.14219/jada.archive.1963.0360. View

Rendenbach C, Sellenschloh K, Gerbig L, Morlock M, Beck-Broichsitter B, Smeets R . CAD-CAM plates versus conventional fixation plates for primary mandibular reconstruction: A biomechanical in vitro analysis. J Craniomaxillofac Surg. 2017; 45(11):1878-1883. DOI: 10.1016/j.jcms.2017.08.024. View

Hanasono M, Jacob R, Bidaut L, Robb G, Skoracki R . Midfacial reconstruction using virtual planning, rapid prototype modeling, and stereotactic navigation. Plast Reconstr Surg. 2010; 126(6):2002-2006. DOI: 10.1097/PRS.0b013e3181f447e1. View

10.

Martola M, Lindqvist C, Hanninen H, Al-Sukhun J . Fracture of titanium plates used for mandibular reconstruction following ablative tumor surgery. J Biomed Mater Res B Appl Biomater. 2006; 80(2):345-52. DOI: 10.1002/jbm.b.30603. View

11.

Lethaus B, Poort L, Bockmann R, Smeets R, Tolba R, Kessler P . Additive manufacturing for microvascular reconstruction of the mandible in 20 patients. J Craniomaxillofac Surg. 2011; 40(1):43-6. DOI: 10.1016/j.jcms.2011.01.007. View

12.

Bill J, Wurzler K, Reinhart E, Bohm H, Eulert S, Reuther J . [Bimaxillary osteotomy with and without condylar positioning--a 1981-2002 long-term study]. Mund Kiefer Gesichtschir. 2003; 7(6):345-50. DOI: 10.1007/s10006-003-0503-y. View

13.

Hoefert S, Taier R . Mechanical stress in plates for bridging reconstruction mandibular defects and purposes of double plate reinforcement. J Craniomaxillofac Surg. 2018; 46(5):785-794. DOI: 10.1016/j.jcms.2018.01.016. View

14.

Essig H, Dressel L, Rana M, Rana M, Kokemueller H, Ruecker M . Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study. Head Face Med. 2013; 9:18. PMC: 3750456. DOI: 10.1186/1746-160X-9-18. View

15.

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(5):661-6. DOI: 10.1016/j.tripleo.2009.05.023. View

16.

Rana M, Chui C, Wagner M, Zimmerer R, Rana M, Gellrich N . Increasing the accuracy of orbital reconstruction with selective laser-melted patient-specific implants combined with intraoperative navigation. J Oral Maxillofac Surg. 2015; 73(6):1113-8. DOI: 10.1016/j.joms.2015.02.014. View

17.

Baker A, McMahon J, Parmar S . Immediate reconstruction of continuity defects of the mandible after tumor surgery. J Oral Maxillofac Surg. 2001; 59(11):1333-9. DOI: 10.1053/joms.2001.27825. View

18.

Rana M, Warraich R, Kokemuller H, Lemound J, Essig H, Tavassol F . Reconstruction of mandibular defects - clinical retrospective research over a 10-year period -. Head Neck Oncol. 2011; 3:23. PMC: 3098818. DOI: 10.1186/1758-3284-3-23. View

19.

Schimmele S . Delayed reconstruction of continuity defects of the mandible after tumor surgery. J Oral Maxillofac Surg. 2001; 59(11):1340-4. DOI: 10.1053/joms.2001.27826. View

20.

Wilde F, Cornelius C, Schramm A . Computer-Assisted Mandibular Reconstruction using a Patient-Specific Reconstruction Plate Fabricated with Computer-Aided Design and Manufacturing Techniques. Craniomaxillofac Trauma Reconstr. 2014; 7(2):158-66. PMC: 4078148. DOI: 10.1055/s-0034-1371356. View