Abstract
This study aimed to present and evaluate alternative lesion-specific mandibulectomy methods for preserving the mandibular anatomical structures as compared with the conventional virtual surgical plan. Fifteen patients who received segmental mandibulectomy were included in this study, and the following parameters were evaluated: (1) the disease-free bone margin, (2) the volume and surface between the tailor-made resection simulation and conventional resection simulation, and (3) the preserved mandibular anatomical structures. In all 15 patients, disease-free bone margins were confirmed by histopathology. Volumes of conventional resection simulation and tail-made resection simulation were 49,468.66 ± 14,007.96 mm3 and 52,610.01 ± 13,755.33 mm3 and the surfaces were 20,927.38 ± 4471.70 mm2 and 22,356.49 ± 4185.73 mm2, respectively; these were statistically significant (both, p < 0.001). Mandibular dentition was partially preserved in six patients. Twelve of the 15 patients had changes in defect classification with preservation of the mandibular inferior border. In conclusion, alternative lesion-specific mandibulectomy was a less invasive method for effectively removing mandibular lesions while preserving the important anatomical structures of the mandible.
Highlights
In diseases of the oral cavity, such as malignant or benign tumors, extensive trauma, osteoradionecrosis, osteomyelitis, or medication-related osteonecrosis of the jaw, segmental mandibulectomy is often inevitable
It has been reported that computer-assisted surgery (CAS) can more safely and accurately resect the mandibular malignancies with virtual surgical planning (VSP)
Thirteen patients presented with a primary tumor, and two patients presented with osteoradionecrosis of the mandible (Table 1)
Summary
In diseases of the oral cavity, such as malignant or benign tumors, extensive trauma, osteoradionecrosis, osteomyelitis, or medication-related osteonecrosis of the jaw, segmental mandibulectomy is often inevitable. Since accurate mandibulectomy and appropriate reconstruction are challenging issues, recently, computer-assisted surgery (CAS) has been introduced and widely used in clinical practice This technique includes preoperative virtual surgical planning (VSP) based on a patient’s images, such as computed tomography (CT) and magnetic resonance. Sci. 2020, 10, 1325 imaging (MRI), and preparation of surgical guides by computer-aided design and computer-aided manufacturing (CAD/CAM) technologies and adding materials layer by layer to transfer VSP into the operative field. These three-dimensional (3D) printed surgical guides are used for the resection of the mandible, and to shape the free bone flap [4,5,6]. It has been reported that CAS can more safely and accurately resect the mandibular malignancies with VSP performed using various imaging modalities, such as CT and MRI simultaneously [9]
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