Abstract
BackgroundAblative tumor surgery often results in continuity defects of the mandible. When an immediate reconstruction using autologous bone grafts is not possible the bridging of the defects with a variety of bridging plates might be achieved. However, those bridging plates have the risk of plate fractures or exposure. Customized titanium implants manufactured using CAD/CAM and the LaserCUSING® technique might be an alternative.MethodsIn the present study, computed tomographies (CT) of porcine cadaver mandibles were generated and transferred into DICOM data. Following, different continuity defects were surgically created in the mandibles. Based on the DICOM data customized titanium implants were manufactured using CAD/CAM procedures and the LaserCUSING® technique. The implants were fixed to the remaining stumps with screws. Subsequently, the accuracy of the reconstructed mandibles was tested using plaster casts.ResultsThe workflow from the CT to the application of the customized implants was proved to be practicable. Furthermore, a stable fixation of the customized implant to the remaining stumps could be achieved. The control of the accuracy showed no frictions or obstacles.ConclusionThe customized titanium implant seems to be a promising approach to bridge continuity defects of the mandible whenever an immediate reconstruction with autologous bone is not possible.
Highlights
Ablative tumor surgery often results in continuity defects of the mandible
According to Markwardt et al [1], four typical localizations of defects resulting from ablative tumor surgery in the mandible are: 1. The defect including the segment from the area between canine/first premolar and the second/third molar on the ipsi lateral side
The data collection using computed tomographies (CT) scans prior to ablative tumor surgery is a standard procedure during the preoperative staging
Summary
When an immediate reconstruction using autologous bone grafts is not possible the bridging of the defects with a variety of bridging plates might be achieved. The immediate reconstruction of the resulting defects using musculo-osseous flaps is considered as the most reliable therapy [2]. Reitemeier et al Head & Face Medicine (2016) 12:17 and the surrounding soft tissue [8] This lack of soft tissue might result in a higher tension and lead to plate exposure. A customized implant being of the same contour as the resected region would be desirable. Such an individualized implant could be produced preoperatively, fixed to remaining stumps by a tube-in-tube like connection and prevent intra-operative adaptation
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