Abstract
Virtual surgical planning (VSP) applicability has recently expanded to include midface reconstruction with free tissue transfer. For the midface, an area that is crucial both functionally and aesthetically, even minor reconstructions (in the millimeter range) can make profound differences in form and function. The use of VSP allows the surgeon to improve accuracy and precision in areas where millimeters drastically impact outcomes. This review focuses on complex midface reconstruction requiring free tissue transfer and assesses the role of VSP in this patient population.
Highlights
Virtual surgical planning (VSP) utilizes computer-aided design and manufacturing
While its most utilized indication in the head and neck region has historically been for mandibular reconstruction, VSP has gained recent interest for use in midface reconstruction
VSP is a compliment to the reconstructive plan and is best viewed as an additional tool for the reconstructive surgeon to maximize functional outcome and limit operative time
Summary
Virtual surgical planning (VSP) utilizes computer-aided design and manufacturing. VSP encompasses the utilization of computer software for operative planning and the creation of patient-specific models, guides, and hardware. The fat content of the flap allows for more predictable long-term volumetric retention as compared to myofascial or myocutaneous alternatives It does not contain a bony component, limiting its utility in midface buttress reconstruction and projection. These patient-specific plates, for the midface, may be designed to have a stronger grade than plates that are traditionally bent intraoperatively Another advantage of custom plates is that engineers may assess the thickness of the donor and recipient's bone to allow the planning of screw placements in areas with adequate bone thickness. It has been reported that VSP improves rates of dental rehabilitation[3,24,25] At this time, there is not sufficient data to assess longterm outcomes for midface reconstruction or to compare immediate and secondary implantations. VSP improved restoration of the midface subunits and resulted in a more accurate approximation with normal bone anatomy[18]
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