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Abstract
BackgroundComputer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome.MethodsTwenty patients were randomly assigned to computer-assisted or conventional mandibular reconstruction with vascularized iliac crest bone graft in a prospective study design.Virtual surgical planning was based on preoperative CT-data using specific surgical planning software. A rapid prototyping guide transferred the virtual surgery plan to the operation site. During surgery the transplant ischemic time, reconstruction time, time for shaping the transplant and amount of bone removed were measured. Additionally, the difference in the intercondylar distance before and after surgery was calculated.ResultsComputer-assisted surgery shortened the time of transplant ischemia (P < 0.005) and defect reconstruction (P < 0.001) compared to conventional surgery. The time to saw and shape the transplant at the donor site was shorter using conventional surgery (P < 0.005); therefore, the overall time for surgery didn’t change (P = 0.527). In the computer-assisted group, the amount of bone harvested equaled the defect size, whereas the transplant size in the conventional group exceeded the defect site by 16.8 ± 5.6 mm (P < 0.001) on average. The intercondylar distance before compared to after surgery was less affected in the computer-assisted than in the conventional group (P < 0.001).ConclusionsThe presented study shows that computer-assisted surgery can help reduce the time for mandibular defect reconstruction and consequently the transplant ischemic time. In the computer-assisted group, the iliac crest donor site defect was downsized and the postoperative condyle position was less altered, reducing possible risks of postoperative complications and donor site morbidity.Trial RegistrationDRKS00005181.
Highlights
Computer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome
The use of iliac crest bone grafts for mandibular reconstruction started in the early twentieth century [1]
Revascularized bone grafts lead to higher graft survival rates and improved functional and aesthetic outcomes [2,3,4]
Summary
Computer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome. In the field of oral and maxillofacial surgery, surgeons are often confronted with the need for complex reconstructions of bony mandibular defects. The reasons for these defects range from severe osteomyelitis to benign and malign mandibular tumors to accidents. The aim of mandibular reconstruction is to achieve the best possible functional and aesthetic outcome; bone grafts play an important role. The use of iliac crest bone grafts for mandibular reconstruction started in the early twentieth century [1]. With the introduction of microvascular surgery, bony reconstruction has been revolutionized because of the possibility of vascularized bone grafts. Revascularized bone grafts lead to higher graft survival rates and improved functional and aesthetic outcomes [2,3,4]
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