Abstract
Purpose: Computer-aided methods for mandibular reconstruction have improved both functional and morphological results in patients who underwent segmental mandibular resection. The purpose of this study is to evaluate the overlaying of virtual planning in terms of measures of the Computer Assisted Design/Computer Assisted Manufacturing CAD/CAM plate for mandibular reconstruction in patients who are ineligible for the insertion of reconstructing the titanium plate supported by fibular free flap, due to their poor health status, or in the presence of specific contraindications to autologous bone flap harvest. Materials and methods: The retrospective study performed analyzed the results of nine patients. The patients were treated at the Maxillofacial Surgery Unit of Policlinico S. Orsola of Bologna, Italy, and Policlinico San Marco, Catania, Italy, from April 2016 to June 2021. Superimposition between planning and post operative Computed Tomography CT scan was performed to assess the accuracy. Results: All reconstructive procedures were carried out successfully. No microsurgery-related complications occurred. In two cases, we had plate misplacement, and in one case, plate exposure that led to plate removal. The average accuracy of the series assessed after CT superimposition, as previously described, was 0.95 mm. Conclusions: Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customized bridging mandibular prosthesis (CBMP), whether or not it is associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.
Highlights
The current study was based on a retrospective multi centric analysis of patients who underwent mandibular reconstruction, benefiting from the application of a plate produced with computer-aided manufactory (CAD-CAM) technology, and for whom a bone free flap was contraindicated
Four patients were affected by ONJ while 6 had BRONJ disease
The results of the case series reported in the present paper showed how it is possible to obtain accurate results in the mandibular reconstruction of ONJ-affected patients, using a bridging prosthesis as an alternative to bony reconstruction
Summary
Thanks to the technological improvements developed in the past few years in support of maxillo-facial surgery, it is possible to obtain better aesthetic and functional results in challenging reconstructions as well, such as mandibular defects, and restore the aesthetic profile and functions performed by the mandible after ablative surgery [1]. The current gold standard for the restoration of extensive mandibular defects after surgical ablation is the insertion of a reconstructive titanium plate supporting a microvascular fibular free flap [2,3]. When it comes down to patients affected by osteonecrosis of the jaw (ONJ). Patients, mandibular reconstruction becomes a different, and more difficult, challenge. A number of ONJ diseases have been described [4,5]
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