P-57804380-28 - Computer-assisted jaw reconstruction: The intraoperative changes and management strategies.

Abstract

<h3>Background</h3> Computer-assisted surgeries (CAS) are increasingly being adopted as the treatment of choice for jaw reconstructions. Although unexpected change of surgical plans remains a major concern of CAS, there is no study focusing on this unfavorable clinical scenario. This study aimed to analyze and classify different clinical scenarios of unexpected change of surgical plans and rationalize the management strategies. <h3>Methods</h3> A retrospective study was performed to evaluate all the patients who underwent computer-assisted jaw resections and free flap reconstructions by the same chief surgeon in our department. The postoperative radiographs were reviewed and compared. Operating records were examined to analyze the reasons for unexpected change of plans and the management. <h3>Results</h3> From November 2014 to May 2021, a total of 89 consecutive computer-assisted jaw reconstruction cases with osseous free flaps were included in this study. Our experience showed that 5.6% of the patients (five cases) needed intra-operative change of the surgical plans. We suggested a clinical classification to record unexpected change of surgical plans and the contingency strategies: type I (extended resection and reconstruction), type II (shortened resection and reconstruction), type III (modified resection without changing reconstruction), and type IV (modified reconstruction without changed resection). <h3>Conclusion</h3> A clinical classification was proposed to record unexpected change of surgical plans and rationalize contingency strategies in computer-assisted jaw reconstruction. This practical classification will help standardize medical record, facilitate comparison among different studies, and most importantly provide management strategies for the beginners in computer-assisted jaw reconstruction. Future studies are warranted to verify this new clinical classification.