Abstract
BackgroundReconstruction of mandibular continuity and function after tumor resection is challenging, particularly in cases including the mandibular condyle. Various approaches for reconstruction after disarticulation resection have been reported. However, the scapula flap has received little attention as a treatment option in these cases.Patients and methodsThree cases of computer aided design and computer aided manufacturing (CAD/CAM) assisted reconstruction after disarticulation resection using a vascularized scapula and latissimus dorsi flap are reported. All cases required reconstruction of the mandibular ramus and condyle in combination with the reconstruction of large and complex soft tissue defects.ResultsThe surgical procedure was deemed successful in all cases. The scapula flap could be placed as preoperatively planned and patients regained their preoperative occlusion pattern and satisfying mouth opening-ranges. The large soft tissue defects could reliably be reconstructed using a latissimus dorsi flap.ConclusionsThe scapula and latissimus dorsi flap can be considered a suitable option for the reconstruction of mandibular disarticulation resection defects in combination with large soft tissue defects.
Highlights
Reconstruction of mandibular continuity and function after tumor resection is challenging, in cases including the mandibular condyle
The scapula and latissimus dorsi flap can be considered a suitable option for the reconstruction of mandibular disarticulation resection defects in combination with large soft tissue defects
In this study we investigated the feasibility of computer aided design (CAD)/ computer aided manufacturing (CAM) planned reconstruction of disarticulation mandibular resection defects using a scapula and latissimus dorsi free flap
Summary
Three patients with pathologies requiring resection of the mandibular ramus, condyle and significant amounts of soft tissue were included in the investigation. Virtual three-dimensional reconstructions of the mandible and the scapula produced from this dataset represent the basis for the virtual planning of the surgical procedure (Fig. 1) This preoperative planning procedure is performed in a web-based conference in collaboration of the maxillofacial surgeon and a technician of the virtual planning vendor (KLS Martin Group, Tuttlingen, Germany). During this planning conference, key parameters like resection margins, placement of cutting and drilling guides and shape of the patient specific osteosynthesis plate are addressed. The patient specific osteosynthesis plate is fixed to the scapula flap, with drill holes placed using the guidance in the cutting guide (Fig. 2c). The open source software MeshLab was used to visualize the resulting heatmaps (Fig. 4)
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