Maxillo-Facial Prosthodontics, Section of Prosthodontics, Department of Oral Science, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Med Biol Eng Comput. 2012 Jul;50(7):743-9. doi: 10.1007/s11517-012-0898-4. Epub 2012 Mar 24.
This paper describes a new protocol for mandibular reconstruction. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to manufacture custom-made cutting guides for tumor ablation and reconstructive plates to support fibula free flaps. CT scan data from a patient with an odontogenic keratocyst on the left mandibular ramus were elaborated to produce a virtual surgical plan of mandibular osteotomy in safe tissue for complete ramus resection. The CAD/CAM procedure was used to construct a customized surgical device composed of a cutting guide and a titanium reconstructive bone plate. The cutting guide allowed the surgeon to precisely transfer the virtual planned osteotomy into the surgical environment. The bone plate, including a custom-made anatomical condylar prosthesis, was designed using the outer surface of the healthy side of the mandible to obtain an ideal contour and avoid the bone deformities present on the side affected by the tumor. Operation time was reduced in the demolition and reconstruction phases. Functional and aesthetic outcomes allowed patients to immediately recover their usual appearance and functionality. This new protocol for mandibular reconstruction using CAD/CAM to construct custom-made guides and plates may represent a viable way to reproduce the patient's anatomical contour, give the surgeon better procedural control, and reduce operation time.
本文描述了一种新的下颌骨重建方案。采用计算机辅助设计/计算机辅助制造（CAD/CAM）技术，为肿瘤消融和重建板制造定制的切割引导器，以支持游离腓骨瓣。对一位左下颌支有牙源性角化囊肿的患者的 CT 扫描数据进行了详细分析，以制定安全组织中下颌骨截骨的虚拟手术计划，实现完全切除。使用 CAD/CAM 程序构建了由切割引导器和钛重建骨板组成的定制手术设备。切割引导器允许外科医生精确地将虚拟规划的截骨术转移到手术环境中。骨板包括定制的解剖状突假体，使用健康侧下颌骨的外表面设计，以获得理想的轮廓，并避免受肿瘤影响侧的骨畸形。在拆除和重建阶段，手术时间缩短。功能和美学结果使患者能够立即恢复他们的正常外观和功能。使用 CAD/CAM 构建定制引导器和板的这种新的下颌骨重建方案，可能是复制患者解剖轮廓的可行方法，为外科医生提供更好的手术控制，并缩短手术时间。
