Cornelius Carl-Peter, Smolka Wenko, Giessler Goetz A, Wilde Frank, Probst Florian A
Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
Department of Plastic, Reconstructive, Esthetic and Hand Surgery, Klinikum Kassel, Kassel, Germany.
J Craniomaxillofac Surg. 2015 Jun;43(5):624-9. doi: 10.1016/j.jcms.2015.02.016. Epub 2015 Mar 2.
Preoperative planning of mandibular reconstruction has moved from mechanical simulation by dental model casts or stereolithographic models into an almost completely virtual environment. CAD/CAM applications allow a high level of accuracy by providing a custom template-assisted contouring approach for bone flaps. However, the clinical accuracy of CAD reconstruction is limited by the use of prebent reconstruction plates, an analogue step in an otherwise digital workstream.
In this paper the integration of computerized, numerically-controlled (CNC) milled, patient-specific mandibular plates (PSMP) within the virtual workflow of computer-assisted mandibular free fibula flap reconstruction is illustrated in a clinical case. Intraoperatively, the bone segments as well as the plate arms showed a very good fit. Postoperative CT imaging demonstrated close approximation of the PSMP and fibular segments, and good alignment of native mandible and fibular segments and intersegmentally. Over a follow-up period of 12 months, there was an uneventful course of healing with good bony consolidation.
The virtual design and automated fabrication of patient-specific mandibular reconstruction plates provide the missing link in the virtual workflow of computer-assisted mandibular free fibula flap reconstruction.
下颌骨重建的术前规划已从通过牙模铸件或立体光刻模型进行机械模拟，发展到几乎完全虚拟的环境。计算机辅助设计/计算机辅助制造（CAD/CAM）应用程序通过为骨瓣提供定制的模板辅助轮廓塑造方法，实现了高度的准确性。然而，CAD重建的临床准确性受到预弯重建板使用的限制，这是原本数字化工作流程中的一个类似步骤。
本文通过一个临床病例展示了计算机数控（CNC）铣削的患者特异性下颌骨板（PSMP）在计算机辅助下颌骨游离腓骨瓣重建虚拟工作流程中的整合。术中，骨段和板臂显示出非常好的贴合度。术后CT成像显示PSMP与腓骨段紧密贴合，天然下颌骨与腓骨段以及节段间对齐良好。在12个月的随访期内，愈合过程顺利，骨愈合良好。
患者特异性下颌骨重建板的虚拟设计和自动化制造为计算机辅助下颌骨游离腓骨瓣重建的虚拟工作流程提供了缺失的环节。
