Mottini Matthias, Seyed Jafari S M, Shafighi Maziar, Schaller Benoît
Department of Cranio-Maxillofacial Surgery, Bern University Hospital, Inselspital, Bern, Switzerland.
Department of Dermatology, Bern University Hospital, Inselspital, Bern, Switzerland.
Oral Oncol. 2016 Aug;59:e6-e9. doi: 10.1016/j.oraloncology.2016.06.001. Epub 2016 Jun 22.
Maxillofacial reconstruction poses a major challenge to surgeons because of the associated anatomical complexity, the sensitivity of the involved systems and the need to maintain a pleasing facial appearance. Here, we present a detailed description of a new method for extensive mandibular reconstruction using open-source virtual design software and a desktop 3D printer. A surgeon segmented preoperative computed tomography angiography scans with the Amira program to create a digital model of the mandible, skull and fibula. These datasets were imported into Blender, an open-source computer-aided design software package, where arrangement of the fibula segments into aligned sections was performed. Then, a desktop 3D printer was used to produce a reconstructed mandible. After fixation of a plate onto the reconstructed mandible, cutting guides were digitally designed using Blender. Following this, the surgeon performed mandible resection using the fixed cutting guides, which were 3D-printed using biocompatible plastic (Med 610/Stratasys Inc.) and fixed to the prebent reconstructed mandible at a predetermined position. After cutting the fibula with the help of the cutting guides and aligning the fibular segments into mandibular space, the surgeon fixed the segments to the reconstruction plate. Postoperatively, multislice computed tomography scans were taken for control purposes. Our method for mandibular reconstruction offers the following benefits: shorter operation planning time, increased accuracy during osteotomy through the use of a special fibula cutting guide and low costs. In brief, this method is an easy, precise and highly flexible technique for mandibular reconstruction with a fibula flap.
颌面重建对外科医生来说是一项重大挑战，因为其涉及解剖结构复杂、相关系统敏感，且需要保持面部美观。在此，我们详细介绍一种使用开源虚拟设计软件和桌面3D打印机进行广泛下颌骨重建的新方法。外科医生使用Amira程序对术前计算机断层扫描血管造影进行分割，以创建下颌骨、颅骨和腓骨的数字模型。这些数据集被导入到Blender（一个开源计算机辅助设计软件包）中，在其中将腓骨段排列成对齐的部分。然后，使用桌面3D打印机制作重建的下颌骨。在将一块钢板固定到重建的下颌骨上之后，使用Blender进行数字化设计切割导板。在此之后，外科医生使用固定的切割导板进行下颌骨切除术，这些切割导板是使用生物相容性塑料（Med 610/Stratasys公司）3D打印的，并在预定位置固定到预弯曲的重建下颌骨上。在借助切割导板切割腓骨并将腓骨段对齐到下颌骨空间后，外科医生将这些段固定到重建钢板上。术后，进行多层计算机断层扫描以进行对照。我们的下颌骨重建方法具有以下优点：手术规划时间缩短、通过使用特殊的腓骨切割导板提高截骨准确性以及成本低。简而言之，这种方法是一种用于腓骨瓣下颌骨重建的简便、精确且高度灵活的技术。
