Witjes Max J H, Schepers Rutger H, Kraeima Joep
Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Curr Opin Otolaryngol Head Neck Surg. 2018 Apr;26(2):108-114. doi: 10.1097/MOO.0000000000000437.
This review describes the advances in 3D virtual planning for mandibular and maxillary reconstruction surgical defects with full prosthetic rehabilitation. The primary purpose is to provide an overview of various techniques that apply 3D technology safely in primary and secondary reconstructive cases of patients suffering from head and neck cancer.
Methods have been developed to overcome the problem of control over the margin during surgery while the crucial decision with regard to resection margin and planning of osteotomies were predetermined by virtual planning. The unlimited possibilities of designing patient-specific implants can result in creative uniquely applied solutions for single cases but should be applied wisely with knowledge of biomechanical engineering principles.
The high surgical accuracy of an executed 3D virtual plan provides tumor margin control during ablative surgery and the possibility of planned combined use of osseus free flaps and dental implants in the reconstruction in one surgical procedure. A thorough understanding of the effects of radiotherapy on the reconstruction, soft tissue management, and prosthetic rehabilitation is imperative in individual cases when deciding to use dental implants in patients who received radiotherapy.
本综述描述了下颌骨和上颌骨重建手术缺损并进行全口义齿修复的三维虚拟规划进展。主要目的是概述在头颈部癌症患者的一期和二期重建病例中安全应用三维技术的各种技术。
已经开发出一些方法来克服手术过程中对切缘控制的问题,而关于切除边缘和截骨术规划的关键决策是通过虚拟规划预先确定的。设计个性化植入物的无限可能性可以为单个病例带来创造性的独特应用解决方案,但应在了解生物力学工程原理的基础上明智地应用。
执行的三维虚拟计划具有很高的手术准确性,可在切除手术期间控制肿瘤边缘,并有可能在一次手术重建中计划联合使用游离骨瓣和牙种植体。在决定对接受过放疗的患者使用牙种植体时,对于放疗对重建、软组织管理和义齿修复的影响,在个别病例中必须有透彻的了解。