Elsharabasy Ibrahim Mohamed, Elhafez Heba Abd Elwahed Abd, Ahmed Salah Abd Elfattah, Ayad Wael Mohamed
Oral and Maxillofacial Department, Faculty of Dentistry, Ain Shams University.
Plastic and Reconstructive Surgery Department, Faculty of Medicine, Alazhar University, Cairo, Egypt.
J Craniofac Surg. 2020 Jun;31(4):950-955. doi: 10.1097/SCS.0000000000006280.
Mandibular reconstruction is considered one of the most complex reconstructive surgeries in the field of craniomaxillofacial surgery. With the introduction of microvascular reconstructive surgery, free fibula flap become the gold standard for reconstruction of mandibular defects. For optimum restoration of the patient's esthetics and function, the free fibular flap should be recontoured to follow the natural premorbid state of the mandible. Virtual surgical planning using preoperative computed tomographic (CT) data can be rendered into 3-dimensional (3D) model for digitalized simulation of the bony resection and reconstruction with reported high accuracy.
Ten patients were included in the study for delayed mandibular reconstruction using free fibular flap. For all the patients, preoperative CT scan for the skull and lower limbs were obtained and integrated into the software for virtual planning and guides fabrications. Postoperative CT was obtained and rendered 3D model to be superimposed on the preoperative record for assessment of the virtual planning accuracy by different linear and angular measurements.
No statistically significant difference was found between virtual group and postoperative group where P = 0.067, regarding average of linear measurements of all patients. Statistically significant difference was found between virtual group and postoperative group in measurements from axial plane where P = 0.004. No statistically significant difference was found between virtual group and postoperative group where P = 0.723, regarding angles between fibular segments.
Virtual surgical planning for mandibular reconstruction offers high reproducibility and precision, reducing the side errors, besides its time saving advantage for both the operator and the patient.
下颌骨重建被认为是颅颌面外科领域最复杂的重建手术之一。随着微血管重建手术的引入，游离腓骨瓣成为下颌骨缺损重建的金标准。为了最佳地恢复患者的美观和功能，游离腓骨瓣应进行重塑，以遵循下颌骨术前的自然状态。利用术前计算机断层扫描（CT）数据进行的虚拟手术规划可以生成三维（3D）模型，用于对骨切除和重建进行数字化模拟，据报道其准确性很高。
本研究纳入10例使用游离腓骨瓣进行延迟下颌骨重建的患者。对所有患者均进行了头颅和下肢的术前CT扫描，并将其整合到软件中进行虚拟规划和导板制作。术后获取CT并生成3D模型，将其叠加在术前记录上，通过不同的线性和角度测量来评估虚拟规划的准确性。
在所有患者的线性测量平均值方面，虚拟组和术后组之间未发现统计学上的显著差异（P = 0.067）。在轴向平面测量中，虚拟组和术后组之间发现了统计学上的显著差异（P = 0.004）。在腓骨段之间的角度方面，虚拟组和术后组之间未发现统计学上的显著差异（P = 0.723）。
下颌骨重建的虚拟手术规划具有很高的可重复性和精确性，减少了侧方误差，同时对术者和患者都具有节省时间的优势。
