Kang Yi-Fan, Lv Xiao-Ming, Qiu Shi-Yu, Ding Meng-Kun, Xie Shang, Zhang Lei, Cai Zhi-Gang, Shan Xiao-Feng
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
National Clinical Research Center for Oral Diseases, Beijing, China.
Front Oncol. 2021 Sep 2;11:718146. doi: 10.3389/fonc.2021.718146. eCollection 2021.
Midface reconstruction is challenging for functional and esthetic reasons. The present study analyzed the effect of virtual surgical planning (VSP) of the deep circumflex iliac artery (DCIA) flap for midface reconstruction.
Thirty-four patients who underwent midface reconstruction with the DCIA flap were included in this retrospective study. Of the 34 patients, 16 underwent preoperative VSP, which used a three-dimensionally printed surgical guide, computer-assisted navigation system, and pre-bent titanium implants to transfer VSP into real-world surgery. The other 18 patients underwent traditional midface reconstruction. The following were compared between the two groups: bony contact rate in the buttress region (BCR), dental arch reconstruction rate (DAR), surgical approach, position of vascular anastomosis, and dental implantation rate. The independent-samples -test and Fisher's exact test were used for analysis. < 0.05 was considered statistically significant.
In total, 12 males and 22 females were included in this study. All patients underwent midface reconstruction using the DCIA flap at the same institution. The median age of patients was 33 years (range: 16-68 years). The average BCR and DAR values in the VSP group were 59.4% ± 27.9% and 87.5% ± 18.9%, respectively, which were significantly higher compared with the non-VSP group (P = 0.049 and P = 0.004, respectively). The dental implantation rate in the VSP group (50.0%) was significantly higher compared with the non-VSP group (11.1%; P = 0.023). The intraoral approach for tumor ablation and vascular anastomosis was the most frequent choice in both groups. There was no significant difference between the two groups. All patients were satisfied with facial symmetry postoperatively.
VSP could effectively augment the effect of midface reconstruction with the DCIA flap. Stronger bone contact in the buttress region and higher DAR provide more opportunity for dental implantation, which might be the best solution to improve masticatory function in patients with midface defects.
由于功能和美学原因，面中部重建具有挑战性。本研究分析了旋髂深动脉（DCIA）皮瓣虚拟手术规划（VSP）用于面中部重建的效果。
本回顾性研究纳入了34例行DCIA皮瓣面中部重建的患者。在这34例患者中，16例接受了术前VSP，其使用三维打印手术导板、计算机辅助导航系统和预弯钛植入物将VSP转化为实际手术。另外18例患者接受了传统的面中部重建。比较两组之间的以下指标：支撑区域骨接触率（BCR）、牙弓重建率（DAR）、手术入路、血管吻合位置和牙种植率。采用独立样本t检验和Fisher精确检验进行分析。P < 0.05被认为具有统计学意义。
本研究共纳入12例男性和22例女性。所有患者均在同一机构接受DCIA皮瓣面中部重建。患者的中位年龄为33岁（范围：16 - 68岁）。VSP组的平均BCR和DAR值分别为59.4% ± 27.9%和87.5% ± 18.9%，与非VSP组相比显著更高（分别为P = 0.049和P = 0.004）。VSP组的牙种植率（50.0%）显著高于非VSP组（11.1%；P = 0.023）。两组中最常选择的是经口途径进行肿瘤切除和血管吻合。两组之间无显著差异。所有患者术后对面部对称性均满意。
VSP可有效增强DCIA皮瓣面中部重建的效果。支撑区域更强的骨接触和更高的DAR为牙种植提供了更多机会，这可能是改善面中部缺损患者咀嚼功能的最佳解决方案。
