Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland.
Regional Specialized Children 's Hospital, Department of Head and Neck Surgery-Maxillofacial Surgery Unit, Craniomaxillofacial Center for Children and Young Adults, Poland.
Oral Oncol. 2022 Apr;127:105800. doi: 10.1016/j.oraloncology.2022.105800. Epub 2022 Mar 4.
Post- resection defects in the area of the head and neck frequently result in functional impairment of the masticatory system and unaesthetic outcome in the facial appearance. In pediatric population they exert a devastating effect on speech development, breathing and facial growth leading to secondary deformations which are extremely challenging in reconstruction by means of conventional surgery protocols.
21 patients (14 males/ 7 females) aged 4-17 years old, treated between 2015 and 2019 due to malignant/benign tumors or congenital deformities requiring mandible resection were enrolled in the study. All patients underwent Virtual Surgical Planning (VSP), mandible tumor resection with use surgery guides and defect reconstruction with microvascular bone graft supported with custom implants. Postoperatively, 3D models used for the planning and postoperative 3D model of the reconstructed mandible were compared using authors method based on easily measurable morphometric measurements (3 angles, 3 linear dimensions), allowing a three-dimensional quantitative assessment of postoperative outcomes of the surgery. Linear regression analysis and one-way analysis of variance were used to evaluate the clinical material. The difference was considered significant if p < 0.05.
Free fibula flap (FFF) was most commonly used type of the reconstruction of the pediatric mandible. The average maximum deviation for the analyzed cases was 7.7 mm, and the average minimum deviation was -6.09 mm, however without significant differences and the postoperative position of the mandible condyle was comparable to the position designed in the 3DVSP preoperatively. Position of the whole reconstructed mandible by means of individually planned grafts and plates provided comparable position of the ramus and mandible body and no chin deviation as the differences between the pre-operative axial and sagittal angles and their post-operative equivalents were insignificant (p > 0,05).
This study confirms applicability of the 3DVSP in pediatric craniomaxillofacial surgery. Preoperative planning of the osteotomies, grafting technique and production of the individualized guides and implants provides precise tumor resection and immediate reconstruction adjusted to the specific anatomy of the pediatric patients.
头颈部切除术后的缺陷常导致咀嚼系统功能受损，面部外观不美观。在儿科人群中，它们对言语发育、呼吸和面部生长产生破坏性影响，导致继发性畸形，这在通过常规手术方案重建时极具挑战性。
2015 年至 2019 年，我们对 21 名 4-17 岁的患者（男 14 例，女 7 例）因恶性/良性肿瘤或先天性畸形行下颌骨切除术进行了治疗。所有患者均接受了虚拟手术规划（VSP）、下颌骨肿瘤切除术、手术导板的使用和微血管骨移植修复缺损，并采用定制植入物支撑。术后，使用作者的方法对用于规划的 3D 模型和重建下颌骨的术后 3D 模型进行比较，该方法基于易于测量的形态测量学测量值（3 个角度，3 个线性尺寸），实现了手术术后结果的三维定量评估。采用线性回归分析和单向方差分析对临床资料进行评价。如果 p<0.05，则认为差异具有统计学意义。
游离腓骨瓣（FFF）是最常用于儿童下颌骨重建的类型。分析病例的平均最大偏差为 7.7mm，平均最小偏差为-6.09mm，但无显著差异，且术后下颌骨髁突位置与术前 3DVSP 设计位置相当。通过个体化设计的移植物和接骨板重建整个下颌骨，提供了类似的下颌支和下颌体位置，且无颏部偏斜，因为术前和术后矢状和轴向角度的差异无统计学意义（p>0.05）。
本研究证实了 3DVSP 在小儿颅颌面外科中的应用。术前对截骨术、植骨技术以及个体化导板和植入物的制作进行规划，可实现精确的肿瘤切除和即刻重建，适应小儿患者的特定解剖结构。
