Annino Donald J, Sethi Rosh K, Hansen Elisabeth E, Horne Sylvia, Dey Tanujit, Rettig Eleni M, Uppaluri Ravindra, Kass Jason I, Goguen Laura A
Division of Otolaryngology Brigham and Women's Hospital, Dana-Farber Cancer Institute Boston Massachusetts USA.
Department of Otolaryngology Harvard Medical School Boston Massachusetts USA.
Laryngoscope Investig Otolaryngol. 2022 Oct 21;7(6):1798-1807. doi: 10.1002/lio2.830. eCollection 2022 Dec.
Examine accuracy and factors impacting accuracy for mandibular reconstruction with virtual surgical planning, 3D printed osteotomy guides and preoperatively bent mandibular reconstruction plate (VSP/3Dprinted-guide/plate).
Retrospective review of osseous-free-flap mandibular reconstructions with VSP/3Dprinted-guide/plate between January 2015 and July 2020 at a single academic medical center.Patient demographics, disease, and treatment variables were extracted. Accuracy was assessed by 3D-model-overlay with cephalometric and donor-bone segment length measurements. Multivariate analyses were performed to determine factors impacting cephalometric accuracy.
60 cases met criteria: 41 (68%) cancer, 14 (23%) osteoradionecrosis (ORN), 5 (8%) secondary mandibular reconstruction. Thirteen cases (22%) were Brown class III or IV. Thirty-nine cases (65%) had ≥2 flap bone segments. Average donor-bone length was 82 mm (SD: 28). 3D-model-overlay accuracy demonstrated minimal deviation between planned and actual reconstruction: intercondylar distance = 2.10 mm (SD: 2.2); intergonial distance = 2.23 mm (SD: 1.9); anterior-posterior distance (APD) = 1.76 mm (SD: 1.5); gonial angle (GA) = 3.11 degrees (SD: 2.4). Mean change in donor-bone segment length inferiorly was 2.67 mm (SD: 2.6) and superiorly 3.27 mm (SD: 3.2). Higher number of donor-bone segments was associated with decreased accuracy in GA ( = .023) and longer donor-bone length was associated with decreased accuracy in APD ( = .031).
To our knowledge this is the largest series assessing surgical accuracy of VSP/3Dprinted-guide/plate for osseous-free-flap mandibular reconstruction. We demonstrate highly accurate results, with increased number of donor-bone segments and donor-bone length associated with decreased accuracy. Our findings further support VSP/3Dprinted-guide/plate as a reliable and accurate tool for mandibular reconstruction.
Level 4.
使用虚拟手术规划、3D打印截骨导板和术前预弯的下颌骨重建钢板（VSP/3D打印导板/钢板）检查下颌骨重建的准确性及影响准确性的因素。
对2015年1月至2020年7月在一家学术医疗中心进行的采用VSP/3D打印导板/钢板的无骨瓣下颌骨重建进行回顾性研究。提取患者的人口统计学、疾病和治疗变量。通过三维模型叠加及头影测量和供骨段长度测量来评估准确性。进行多因素分析以确定影响头影测量准确性的因素。
60例符合标准：41例（68%）为癌症，14例（23%）为放射性骨坏死（ORN），5例（8%）为二期下颌骨重建。13例（22%）为Brown III级或IV级。39例（65%）有≥2个皮瓣骨段。平均供骨长度为82mm（标准差：28）。三维模型叠加准确性显示计划重建与实际重建之间偏差极小：髁间距离 = 2.10mm（标准差：2.2）；下颌角间距离 = 2.23mm（标准差：1.9）；前后距离（APD） = 1.76mm（标准差：1.5）；下颌角（GA） = 3.11度（标准差：2.4）。供骨段长度在下方向的平均变化为2.67mm（标准差：2.6），在上方向为3.27mm（标准差：3.2）。供骨段数量较多与GA准确性降低相关（P = 0.023），供骨长度较长与APD准确性降低相关（P = 0.031）。
据我们所知，这是评估VSP/3D打印导板/钢板用于无骨瓣下颌骨重建手术准确性的最大系列研究。我们展示了高度准确的结果，供骨段数量增加和供骨长度增加与准确性降低相关。我们的研究结果进一步支持VSP/3D打印导板/钢板作为下颌骨重建的可靠且准确的工具。
4级。
