From the Departments of Plastic and Reconstructive Surgery.
Maxillofacial Surgery.
Plast Reconstr Surg. 2023 Jul 1;152(1):143e-154e. doi: 10.1097/PRS.0000000000010142. Epub 2023 Jan 2.
Virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD/CAM) of surgical guides and jigs have dramatically changed the predictability of bony reconstruction of the jaw. VSP craftsmanship can lead to precision and enables the surgeon to complement the donor bone osteotomies with bony resection of the jaw. In recent years, immediate dental rehabilitation has become an integral part of VSP. However, outsourced CAD/CAM technology is expensive and may not be an option for many institutions worldwide.
The authors present here a consecutive series of 75 maxillofacial reconstructions from 2015 to 2020. We established an insourced "in-house" protocol for VSP and "home-made" CAD/CAM for the reconstruction of maxilla-mandibular defects with fibula, iliac crest, and scapular angle flaps. All patient files were analyzed retrospectively, and relevant parameters influencing the reconstructive outcome were determined.
The authors went from a fibula-based protocol toward the selection of optimal vascularized bone for immediate placement of osteointegrated implants. Bone flap survival was 94.7% after 4 months. The 3-year patient survival is 77.6%. The authors show the multiple steps required for the routine use of in-house CAD/CAM and report the related financial balance.
Insourced VSP and CAD/CAM has evolved into a valuable strategy in maxillomandibular reconstruction that promotes accuracy and precision and allows for occlusion-based planning with quality-of-life and aesthetic outcomes as essential parts of the reconstruction even in high-level oral cancers. Further reductions in the hardware and software acquisition costs may lead to widespread implementation of this innovative technology.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
虚拟手术规划（VSP）和手术导板和夹具的计算机辅助设计和制造（CAD/CAM）极大地改变了颌骨重建的可预测性。VSP 工艺可以实现精度，并使外科医生能够通过颌骨切除术来补充供骨的骨切开术。近年来，即刻牙修复已成为 VSP 的一个组成部分。然而，外包的 CAD/CAM 技术价格昂贵，可能不是全球许多机构的选择。
作者在此介绍了 2015 年至 2020 年期间连续进行的 75 例颌面重建。我们建立了一个内部的“内部”VSP 协议和“自制”CAD/CAM 协议，用于使用腓骨、髂嵴和肩胛骨角皮瓣重建上颌骨-下颌骨缺损。所有患者的档案均进行回顾性分析，并确定了影响重建结果的相关参数。
作者从基于腓骨的方案转向选择最佳的血管化骨，以便立即植入骨整合种植体。4 个月后，骨瓣存活率为 94.7%。3 年患者存活率为 77.6%。作者展示了常规使用内部 CAD/CAM 所需的多个步骤，并报告了相关的财务平衡。
内部 VSP 和 CAD/CAM 已发展成为颌骨重建的一种有价值的策略，它可以提高精度，并允许基于咬合的规划，将生活质量和美学结果作为重建的重要组成部分，即使在高级别的口腔癌中也是如此。进一步降低硬件和软件的获取成本可能会导致这项创新技术的广泛实施。
临床问题/证据水平：治疗，IV 级。
