Evaluation of the postoperative effect of computer-assisted free fibula mandibular reconstruction

doi:10.7518/hxkq.2022.02.010

Abstract

Abstract: Objective

This study aims to establish a standardized, repeatable, and simple digital evaluation method for accurately determining the effect of computer-assisted free fibula mandibular reconstruction.

Methods

A total of 20 mandibular defect cases caused by tumors were analyzed retrospectively. The coronal, sagittal, and axial mandibular angles were measured and analyzed with Mimics Research 21.0 and 3-matic Research 13.0 software before and after surgery. The effect of computer-assisted free fibula mandibular reconstruction was evaluated.

Results

No significant difference was observed in the coronal and axial mandibular angles between the healthy and affected sides before operation (P>0.05). By contrast, a significant difference in sagittal mandibular angle (P<0.05) was noted. No significant difference was found in the coronal, sagittal, and axial mandibular angles between the healthy and affected sides after operation (P>0.05). Conversely, a significant difference was recorded in the absolute value of the coronal, sagittal, and axial mandibular angles between the healthy and affected sides pre-operation and post-operation (P<0.01). Meanwhile, a significant difference was observed in the sagittal mandibular angle between the healthy and affected sides before operation and the axial mandibular angle between the healthy and affected sides after operation in Type Ⅰ defect (P<0.05). Moreover, no significant difference in the 3D mandibular angle was found between the healthy and affected sides before and after operation in other types (P>0.05). Furthermore, no significant difference was recorded in the absolute values of the sagittal and coronal mandibular angles between the healthy and affected sides before and after operation in Type Ⅰ defect (P>0.05). Lastly, a significant difference was found in the absolute values of the 3D mandibular angles between the healthy and affected sides before and after operation in other types (P<0.05).

Conclusion

Computer-assisted free fibula mandibular reconstruction can significantly improve 3D mandibular deformities caused by tumors and effectively restore the accurate symmetry of the mandibular anatomical structure. The evaluation method used in this study can accurately evaluate the effects of mandibular reconstruction and provide guidance to preoperative design.

Key words: mandibular reconstruction, computer-assisted surgery, accuracy, free fibula flap

CLC Number:

R 782.05

Kang Zebiao, Mai Xiaoxue, Wang Xin, Xie Fuqiang. Evaluation of the postoperative effect of computer-assisted free fibula mandibular reconstruction[J]. West China Journal of Stomatology, 2022, 40(2): 189-196.

Figures/Tables 11

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References 15

1	Bak M, Jacobson AS, Buchbinder D, et al. Contemporary reconstruction of the mandible[J]. Oral Oncol, 2010, 46(2): 71-76.
2	中华口腔医学会口腔颌面修复专业委员会. 下颌骨缺损修复重建治疗专家共识[J]. 中华口腔医学杂志, 2019, 54(7): 433-439.
	Society of Oral Maxillofacial Rehabilitation of Chinese Stomatological Association. Expert consensus statement on reconstruction principle for mandibular defect[J]. Chin J Stomatol, 2019, 54(7): 433-439.
3	Sieira Gil R, Roig AM, Obispo CA, et al. Surgical planning and microvascular reconstruction of the mandible with a fibular flap using computer-aided design, rapid prototype modelling, and precontoured titanium reconstruction plates: a prospective study[J]. Br J Oral Maxillofac Surg, 2015, 53(1): 49-53.
4	Adolphs N, Haberl EJ, Liu WC, et al. Virtual planning for craniomaxillofacial surgery: 7 years of experience[J]. J Craniomaxillofac Surg, 2014, 42(5): e289-e295.
5	Wilde F, Cornelius CP, Schramm A. Computer-assisted mandibular reconstruction using a patient-specific reconstruction plate fabricated with computer-aided design and manufacturing techniques[J]. Craniomaxillofac Trauma Reconstr, 2014, 7(2): 158-166.
6	Rodby KA, Turin S, Jacobs RJ, et al. Advances in oncologic head and neck reconstruction: systematic review and future considerations of virtual surgical planning and computer aided design/computer aided modeling[J]. J Plast Reconstr Aesthet Surg, 2014, 67(9): 1171-1185.
7	Tarsitano A, Battaglia S, Ricotta F, et al. Accuracy of CAD/CAM mandibular reconstruction: a three-dimensional, fully virtual outcome evaluation method[J]. J Craniomaxillofac Surg, 2018, 46(7): 1121-1125.
8	Zhang L, Liu ZX, Li B, et al. Evaluation of computer-assisted mandibular reconstruction with vascularized fibular flap compared to conventional surgery[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2016, 121(2): 139-
148
9	Succo G, Berrone M, Battiston B, et al. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning[J]. Eur Arch Otorhinolaryngol, 2015, 272(6): 1491-1501.
10	Brown JS, Barry C, Ho M, et al. A new classification for mandibular defects after oncological resection[J]. Lancet Oncol, 2016, 17(1): e23-e30.
11	Pittayapat P, Jacobs R, Bornstein MM, et al. Three-dimensional Frankfort horizontal plane for 3D cephalometry: a comparative assessment of conventional versus novel landmarks and horizontal planes[J]. Eur J Orthod, 2018, 40(3): 239-248.
12	Green MN, Bloom JM, Kulbersh R. A simple and accurate craniofacial midsagittal plane definition[J]. Am J Orthod Dentofacial Orthop, 2017, 152(3): 355-363.
13	Hirsch DL, Garfein ES, Christensen AM, et al. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction[J]. J Oral Maxillofac Surg, 2009, 67(10): 2115-2122.
14	Edwards SP. Computer-assisted craniomaxillofacial surgery[J]. Oral Maxillofac Surg Clin North Am, 2010, 22(1): 117-134.
15	van Baar GJC, NPTJ Liberton, Forouzanfar T, et al. Accuracy of computer-assisted surgery in mandibular reconstruction: a postoperative evaluation guideline[J]. Or-al Oncol, 2019, 88: 1-8.

患者	年龄/岁	性别	病理诊断	缺损类型	术中失血量/mL	住院时长/d
1	35	女	骨化纤维瘤	Ⅰ类	200	48
2	49	男	成釉细胞瘤	Ⅰ类	250	30
3	54	男	成釉细胞瘤	Ⅱc类	220	31
4	58	男	成釉细胞瘤	Ⅰ类	230	32
5	17	女	角化囊性瘤	Ⅱ类	300	25
6	19	男	角化囊性瘤	Ⅱ类	200	28
7	41	女	成釉细胞瘤	Ⅱ类	250	31
8	41	女	成釉细胞瘤	Ⅱ类	230	30
9	19	女	成釉细胞瘤	Ⅱc类	280	29
10	59	男	成釉细胞瘤	Ⅰ类	100	20
11	30	男	成釉细胞瘤	Ⅱc类	240	34
12	40	女	成釉细胞瘤	Ⅱ类	200	25
13	34	男	成釉细胞瘤	Ⅱc类	500	29
14	46	男	成釉细胞瘤	Ⅰ类	250	30
15	55	女	成釉细胞瘤	Ⅰ类	120	20
16	20	女	骨化纤维瘤	Ⅱc类	200	31
17	35	女	成釉细胞瘤	Ⅱc类	220	28
18	55	男	成釉细胞瘤	Ⅱc类	200	32
19	45	男	成釉细胞瘤	Ⅱc类	210	35
20	22	女	骨化纤维瘤	Ⅰ类	200	37
平均值	38.70±13.72	-	-	-	230±76.35	30.25±5.85

患者	术前						术后
	冠状下颌角/°		矢状下颌角/°		轴向下颌角/°		冠状下颌角/°		矢状下颌角/°		轴向下颌角/°
	健侧	患侧	健侧	患侧	健侧	患侧	健侧	患侧	健侧	患侧	健侧	患侧
P值	0.918		0.039		0.299		0.539		0.074		0.122
1	23.74	25.27	10.27	25.39	74.89	64.89	22.61	22.84	11.61	16.63	73.48	73.32
2	6.02	23.20	23.86	28.74	60.81	58.95	6.97	9.75	24.19	28.03	59.54	56.76
3	18.41	13.82	32.63	24.33	61.07	64.60	18.45	16.65	29.16	31.62	61.72	61.21
4	21.75	16.63	25.51	25.49	65.31	60.77	22.11	23.52	26.37	25.56	67.56	66.78
5	12.99	14.99	25.08	28.45	71.45	67.34	14.72	13.46	24.63	25.79	70.66	69.51
6	9.60	23.03	23.88	33.62	51.99	60.01	10.67	12.18	23.49	20.55	50.97	52.98
7	16.53	15.90	23.57	22.44	62.01	60.80	17.43	17.81	22.30	23.68	62.30	62.83
8	8.74	6.31	31.45	27.82	52.33	49.13	7.72	6.58	31.05	29.98	53.94	54.67
9	15.04	7.49	30.89	25.53	66.23	71.82	15.29	14.98	29.45	31.31	65.54	67.42
10	24.10	17.95	23.02	25.89	65.29	59.43	25.01	24.05	24.49	25.11	66.34	62.71
11	14.58	12.38	31.44	36.99	59.19	56.69	14.99	16.80	36.00	37.61	60.19	61.45
12	17.81	13.06	26.54	27.95	65.91	70.26	18.77	17.63	26.18	26.98	66.76	65.68
13	7.06	19.23	32.45	29.28	85.34	81.83	8.27	12.68	32.40	30.49	86.96	84.75
14	28.04	16.26	14.26	31.61	57.46	55.41	29.26	27.03	15.65	19.96	57.37	56.79
15	18.11	18.36	38.69	40.37	77.73	62.73	17.96	16.44	39.44	38.23	78.68	76.00
16	19.16	6.43	31.66	26.17	72.22	69.30	18.68	19.32	30.21	27.66	72.11	71.08
17	20.86	19.15	25.16	31.91	57.52	63.64	21.62	21.29	26.64	27.55	59.90	61.69
18	16.65	12.92	27.86	31.37	68.68	55.73	15.69	16.18	29.22	31.15	67.63	66.51
19	13.67	20.56	23.45	40.36	76.72	80.67	13.86	13.46	24.24	25.37	75.86	76.49
20	15.67	21.88	21.84	34.32	78.74	85.99	15.78	17.98	21.89	23.67	77.64	73.56
平均值	16.43±5.80	16.24±5.46	26.18±6.50	29.90±5.13	66.54±9.12	65.00±9.46	16.79±5.76	17.03±5.06	26.43±6.31	27.35±5.36	66.76±8.98	66.11±8.16

缺损类型	术前平均值									术后平均值
	冠状下颌角/°		P值	矢状下颌角/°		P值	轴向下颌角/°		P值	冠状下颌角/°		P值	矢状下颌角/°		P值	轴向下颌角/°		P值
	健侧	患侧	P值	健侧	患侧	P值	健侧	患侧	P值	健侧	患侧	P值	健侧	患侧	P值	健侧	患侧	P值
Ⅰ类	19.63±7.25	19.94±3.51	0.935	22.49±9.05	30.26±5.60	0.027	68.60±8.49	64.02±10.14	0.134	19.96±7.23	20.23±5.88	0.721	23.38±8.84	25.31±6.84	0.088	68.66±8.38	66.56± 8.06	0.012
Ⅱ类	13.13±4.04	14.66±6.00	0.656	26.10±3.21	28.06±3.96	0.439	60.74±8.52	61.51±8.16	0.758	13.86±4.62	13.53±4.62	0.581	25.53±3.40	25.40±3.54	0.879	60.93±8.35	61.13± 7.11	0.745
Ⅱc类	15.68±4.26	14.00±5.35	0.566	29.44±3.52	30.74±5.66	0.676	68.37±9.51	68.04±9.84	0.887	15.86±3.97	16.42±2.86	0.422	29.67±3.53	30.35±3.70	0.337	68.74±9.30	68.83±8.35	0.877

缺损类型	冠状下颌角差值的绝对值/°		P值	矢状下颌角差值的绝对值/°		P值	轴向下颌角差值的绝对值/°		P值
缺损类型	术前	术后	P值	术前	术后	P值	术前	术后	P值
Ⅰ类	6.89±5.87	1.62±0.86	0.037	7.77±7.04	2.51±1.83	0.053	6.65±4.66	2.10±1.57	0.044
Ⅱ类	4.65±5.13	1.09±0.42	0.176	3.86±3.48	1.47±0.85	0.122	4.18±2.48	1.10±0.57	0.023
Ⅱc类	6.45±4.22	1.27±1.41	0.007	6.88±4.37	1.80±0.57	0.017	5.13±3.40	1.30 ±0.61	0.018

患者	冠状下颌角差值的绝对值/°		矢状下颌角差值的绝对值/°		轴向下颌角差值的绝对值/°
患者	术前	术后	术前	术后	术前	术后
P值	0.000		0.000		0.000
1	1.53	0.23	15.12	5.02	10.00	0.16
2	17.18	2.78	4.88	3.84	1.86	2.78
3	4.59	1.80	8.30	2.46	3.53	0.51
4	5.12	1.41	0.02	0.81	4.54	0.78
5	2.00	1.26	3.37	1.16	4.11	1.15
6	13.43	1.51	9.74	2.94	8.02	2.01
7	0.63	0.38	1.13	1.38	1.21	0.53
8	2.43	1.14	3.63	1.07	3.20	0.73
9	7.55	0.31	5.36	1.86	5.59	1.88
10	6.15	0.96	2.87	0.62	5.86	3.63
11	2.20	1.81	5.55	1.61	2.50	1.26
12	4.75	1.14	1.41	0.80	4.35	1.08
13	12.17	4.41	3.17	1.91	3.51	2.21
14	11.78	2.23	17.35	4.31	2.05	0.58
15	0.25	1.52	1.68	1.21	15.00	2.68
16	12.73	0.64	5.49	2.55	2.92	1.03
17	1.71	0.33	6.75	0.91	6.12	1.79
18	3.73	0.49	3.51	1.93	12.95	1.12
19	6.89	0.40	16.91	1.13	3.95	0.63
20	6.21	2.20	12.48	1.78	7.25	4.08
平均值	6.15± 4.88	1.35± 1.03	6.44± 5.27	1.97± 1.23	5.43± 3.66	1.53± 1.08