Share This Article:

Computer-Assisted Surgery for Mandibular Reconstruction Using a Patient-Specific Titanium Mesh Tray and Particulate Cancellous Bone and Marrow

Abstract Full-Text HTML XML Download Download as PDF (Size:630KB) PP. 85-92
DOI: 10.4236/crcm.2015.43019    2,959 Downloads   3,447 Views  

ABSTRACT

Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon’s hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Kondo, S. , Katsuta, H. , Akizuki, A. , Kurihara, Y. , Kamatani, T. , Yaso, A. , Nagasaki, M. , Shimane, T. and Shirota, T. (2015) Computer-Assisted Surgery for Mandibular Reconstruction Using a Patient-Specific Titanium Mesh Tray and Particulate Cancellous Bone and Marrow. Case Reports in Clinical Medicine, 4, 85-92. doi: 10.4236/crcm.2015.43019.

References

[1] Liu, Y.F., Xu, L.W., Zhu, H.Y. and Liu, S.S. (2014) Technical Procedures for Template-Guided Surgery for Mandibular Reconstruction Based on Digital Design and Manufacturing. Biomed Eng Online, 13, 63.
[2] Willems, P.W., van der Sprenkel, J.W., Tulleken, C.A., Viergever, M.A. and Taphoorn, M.J. (2006) Neuronavigation and Surgery of Intracerebral Tumours. Journal of Neurology, 253, 1123-1136.
http://dx.doi.org/10.1007/s00415-006-0158-3
[3] Satcher Jr., R.L. (2013) How Intraoperative Navigation Is Changing Musculoskeletal Tumor Surgery. Orthopedic Clinics of North America, 44, 645-656.
http://dx.doi.org/10.1016/j.ocl.2013.07.001
[4] Fuller, S.C. and Strong, E.B. (2007) Computer Applications in Facial Plastic and Reconstructive Surgery. Current Opinion in Otolaryngology & Head & Neck Surgery, 15, 233-237.
http://dx.doi.org/10.1097/MOO.0b013e3281df2c5f
[5] Eiland, M., Habermann, C.R. and Schmelzle, R. (2004) Indications and Limitations of Intraoperative Navigation in Maxillofacial Surgery. Journal of Oral and Maxillofacial Surgery, 62, 1059-1063.
[6] Ayoub, N., Ghassemi, A., Rana, M., Gerressen, M., Riediger, D., Holzle, F. and Modabber, A. (2014) Evaluation of Computer-Assisted Mandibular Reconstruction with Vascularized Iliac Crest Bone Graft Compared to Conventional Surgery: A Randomized Prospective Clinical Trial. Trials, 15, 114.
http://dx.doi.org/10.1186/1745-6215-15-114
[7] Liu, Y.F., Xu, L.W., Zhu, H.Y. and Liu, S.S. (2014) Technical Procedures for Template-Guided Surgery for Mandibular Reconstruction Based on Digital Design and Manufacturing. Biomed Eng Online, 13, 63.
http://dx.doi.org/10.1186/1475-925X-13-63
[8] Bell, R.B., Weimer, K.A., Dierks, E.J., Buehler, M. and Lubek, J.E. (2011) Computer Planning and Intraoperative Navigation for Palatomaxillary and Mandibular Reconstruction with Fibular Free Flaps. Journal of Oral and Maxillofacial Surgery, 69, 724-732.
http://dx.doi.org/10.1016/j.joms.2009.12.040
[9] Wilde, F., Cornelius, C.P. and Schramm, A. (2014) Computer-Assisted Mandibular Reconstruction Using a Patient-Specific Reconstruction Plate Fabricated with Computer-Aided Design and Manufacturing Techniques. Cranial Maxillofac Trauma Reconstruction, 7, 158-166.
http://dx.doi.org/10.1055/s-0034-1371356
[10] Ferreira, J.J., Zagalo, C.M., Oliveira, M.L., Correia, A.M. and Reis, A.R. (2014) Mandible Reconstruction: History, State of the Art and Persistent Problems. Prosthetics & Orthotics International, Published Online.
[11] Yamada, H., Nakaoka, K., Horiuchi, T., Kumagai, K., Ikawa, T., Shigeta, Y., Imamura, E., Iino, M., Ogawa, T. and Hamada, Y. (2014) Mandibular Reconstruction Using Custom-Made Titanium Mesh Tray and Particulate Cancellous Bone and Marrow Harvested from Bilateral Posterior Ilia. Journal of Plastic Surgery and Hand Surgery, 48, 183-190.
http://dx.doi.org/10.3109/2000656X.2013.848809
[12] Oh, S.M., Lee, C.Y., Kim, J.W., Jang, C.S., Kim, J.Y. and Yang, B.E. (2013) Condylar Repositioning in Bilateral Sagittal Split Ramus Osteotomy with Centric Relation Bite. Journal of Craniofacial Surgery, 24, 1535-1538.
http://dx.doi.org/10.1097/SCS.0b013e31829028be
[13] Ohba, S., Yoshimura, H., Ishimaru, K., Awara, K. and Sano, K. (2014) Application of a Real-Time Three-Demensional Navigation System to Various Oral and Maxillofacial Surgical Procedures. Odontology, Published Online.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.