Patient-specific implant modification for alloplastic bridging of mandibular segmental defects in head and neck surgery. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Jehn, Philipp; Spalthoff, Simon; Korn, Philippe; Zeller, Alexander-Nicolai; Dittmann, Jan; Zimmerer, Rüdiger; Tavassol, Frank; Gellrich, Nils-Claudius
• Is Part Of: Journal of cranio-maxillofacial surgery. Volume 48:Issue 3(2020)
• Page Start: 315
• Page End: 322
• Publication Date: 2020-03
• Subjects: Patient-specific implant -- Mandibular reconstruction plate -- Alloplastic mandibular reconstruction -- Mandibular segmental defect -- Selective laser melting -- Computer-aided design and manufacturing; Skull -- Surgery -- Periodicals; Maxilla -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; Maxilla -- surgery -- Periodicals; Face -- surgery -- Periodicals; Skull -- surgery -- Periodicals; Oral Surgical Procedures -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Periodicals; Surgery, Oral -- Periodicals; Electronic journals; 617.514
• DOI: 10.1016/j.jcms.2020.01.018
• Languages: English
• ISSNs: 1010-5182

Abstract

Abstract: Displacement of the remaining mandibular segments may occur after alloplastic bridging of mandibular segmental defects using patient-specific reconstruction plates. Consequently, additional surgical devices are required for correct plate positioning. Patient-specific reconstruction plates with a conventional one beam-like design (cPSRP) have been modified by adding two flanges and giving a Y-shape to the distal ascending implant part to allow for segment positioning without using additional devices. We aimed to evaluate reconstruction results after using these modified patient-specific reconstruction plates (mPSRP). We compared the reconstruction results for mPSRP and cPSRP and evaluated mandibular segment dislocations after reconstruction using digital image analysis of the pre- and postoperative radiological data sets. Analysis showed better reconstruction results with mPSRP than with cPSRP; mean dislocation values concerning shifts and rotations of mandibular segments were lower for mPSRP ( x -axis: 2.9 mm vs 1.1 mm, 4.2° vs 3.6°; y -axis: 6.0 mm vs 2.0 mm, 3.5° vs 2.8°; z -axis: 3.9 mm vs 3.3 mm, 4.2° vs 1.2°). Significant differences were found for shifts along the y -axis ( p = 0.039) and rotations around the z -axis ( p = 0.041). Therefore, implant design modifications with additional positioning elements could help simplify surgical reconstruction procedures and improve reconstruction in head and neck surgery.