Maxillo-mandibular Reconstruction With Vascularized Bone Flaps Using Insourced Virtual Surgical Planning And Home-made Cad-cam: A 5-year Single-center Evolution In 75 Patients.
Winston Wittesaele, MD, Odille Desmet, MD, Ernest Schouppe, MD, Jan Jeroen Vranckx, MD, PhD.
KUL Leuven University Hospitals, Leuven, Belgium.
PURPOSE: Virtual surgical planning (VSP) and computer aided design (CAD) and manufacturing (CAM) of surgical guides and jigs turned craftmanship into precision and enables the surgeon to complement the donor bone osteotomies with the bony resection of the jaw. In recent years, immediate dental rehabilitation became an integral part of VSP. However, outsourced CAD-CAM is expensive and may be no option to many institutions worldwide. We developed an insourced facility for 'in-house' VSP and 'home-made' 3D printing.
METHODS: We present a consecutive series of 150 cases (2010-2020). In 75 cases (2015 -2020) we used insourced VSP and CAD-CAM for the reconstruction of maxilla-mandibular defects with fibula, iliac crest and scapular angle flaps. Relevant parameters influencing the reconstructive outcome were determined. We compared data with 75 previous reconstructions of the jaw without CAD-CAM (2010-2015). Mann-Whitney U tests and Fisher's exact tests were used to compare continuous and binary variables between both groups.
RESULTS: We went from a fibula-based protocol, towards the selection of optimal vascularized bone for immediate placement of Osseo integrated implants. Bone flap survival was 94,7 % after 4 months. The three-year patient survival is 77,6 %. There were no significant prognostic factors for bone flap failure (such as smoking, radiotherapy or previous interventions). CONCLUSION: In-house VSP and CAD-CAM have evolved into a valuable strategies in maxillo-mandibular reconstruction that promote precision and allow for occlusion-based planning with quality of life, aesthetic outcome and minimizing donorsite morbidity as essential parts of the reconstruction even in high level oral cancers.
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