Application of personalized guide plate combined with real-time navigation in repairing mandibular defect using fibula muscle flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Tingyi , WANG Dong , CHEN Mo , ZHAN Zhaojun , PENG Xiao ,  ZHANG Kai

Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China;

Corresponding?author：

ZHANG Kai, Email: zk29788@163.com

Keywords：

Mandibular defect; fibula muscle flap; real-time navigation; personalized guide plate

DOI：

10.7507/1002-1892.202202090

Video：

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Objective To explore the application of personalized guide plate combined with intraoperative real-time navigation in repairing of mandibular defect using fibula muscle flap, providing the basis for the precise repair and reconstruction of mandible. Methods The clinical data of 12 patients (9 males and 3 females) aged from 23 to 71 years (mean, 55.5 years) between July 2019 and December 2021 were recorded. These patients were diagnosed as benign or malignant mandibular tumors, including 2 cases of ameloblastoma, 6 cases of squamous cell carcinoma, 2 cases of osteosarcoma, 1 case of adenoid cystic carcinoma, and 1 case of squamous carcinoma. All patients were treated with mandibular amputation, and then repaired by double-stacked three-segment fibula muscle flap. Preoperative virtual design scheme and guide plate were performed. During the operation, personalized guide plate combined with real-time navigation was used for fibular osteotomy and shaping. Thin-slice CT examination was performed at 2-3 weeks after operation, and was fitted with the preoperative virtual design scheme. The difference between the distance of bilateral mandibular angles relative to the reference plane in three-dimensional directions (left-right, vertical, and anterior-posterior) and the difference of the medial angle of the lower edge of the mandible reconstructed by fibula were measured, and the mean error of chromatographic fitting degree was calculated. Results The guide plate and navigation were applied well, and the fibula shaping and positioning were accurate. The fibula muscle flap survived, the incision healed well, and the occlusal relationship was good. All 12 patients were followed up 1-29 months, with an average of 17 months. There was no significant difference on the distance of bilateral mandibular angles relative to the reference plane in the left-right [(?0.24±1.35) mm; t=?0.618, P=0.549], vertical [?0.85 (?1.35, 1.40) mm; Z=?0.079, P=0.937], and anterior-posterior [(?0.46±0.78) mm; t=?2.036, P=0.067] directions. The difference of the medial angle of the lower edge of the mandible reconstructed by fibula was also not significant [(?1.35±4.34)°; t=?1.081, P=0.303)]. Postoperative CT and preoperative virtual design fitting verified that there was no significant difference in the change of the mandibular angle on both sides, and the average error was (0.47±1.39) mm. Conclusion The personalized guide combined with intraoperative real-time navigation improves the accuracy of peroneal muscle flap reconstruction of the mandible, reduces the complications, and provides a preliminary basis for the application of visual intraoperative navigation in fibula muscle flap reconstruction of the mandible.

Citation： GAO Tingyi, WANG Dong, CHEN Mo, ZHAN Zhaojun, PENG Xiao, ZHANG Kai. Application of personalized guide plate combined with real-time navigation in repairing mandibular defect using fibula muscle flap. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 691-697. doi: 10.7507/1002-1892.202202090 Copy

1.	顏光啟, 王雪, 譚學新, 等. 應用SurgiCase軟件指導游離腓骨皮瓣修復下頜骨缺損的研究. 中國修復重建外科雜志, 2013, 27(8): 1006-1009.
2.	Prabu NP, Rakesh Mohan M, Shanmugapriyan D, et al. Fibula free flap in reconstruction of mandibular defects. Indian Journal of Public Health Research & Development, 2019, 10(12): 2104. doi: 10.37506/v10/i12/2019/ijphrd/192307.
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4.	牛曉輝. 計算機導航輔助技術在骨腫瘤手術中的應用. 骨科臨床與研究雜志, 2017, 2(5): 257-261.
5.	Bibbo C. The free fibula flap for lower extremity reconstruction. Clin Podiatr Med Surg, 2021, 38(1): 117-130.
6.	Mazzola F, Smithers F, Cheng K, et al. Time and cost-analysis of virtual surgical planning for head and neck reconstruction: A matched pair analysis. Oral Oncol, 2020, 100: 104491. doi: 10.1016/j.oraloncology.2019.104491.
7.	May MM, Howe BM, O’Byrne TJ, et al. Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: Decreased nonunion and complication rates. Head Neck, 2021, 43(8): 2342-2352.
8.	Knitschke M, B?cker C, Schmermund D, et al. Impact of planning method (conventional versus virtual) on time to therapy initiation and resection margins: A retrospective analysis of 104 immediate jaw reconstructions. Cancers (Basel), 2021, 13(12): 3013. doi: 10.3390/cancers13123013.
9.	Berrone M, Crosetti E, Battiston B, et al. Virtual surgical planning for mandible reconstruction with a double barrel fibula flap and immediate implant placement. J Craniofac Surg, 2020, 31(1): e41-e43.
10.	Seier T, Hingsammer L, Schumann P, et al. Virtual planning, simultaneous dental implantation and CAD/CAM plate fixation: a paradigm change in maxillofacial reconstruction. Int J Oral Maxillofac Surg, 2020, 49(7): 854-861.
11.	虎小毅, 李立峰, 史婧怡, 等. 手術導航技術在顴骨顴弓骨折治療應用中的精確度評價. 中國美容醫學, 2019, 28(10): 82-85.
12.	Azarmehr I, Stokbro K, Bell RB, et al. Surgical navigation: A systematic review of indications, treatments, and outcomes in oral and maxillofacial surgery. J Oral Maxillofac Surg, 2017, 75(9): 1987-2005.
13.	楊成帥, 回文宇, 徐曉峰, 等. 個體化導板聯合術中導航輔助陳舊性面中部骨折的精準整復治療. 精準醫學雜志, 2020, 35(5): 420-423, 427.
14.	呂欣蔚, 李龍江. 計算機輔助導航技術在口腔頜面外科的應用進展. 口腔頜面修復學雜志, 2019, 20(5): 309-312, 318.
15.	Hashemi S, Oda M, Onoue K, et al. Determining the optimal osteotomy distance with the fibula free flap in mandibular reconstruction. Am J Otolaryngol, 2020, 41(3): 102436. doi: 10.1016/j.amjoto.2020.102436.
16.	蔡嫚, 王義洲, 祝慶海, 等. 改良數字化導板技術在下頜骨缺損腓骨肌皮瓣修復中的應用評價. 上海口腔醫學, 2021, 30(6): 618-623.

1. 顏光啟, 王雪, 譚學新, 等. 應用SurgiCase軟件指導游離腓骨皮瓣修復下頜骨缺損的研究. 中國修復重建外科雜志, 2013, 27(8): 1006-1009.
2. Prabu NP, Rakesh Mohan M, Shanmugapriyan D, et al. Fibula free flap in reconstruction of mandibular defects. Indian Journal of Public Health Research & Development, 2019, 10(12): 2104. doi: 10.37506/v10/i12/2019/ijphrd/192307.
3. Zheng GS, Su YX, Liao GQ, et al. Mandibular reconstruction assisted by preoperative simulation and accurate transferring templates: preliminary report of clinical application. J Oral Maxillofac Surg, 2013, 71(9): 1613-1618.
4. 牛曉輝. 計算機導航輔助技術在骨腫瘤手術中的應用. 骨科臨床與研究雜志, 2017, 2(5): 257-261.
5. Bibbo C. The free fibula flap for lower extremity reconstruction. Clin Podiatr Med Surg, 2021, 38(1): 117-130.
6. Mazzola F, Smithers F, Cheng K, et al. Time and cost-analysis of virtual surgical planning for head and neck reconstruction: A matched pair analysis. Oral Oncol, 2020, 100: 104491. doi: 10.1016/j.oraloncology.2019.104491.
7. May MM, Howe BM, O’Byrne TJ, et al. Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: Decreased nonunion and complication rates. Head Neck, 2021, 43(8): 2342-2352.
8. Knitschke M, B?cker C, Schmermund D, et al. Impact of planning method (conventional versus virtual) on time to therapy initiation and resection margins: A retrospective analysis of 104 immediate jaw reconstructions. Cancers (Basel), 2021, 13(12): 3013. doi: 10.3390/cancers13123013.
9. Berrone M, Crosetti E, Battiston B, et al. Virtual surgical planning for mandible reconstruction with a double barrel fibula flap and immediate implant placement. J Craniofac Surg, 2020, 31(1): e41-e43.
10. Seier T, Hingsammer L, Schumann P, et al. Virtual planning, simultaneous dental implantation and CAD/CAM plate fixation: a paradigm change in maxillofacial reconstruction. Int J Oral Maxillofac Surg, 2020, 49(7): 854-861.
11. 虎小毅, 李立峰, 史婧怡, 等. 手術導航技術在顴骨顴弓骨折治療應用中的精確度評價. 中國美容醫學, 2019, 28(10): 82-85.
12. Azarmehr I, Stokbro K, Bell RB, et al. Surgical navigation: A systematic review of indications, treatments, and outcomes in oral and maxillofacial surgery. J Oral Maxillofac Surg, 2017, 75(9): 1987-2005.
13. 楊成帥, 回文宇, 徐曉峰, 等. 個體化導板聯合術中導航輔助陳舊性面中部骨折的精準整復治療. 精準醫學雜志, 2020, 35(5): 420-423, 427.
14. 呂欣蔚, 李龍江. 計算機輔助導航技術在口腔頜面外科的應用進展. 口腔頜面修復學雜志, 2019, 20(5): 309-312, 318.
15. Hashemi S, Oda M, Onoue K, et al. Determining the optimal osteotomy distance with the fibula free flap in mandibular reconstruction. Am J Otolaryngol, 2020, 41(3): 102436. doi: 10.1016/j.amjoto.2020.102436.
16. 蔡嫚, 王義洲, 祝慶海, 等. 改良數字化導板技術在下頜骨缺損腓骨肌皮瓣修復中的應用評價. 上海口腔醫學, 2021, 30(6): 618-623.

Chinese Journal of Reparative and Reconstructive Surgery

Application of personalized guide plate combined with real-time navigation in repairing mandibular defect using fibula muscle flap

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