The Experts below are selected from a list of 1113 Experts worldwide ranked by ideXlab platform
Frank Wilde - One of the best experts on this subject based on the ideXlab platform.
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accuracy of computer assisted mandibular Reconstructions using patient specific implants in combination with cad cam fabricated transfer keys
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: F. Mascha, Karsten Winter, S. Pietzka, M. Heufelder, Alexander Schramm, Frank WildeAbstract:Abstract Background A new method in Mandible Reconstruction has recently been developed using patient-specific Mandible Reconstruction plates (PSMP) after preoperative computer planning using CAD/CAM procedures. To transfer the virtual planned position of the PSMP into the intraoperative situs resection margins and plate position is determined by using surgical guides made by CAD/CAM procedures as well (PSMP-method). Methods Mandibular Reconstruction with the PSMP-method was performed on 18 patients. The study included sole alloplastic Reconstruction cases (AP, n = 10) and microvascular osseous Reconstruction cases (MV, n = 8). Pre- and postoperative CT-scans were evaluated by measuring distances between corresponding landmarks on the mandibular rami. The difference was used to evaluate Reconstruction accuracy. Results The median deviation of all distances was 1.13 mm for PSMP-method including all cases. For AP-group, the median deviation was 0,80 mm, for MV-group it was 2,47 mm. There was a high significant difference between both groups (AP and MV). Larger mandibular resections in combination with the need of positioning the surgical guides in the region of the upper condyle seemed to reduce Reconstruction-accuracy. This was found more often in MV-group as in the AP-group. Conclusions PSMP-method seems to be an effective and satisfying method for accurate mandibular Reconstruction. Microvascular Reconstruction seems less accurate than sole alloplastic Reconstruction. Larger resections of the Mandible and technical more challenging approaches up to the mandibular condyle might explain this result.
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Accuracy of computer-assisted mandibular Reconstructions using patient-specific implants in combination with CAD/CAM fabricated transfer keys
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: F. Mascha, Karsten Winter, S. Pietzka, M. Heufelder, Alexander Schramm, Frank WildeAbstract:Abstract Background A new method in Mandible Reconstruction has recently been developed using patient-specific Mandible Reconstruction plates (PSMP) after preoperative computer planning using CAD/CAM procedures. To transfer the virtual planned position of the PSMP into the intraoperative situs resection margins and plate position is determined by using surgical guides made by CAD/CAM procedures as well (PSMP-method). Methods Mandibular Reconstruction with the PSMP-method was performed on 18 patients. The study included sole alloplastic Reconstruction cases (AP, n = 10) and microvascular osseous Reconstruction cases (MV, n = 8). Pre- and postoperative CT-scans were evaluated by measuring distances between corresponding landmarks on the mandibular rami. The difference was used to evaluate Reconstruction accuracy. Results The median deviation of all distances was 1.13 mm for PSMP-method including all cases. For AP-group, the median deviation was 0,80 mm, for MV-group it was 2,47 mm. There was a high significant difference between both groups (AP and MV). Larger mandibular resections in combination with the need of positioning the surgical guides in the region of the upper condyle seemed to reduce Reconstruction-accuracy. This was found more often in MV-group as in the AP-group. Conclusions PSMP-method seems to be an effective and satisfying method for accurate mandibular Reconstruction. Microvascular Reconstruction seems less accurate than sole alloplastic Reconstruction. Larger resections of the Mandible and technical more challenging approaches up to the mandibular condyle might explain this result.
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Mandible Reconstruction using patient specific pre bent Reconstruction plates comparison of standard and transfer key methods
Computer Assisted Radiology and Surgery, 2015Co-Authors: Frank Wilde, Karsten Winter, Katharina Kletsch, Kai Lorenz, Alexander SchrammAbstract:Purpose Mandible Reconstruction with Reconstruction plates requires bending the plates during the operation and fixation using the “standard method” (ST-method). The ST-method is limited when a pathological process has perforated the mandibular outer cortex. A transfer key method (TK-method) was developed where plates are pre-bent using a patient-specific Mandible model and positioned on the Mandible with the help of transfer keys. The ST-method and TK-method were compared in a clinical trial.
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Mandible Reconstruction using patient-specific pre-bent Reconstruction plates: comparison of standard and transfer key methods
International Journal of Computer Assisted Radiology and Surgery, 2015Co-Authors: Frank Wilde, Karsten Winter, Katharina Kletsch, Kai Lorenz, Alexander SchrammAbstract:Purpose Mandible Reconstruction with Reconstruction plates requires bending the plates during the operation and fixation using the “standard method” (ST-method). The ST-method is limited when a pathological process has perforated the mandibular outer cortex. A transfer key method (TK-method) was developed where plates are pre-bent using a patient-specific Mandible model and positioned on the Mandible with the help of transfer keys. The ST-method and TK-method were compared in a clinical trial. Methods Mandibular Reconstruction was performed on 42 patients in this study: 22 were performed using the TK-method and 20 using the ST-method. Pre- and postoperative CT scans were evaluated by measuring the distances between six corresponding landmarks on the mandibular condyles and rami. The difference between pre- and postoperative distances was used to evaluate Reconstruction accuracy. Results The median deviation of the unsigned/ absolute values of all six distances was 1.07 mm for the TK-method and 1.67 mm for the ST-method. The TK-method showed significantly better results. For the signed values, the median deviation of the six distances was $$-$$ - 0.6 mm for the TK-method and $$-$$ - 1.47 mm for the ST-method, indicating that the Mandibles became narrower with both methods. This width difference was not statistically significant. Conclusion The TK-method was more accurate than the ST-method in a clinical trial. The TK-method was effective and accurate for Mandible Reconstruction using pre-bent fixation plates.
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Mandible Reconstruction with patient specific pre bent Reconstruction plates comparison of a transfer key method to the standard method results of an in vitro study
Computer Assisted Radiology and Surgery, 2012Co-Authors: Frank Wilde, Alexander Schramm, Marcus Plail, Christoph Riese, Karsten WinterAbstract:Purpose Patient-specific Mandible Reconstruction plates may be pre-bent to facilitate the surgical procedure. A method using transfer keys (TK) for repositioning pre-bent plates was compared with the standard method on mandibular models to evaluate its feasibility.
Karsten Winter - One of the best experts on this subject based on the ideXlab platform.
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accuracy of computer assisted mandibular Reconstructions using patient specific implants in combination with cad cam fabricated transfer keys
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: F. Mascha, Karsten Winter, S. Pietzka, M. Heufelder, Alexander Schramm, Frank WildeAbstract:Abstract Background A new method in Mandible Reconstruction has recently been developed using patient-specific Mandible Reconstruction plates (PSMP) after preoperative computer planning using CAD/CAM procedures. To transfer the virtual planned position of the PSMP into the intraoperative situs resection margins and plate position is determined by using surgical guides made by CAD/CAM procedures as well (PSMP-method). Methods Mandibular Reconstruction with the PSMP-method was performed on 18 patients. The study included sole alloplastic Reconstruction cases (AP, n = 10) and microvascular osseous Reconstruction cases (MV, n = 8). Pre- and postoperative CT-scans were evaluated by measuring distances between corresponding landmarks on the mandibular rami. The difference was used to evaluate Reconstruction accuracy. Results The median deviation of all distances was 1.13 mm for PSMP-method including all cases. For AP-group, the median deviation was 0,80 mm, for MV-group it was 2,47 mm. There was a high significant difference between both groups (AP and MV). Larger mandibular resections in combination with the need of positioning the surgical guides in the region of the upper condyle seemed to reduce Reconstruction-accuracy. This was found more often in MV-group as in the AP-group. Conclusions PSMP-method seems to be an effective and satisfying method for accurate mandibular Reconstruction. Microvascular Reconstruction seems less accurate than sole alloplastic Reconstruction. Larger resections of the Mandible and technical more challenging approaches up to the mandibular condyle might explain this result.
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Accuracy of computer-assisted mandibular Reconstructions using patient-specific implants in combination with CAD/CAM fabricated transfer keys
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: F. Mascha, Karsten Winter, S. Pietzka, M. Heufelder, Alexander Schramm, Frank WildeAbstract:Abstract Background A new method in Mandible Reconstruction has recently been developed using patient-specific Mandible Reconstruction plates (PSMP) after preoperative computer planning using CAD/CAM procedures. To transfer the virtual planned position of the PSMP into the intraoperative situs resection margins and plate position is determined by using surgical guides made by CAD/CAM procedures as well (PSMP-method). Methods Mandibular Reconstruction with the PSMP-method was performed on 18 patients. The study included sole alloplastic Reconstruction cases (AP, n = 10) and microvascular osseous Reconstruction cases (MV, n = 8). Pre- and postoperative CT-scans were evaluated by measuring distances between corresponding landmarks on the mandibular rami. The difference was used to evaluate Reconstruction accuracy. Results The median deviation of all distances was 1.13 mm for PSMP-method including all cases. For AP-group, the median deviation was 0,80 mm, for MV-group it was 2,47 mm. There was a high significant difference between both groups (AP and MV). Larger mandibular resections in combination with the need of positioning the surgical guides in the region of the upper condyle seemed to reduce Reconstruction-accuracy. This was found more often in MV-group as in the AP-group. Conclusions PSMP-method seems to be an effective and satisfying method for accurate mandibular Reconstruction. Microvascular Reconstruction seems less accurate than sole alloplastic Reconstruction. Larger resections of the Mandible and technical more challenging approaches up to the mandibular condyle might explain this result.
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Mandible Reconstruction using patient specific pre bent Reconstruction plates comparison of standard and transfer key methods
Computer Assisted Radiology and Surgery, 2015Co-Authors: Frank Wilde, Karsten Winter, Katharina Kletsch, Kai Lorenz, Alexander SchrammAbstract:Purpose Mandible Reconstruction with Reconstruction plates requires bending the plates during the operation and fixation using the “standard method” (ST-method). The ST-method is limited when a pathological process has perforated the mandibular outer cortex. A transfer key method (TK-method) was developed where plates are pre-bent using a patient-specific Mandible model and positioned on the Mandible with the help of transfer keys. The ST-method and TK-method were compared in a clinical trial.
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Mandible Reconstruction using patient-specific pre-bent Reconstruction plates: comparison of standard and transfer key methods
International Journal of Computer Assisted Radiology and Surgery, 2015Co-Authors: Frank Wilde, Karsten Winter, Katharina Kletsch, Kai Lorenz, Alexander SchrammAbstract:Purpose Mandible Reconstruction with Reconstruction plates requires bending the plates during the operation and fixation using the “standard method” (ST-method). The ST-method is limited when a pathological process has perforated the mandibular outer cortex. A transfer key method (TK-method) was developed where plates are pre-bent using a patient-specific Mandible model and positioned on the Mandible with the help of transfer keys. The ST-method and TK-method were compared in a clinical trial. Methods Mandibular Reconstruction was performed on 42 patients in this study: 22 were performed using the TK-method and 20 using the ST-method. Pre- and postoperative CT scans were evaluated by measuring the distances between six corresponding landmarks on the mandibular condyles and rami. The difference between pre- and postoperative distances was used to evaluate Reconstruction accuracy. Results The median deviation of the unsigned/ absolute values of all six distances was 1.07 mm for the TK-method and 1.67 mm for the ST-method. The TK-method showed significantly better results. For the signed values, the median deviation of the six distances was $$-$$ - 0.6 mm for the TK-method and $$-$$ - 1.47 mm for the ST-method, indicating that the Mandibles became narrower with both methods. This width difference was not statistically significant. Conclusion The TK-method was more accurate than the ST-method in a clinical trial. The TK-method was effective and accurate for Mandible Reconstruction using pre-bent fixation plates.
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Mandible Reconstruction with patient specific pre bent Reconstruction plates comparison of a transfer key method to the standard method results of an in vitro study
Computer Assisted Radiology and Surgery, 2012Co-Authors: Frank Wilde, Alexander Schramm, Marcus Plail, Christoph Riese, Karsten WinterAbstract:Purpose Patient-specific Mandible Reconstruction plates may be pre-bent to facilitate the surgical procedure. A method using transfer keys (TK) for repositioning pre-bent plates was compared with the standard method on mandibular models to evaluate its feasibility.
Alexander Schramm - One of the best experts on this subject based on the ideXlab platform.
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accuracy of computer assisted mandibular Reconstructions using patient specific implants in combination with cad cam fabricated transfer keys
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: F. Mascha, Karsten Winter, S. Pietzka, M. Heufelder, Alexander Schramm, Frank WildeAbstract:Abstract Background A new method in Mandible Reconstruction has recently been developed using patient-specific Mandible Reconstruction plates (PSMP) after preoperative computer planning using CAD/CAM procedures. To transfer the virtual planned position of the PSMP into the intraoperative situs resection margins and plate position is determined by using surgical guides made by CAD/CAM procedures as well (PSMP-method). Methods Mandibular Reconstruction with the PSMP-method was performed on 18 patients. The study included sole alloplastic Reconstruction cases (AP, n = 10) and microvascular osseous Reconstruction cases (MV, n = 8). Pre- and postoperative CT-scans were evaluated by measuring distances between corresponding landmarks on the mandibular rami. The difference was used to evaluate Reconstruction accuracy. Results The median deviation of all distances was 1.13 mm for PSMP-method including all cases. For AP-group, the median deviation was 0,80 mm, for MV-group it was 2,47 mm. There was a high significant difference between both groups (AP and MV). Larger mandibular resections in combination with the need of positioning the surgical guides in the region of the upper condyle seemed to reduce Reconstruction-accuracy. This was found more often in MV-group as in the AP-group. Conclusions PSMP-method seems to be an effective and satisfying method for accurate mandibular Reconstruction. Microvascular Reconstruction seems less accurate than sole alloplastic Reconstruction. Larger resections of the Mandible and technical more challenging approaches up to the mandibular condyle might explain this result.
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Accuracy of computer-assisted mandibular Reconstructions using patient-specific implants in combination with CAD/CAM fabricated transfer keys
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: F. Mascha, Karsten Winter, S. Pietzka, M. Heufelder, Alexander Schramm, Frank WildeAbstract:Abstract Background A new method in Mandible Reconstruction has recently been developed using patient-specific Mandible Reconstruction plates (PSMP) after preoperative computer planning using CAD/CAM procedures. To transfer the virtual planned position of the PSMP into the intraoperative situs resection margins and plate position is determined by using surgical guides made by CAD/CAM procedures as well (PSMP-method). Methods Mandibular Reconstruction with the PSMP-method was performed on 18 patients. The study included sole alloplastic Reconstruction cases (AP, n = 10) and microvascular osseous Reconstruction cases (MV, n = 8). Pre- and postoperative CT-scans were evaluated by measuring distances between corresponding landmarks on the mandibular rami. The difference was used to evaluate Reconstruction accuracy. Results The median deviation of all distances was 1.13 mm for PSMP-method including all cases. For AP-group, the median deviation was 0,80 mm, for MV-group it was 2,47 mm. There was a high significant difference between both groups (AP and MV). Larger mandibular resections in combination with the need of positioning the surgical guides in the region of the upper condyle seemed to reduce Reconstruction-accuracy. This was found more often in MV-group as in the AP-group. Conclusions PSMP-method seems to be an effective and satisfying method for accurate mandibular Reconstruction. Microvascular Reconstruction seems less accurate than sole alloplastic Reconstruction. Larger resections of the Mandible and technical more challenging approaches up to the mandibular condyle might explain this result.
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Mandible Reconstruction using patient specific pre bent Reconstruction plates comparison of standard and transfer key methods
Computer Assisted Radiology and Surgery, 2015Co-Authors: Frank Wilde, Karsten Winter, Katharina Kletsch, Kai Lorenz, Alexander SchrammAbstract:Purpose Mandible Reconstruction with Reconstruction plates requires bending the plates during the operation and fixation using the “standard method” (ST-method). The ST-method is limited when a pathological process has perforated the mandibular outer cortex. A transfer key method (TK-method) was developed where plates are pre-bent using a patient-specific Mandible model and positioned on the Mandible with the help of transfer keys. The ST-method and TK-method were compared in a clinical trial.
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Mandible Reconstruction using patient-specific pre-bent Reconstruction plates: comparison of standard and transfer key methods
International Journal of Computer Assisted Radiology and Surgery, 2015Co-Authors: Frank Wilde, Karsten Winter, Katharina Kletsch, Kai Lorenz, Alexander SchrammAbstract:Purpose Mandible Reconstruction with Reconstruction plates requires bending the plates during the operation and fixation using the “standard method” (ST-method). The ST-method is limited when a pathological process has perforated the mandibular outer cortex. A transfer key method (TK-method) was developed where plates are pre-bent using a patient-specific Mandible model and positioned on the Mandible with the help of transfer keys. The ST-method and TK-method were compared in a clinical trial. Methods Mandibular Reconstruction was performed on 42 patients in this study: 22 were performed using the TK-method and 20 using the ST-method. Pre- and postoperative CT scans were evaluated by measuring the distances between six corresponding landmarks on the mandibular condyles and rami. The difference between pre- and postoperative distances was used to evaluate Reconstruction accuracy. Results The median deviation of the unsigned/ absolute values of all six distances was 1.07 mm for the TK-method and 1.67 mm for the ST-method. The TK-method showed significantly better results. For the signed values, the median deviation of the six distances was $$-$$ - 0.6 mm for the TK-method and $$-$$ - 1.47 mm for the ST-method, indicating that the Mandibles became narrower with both methods. This width difference was not statistically significant. Conclusion The TK-method was more accurate than the ST-method in a clinical trial. The TK-method was effective and accurate for Mandible Reconstruction using pre-bent fixation plates.
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Mandible Reconstruction with patient specific pre bent Reconstruction plates comparison of a transfer key method to the standard method results of an in vitro study
Computer Assisted Radiology and Surgery, 2012Co-Authors: Frank Wilde, Alexander Schramm, Marcus Plail, Christoph Riese, Karsten WinterAbstract:Purpose Patient-specific Mandible Reconstruction plates may be pre-bent to facilitate the surgical procedure. A method using transfer keys (TK) for repositioning pre-bent plates was compared with the standard method on mandibular models to evaluate its feasibility.
Joseph J Disa - One of the best experts on this subject based on the ideXlab platform.
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Mandible Reconstruction with microvascular surgery
Seminars in Surgical Oncology, 2000Co-Authors: Joseph J Disa, Peter G CordeiroAbstract:Microvascular surgery has become the preferred method for Mandible Reconstruction. Whenever possible, immediate Reconstruction at the time of segmental Mandible resection will provide the best aesthetic and functional result. Four donor sites (fibula, iliac crest, radial forearm, and scapula) have become the primary sources of vascularized bone and soft tissue for the Reconstruction. The fibula has multiple advantages, including bone length and thickness, donor site location permitting flap harvest simultaneously with tumor resection, and minimal donor site morbidity. The fibula donor site should be the first choice for most defects, particularly those with anterior or large bony defects requiring multiple osteotomies. Use of an alternative donor site is best reserved for cases with large soft tissue and minimal bone requirements. Dental rehabilitation through the use of prostheses and osseointegrated dental implants is an important part of the reconstructive process to optimize aesthetics and function. An algorithm for Mandible Reconstruction with microvascular osseous flaps is presented. Semin. Surg. Oncol. 19:226–234, 2000. © 2000 Wiley-Liss, Inc.
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evaluation of bone height in osseous free flap Mandible Reconstruction an indirect measure of bone mass
Plastic and Reconstructive Surgery, 1999Co-Authors: Joseph J Disa, Peter G Cordeiro, David A. Hidalgo, Richard M Winters, Howard ThalerAbstract:: Osseous free flaps have become the preferred method of mandibular Reconstruction after oncologic surgical ablation. To elucidate the long-term effects of free flap mandibular Reconstruction on bone mass, maintenance or reduction in bone height over time was used as an indirect measure of preservation or loss in bone mass. Factors potentially influencing bone mass preservation were evaluated; these included site of Reconstruction (central, body, ramus), patient age, length of follow-up, adjuvant radiotherapy, and the delayed placement of osseointegrated dental implants. A retrospective analysis of patients undergoing osseous free flap Mandible Reconstruction for oncologic surgical defects between 1987 and 1995 was performed. Postoperative Panorex examinations were used to evaluate bone height and bony union after osteotomy. Fixation hardware was used as a reference to eliminate magnification as a possible source of error in measurement. There were 48 patients who qualified for this study by having at least 24 months of follow-up. There were 27 male and 21 female patients, with a mean age of 45 years (range, 5 to 75 years). Mandibular defects were anterior (24) and lateral (24). Osseous donor sites included the fibula (35), radius (6), scapula (4), and ilium (3). There were between zero and four segmental osteotomies per patient (excluding the ends of the graft). Nineteen percent of all patients had delayed placement of osseointegrated dental implants. Initial Panorex examinations were taken between 1 and 9 months postoperatively (mean, 2 months). Follow-up Panorex examinations were taken 24 to 104 months postoperatively (mean, 47 months). The bony union rate after osteotomy was 97 percent. Bone height measurements were compared by site and type of Reconstruction. The mean loss in fibula height by site of Reconstruction was 2 percent in central segments, 7 percent in body segments, and 5 percent in ramus segments. The mean loss in bone height after radial free flap Mandible Reconstruction was 33 percent in central segments and 37 percent in body segments; ramus segments did not lose height. The central and body segments reconstructed with scapular free flaps did not lose height, but one ramus segment lost 20 percent of height. There was no loss in bone height in mandibular body Reconstruction with the ilium free flap. Fibula free flaps did not significantly lose bone height when evaluated with respect to age, follow-up, radiation therapy, or dental implant placement. The retention in bone height demonstrated in this study suggests that bone mass is preserved after osseous free flap Mandible Reconstruction. The greatest amount of bone loss was seen after multiply osteotomized radial free flaps were used for central mandibular Reconstruction. The ability of the fibula free flap to maintain mass over time, coupled with its known advantages, further supports its use as the "work horse" donor site for Mandible Reconstruction.
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long term evaluation of bone mass in free fibula flap Mandible Reconstruction
American Journal of Surgery, 1997Co-Authors: Joseph J Disa, David A. Hidalgo, Richard M WintersAbstract:BACKGROUND: Vascularized fibula transfer has become a preferred method of mandibular restoration after oncologic surgical ablation. In order to elucidate the long-term effect on fibular mass after mandibular Reconstruction, change in fibular height was utilized as an indirect measure of change in bone mass over time. Other potentially influential factors in long-term bone mass preservation were evaluated; these included site of Reconstruction (central, body, ramus), patient age, length of follow-up, adjuvant radiotherapy, and the delayed placement of osseointegrated dental implants. METHODS: A retrospective analysis of patients undergoing free fibula Mandible Reconstruction for oncologic surgical defects between 1987 and 1993 was performed. Postoperative panorex examinations were used to evaluate fibular height and bony union after osteotomy. Fixation hardware was used as a reference to eliminate magnification as a possible source of error in measurement. Only patients with at least 24 months follow-up were included in this study. RESULTS: There were 27 patients (15 males and 12 females) with a mean age of 43 years (range 14 to 65) included in this study. Mandibular defects were anterior (16) and lateral (11). There were between two and five segmental osteotomies per patient (excluding the ends of the graft). Thirty percent of patients had delayed placement of osseointegrated dental implants. Initial panorex examinations were taken between 1 and 9 months (mean 2) postoperatively. Follow-up panorex examinations were taken 24 to 104 months (mean 54) postoperatively. The bony union rate after osteotomy was 93%. Comparative measurements of fibular height revealed that central segments underwent a mean decrease in height by 4% (range 0% to 22%); body segments decreased in height by 7% (range 0% to 33%); ramus segments decreased in height by 5% (range 0% to 15%). In each anatomic segment, fibular height varied by 10% or less when compared with respect to patient age, length of follow-up, adjuvant radiation therapy, and the presence of osseointegrated dental implants. CONCLUSIONS: We conclude that the retention of fibula height seen in this study indicates that fibula bone mass is preserved after free flap Mandible Reconstruction. Furthermore, these findings are not affected by the site of Reconstruction, patient age, length of follow-up, adjuvant radiation therapy, or presence of osseointegrated dental implants. This study further supports the efficacy of vascularized fibula grafts for Mandible Reconstruction.
Eric I. Chang - One of the best experts on this subject based on the ideXlab platform.
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long term operative outcomes of preoperative computed tomography guided virtual surgical planning for osteocutaneous free flap Mandible Reconstruction
Plastic and Reconstructive Surgery, 2016Co-Authors: Eric I. ChangAbstract:BACKGROUND: Osteocutaneous free flaps have become the primary reconstructive modality for segmental mandibulectomy defects. The advent of preoperative virtual surgical planning with stereolithic models and cutting templates has led to significant refinements in operative technique. In this article, the authors examine the value of computed tomography-guided preoperative virtual surgical planning on operative outcomes and efficiency after mandibular Reconstruction with osteocutaneous free flaps. METHODS: A retrospective review was performed of all patients undergoing free flap Mandible Reconstruction at a single cancer center from 2002 to 2013. Surgical technique and operative time were assessed, as were overall complications and outcomes. Postoperative computed tomographic scans were also examined to determine the accuracy of osteotomies with and without virtual surgical planning. RESULTS: Ninety-two patients underwent osteocutaneous free flap Reconstruction of the Mandible during the study period. In 43 patients, the shaping of the neoMandible was performed based on the prefabricated stereolithic models. The remaining 49 patients underwent preoperative computed tomographic imaging to design patient-specific cutting guides for the native Mandible and the osteocutaneous flap. The use of preoperative computed tomography-guided planning resulted in less burring, fewer osteotomy revisions, and less bone grafting. Virtual surgical planning also significantly decreased operative time (666 minutes versus 545 minutes; p < 0.005). Review of postoperative computed tomographic scans demonstrated decreased rates of bony nonunion with virtual surgical planning, and there were no significant differences in overall outcomes or complications between the groups. CONCLUSIONS: Preoperative virtual surgical planning has refined Mandible Reconstruction with osteocutaneous free flaps through the introduction of patient-specific models, prebent plates, and osteotomy guides. Virtual surgical planning decreases operative time and improves the accuracy of free flap mandibular Reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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Improved operative efficiency of free fibula flap Mandible Reconstruction with patient-specific, computer-guided preoperative planning.
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2015Co-Authors: Julia M. Toto, Eric I. Chang, Richard Agag, Karthik Devarajan, Sameer A. Patel, Neal S. TophamAbstract:Background Free fibula osteocutaneous flaps are the primary option for Reconstruction after segmental mandibulectomies. This study evaluates the impact of CT-guided preoperative planning on operative outcomes after free fibula Mandible Reconstruction. Methods We conducted a retrospective review of all patients undergoing free fibula Reconstruction of the Mandible from 2002 to 2011. Results Fifty-seven patients underwent free fibula osteocutaneous flap Reconstruction for head and neck cancers involving the Mandible. Twelve patients had shaping of the neoMandible performed on the back table while 20 patients underwent shaping in situ without the use of any adjunctive technology. The remaining 25 patients underwent preoperative CT imaging, which significantly decreased operative time (707 minutes vs 534 minutes; p
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improved operative efficiency of free fibula flap Mandible Reconstruction with patient specific computer guided preoperative planning
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2015Co-Authors: Julia M. Toto, Eric I. Chang, Richard Agag, Karthik Devarajan, Sameer A. Patel, Neal S. TophamAbstract:Background Free fibula osteocutaneous flaps are the primary option for Reconstruction after segmental mandibulectomies. This study evaluates the impact of CT-guided preoperative planning on operative outcomes after free fibula Mandible Reconstruction. Methods We conducted a retrospective review of all patients undergoing free fibula Reconstruction of the Mandible from 2002 to 2011. Results Fifty-seven patients underwent free fibula osteocutaneous flap Reconstruction for head and neck cancers involving the Mandible. Twelve patients had shaping of the neoMandible performed on the back table while 20 patients underwent shaping in situ without the use of any adjunctive technology. The remaining 25 patients underwent preoperative CT imaging, which significantly decreased operative time (707 minutes vs 534 minutes; p < .0003) as well as overall costs ($24,532.50 vs $20,950.48). There were no significant differences in outcomes or complications. Conclusion Preoperative, patient-specific CT modeling, and cutting guide fabrication outweigh the costs associated with the additional technology without jeopardizing overall outcomes or increasing complication rates. © 2014 Wiley Periodicals, Inc. Head Neck, 2015