[논문]Preliminary clinic study on computer assisted mandibular reconstruction: the positive role of surgical navigation technique

Huang, Jin-Wei; Shan, Xiao-Feng; Lu, Xu-Guang; Cai, Zhi-Gang

doi:10.1186/s40902-015-0017-1

Preliminary clinic study on computer assisted mandibular reconstruction: the positive role of surgical navigation technique 원문보기

Maxillofacial plastic and reconstructive surgery, v.37 = v.37 no.1, 2015년, pp.20.1 - 20.7

Huang, Jin-Wei (Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology) , Shan, Xiao-Feng (Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology) , Lu, Xu-Guang (Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology) , Cai, Zhi-Gang (Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology)

Abstract ▼ AI-Helper

Background: The objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery. Methods: Eight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software. Results: All 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group. Conclusions: The computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.

주제어

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

제안 방법

JWH, XFS and ZGC designed the study and collected the clinic data. JWH carried out the stastical analysis and drafted the manuscript.
The thincut axial CT scan of the mandible was performed with the splint fixing the occlusion. The CT data was imported into the SurgiCase CMF 5.0, where 3D virtual osteotomies, bony reductions and fibula reconstructions were performed [Fig. 1]. The osteotomy lines and the position of the fibula graft were designed according to the 3D images in the virtual platform.
4 After natural head posture registration, the BrainLab navigation system permitted 3D analysis to help the surgeon to quantify a complex position of the bone graft. The navigation system projected the location of the surgical probe on a computer monitor in axial, coronal, sagittal and 3D views. The position of the fibula could be verified intra-operatively
With preoperative planning and intra-operative navigation, these techniques can help plastic surgeons to manage mandibular reconstructive surgery. This study compared the CAS group and the traditional group of mandibular reconstruction using free fibula flaps to analyze the variations of the mandible and 3D facial contour.
0 software was utilized for chromatographic analysis. With upgraded point-cloud handling and polygon mesh processing, it could visualize the differences of the pre and post 3D facial configurations, used for demonstration to the patients.

대상 데이터

Eight patients, two males and six females, with an average age of 33.3 years (24 ~ 53 years), were enrolled in the CAS group in the Oral and Maxillofacial Surgery Department of Peking University School of Stomatology, from June 2009 to June 2012. The causes of the mandibular defects were tumors, six malignant and two benign [Table 1].
3 years (24 ~ 53 years), were enrolled in the CAS group in the Oral and Maxillofacial Surgery Department of Peking University School of Stomatology, from June 2009 to June 2012. The causes of the mandibular defects were tumors, six malignant and two benign [Table 1]. The control group, as a traditional treatment, involved 14 patients during the same time period.

데이터처리

Due to the low sample size, the non-parametric analysis, Wilcoxon rank sum test was used to compare the variations of the CAS group and the traditional group, with statistical significance set at p < 0.05.

이론/모형

The reconstructed mandibular models were fabricated with the CAD/CAM technique. A titanium template was made according to the virtual design for the bone graft through rapid prototyping (RP) technique and served as a guide when surgeons were shaping and placing the fibula grafts.

성능/효과

Based on the Wilcoxon rank sum test analysis, the variations of Ci-Ci, Cl-Cl, Cp-Cp and Go-Gn had significant differences statistically, while Ga, Co-Go, Go-Go, LmLm and Co-Gn did not [Table 3]. This result indicated that the CAS group might have advantages in maintaining the original configuration of the mandible compared to the traditional group.
Mandibular reconstruction was performed accurately according to the virtual planning, all 22 fibula flaps survived. The anatomic landmark measurements of the mandible configuration, included the Gonial angle (Ga), the distance of Condylion - Gonion (Co-Go), Gonion - Gonion (Go-Go), Condylion internale - Condylion internale (Ci-Ci), Condylion laterale - Condylion laterale (Cl-Cl), Coronoid process - Coronoid process (Cp-Cp), Lingula mandibulae - Lingula mandibulae (Lm-Lm), Condylion - Gnathion (Co-Gn) and Gonion - Gnathion (Go-Gn), all these items in the CAS group had less change as compared to the traditional group, even though the amplitude varied respectively [Fig. 6].
The results of our study showed that some measured items of mandibular configuration were even better in the traditional group than the CAS group. It seemed that even though the experienced surgeons can place the fibula flap in an ideal position without computer techniques, this would not be an argument against CAS techniques.

참고문헌 (25)

1. Rashid M Tamimy MS Ehtesham-Ul-Haq SSU Rizvi ST Benign paediatric mandibular tumours: experience in reconstruction using vascularised fibula J Plast Reconstr Aesthet Surg 2012 65 325 31 10.1016/j.bjps.2012.07.006

상세보기
2. Shan XF Cai ZG Zhang J Zhang JG Bimaxillary reconstruction with vascularised and non-vascularised fibula J Plast Reconstr Aesthet Surg 2009 62 474 6 10.1016/j.bjps.2008.06.088

상세보기
3. Punpale AS Rajendra Prasad JS Shetty KP Kadam S Udupa V An innovative design for simultaneous reconstruction of complexmaxillo-mandibular defects with single free fibula osteocutaneous flap J Plast Reconstr Aesthet Surg 2006 59 96 101 10.1016/j.bjps.2005.07.006 16482797

상세보기
4. Nanjappa M Natashekara M Sendil Kumar C Kumaraswamy SV Keerthi R Ashwin DP Transport distraction osteogenesis for reconstruction of mandibular defects": our experience J Maxillofac Oral Surg 2011 10 93 100 10.1007/s12663-011-0190-4 22654358

상세보기
5. Noordhoek R Pizer ME Laskin DM Ameloblastic fibrosarcoma of the mandible: treatment, long-term follow-up, and subsequent reconstruction of a case J Oral Maxillofac Surg 2012 70 2930 5 10.1016/j.joms.2012.02.018 22542333

상세보기
6. Hanasono MM Skoracki RJ Computer-assisted design and rapid prototype modeling in microvascular mandible reconstruction Laryngoscope 2013 123 597 604 10.1002/lary.23717 23007556

상세보기
7. Katsuragi Y Kayano S Akazawa S Naqamatsu S Koizumi T Matsui T Mandible reconstruction using the calcium-sulphate three-dimensional model and rubber stick: a new method, ‘mould technique’, for more accurate, efficient and simplified fabrication J Plast Reconstr Aesthet Surg 2011 64 614 22 10.1016/j.bjps.2010.08.010 20884306

상세보기
8. Tepper O Hirsch D Levine J Garfein E The new age of three-dimensional virtual surgical planning in reconstructive plastic surgery Plast Reconstr Surg 2012 130 192 4 10.1097/PRS.0b013e318254fbf6

상세보기
9. Zheng GS Su YX Liao GQ Jiao PF Liang LZ Zhang SE Mandible reconstruction assisted by preoperative simulation and transferring templates: cadaveric study of accuracy J Oral Maxillofac Surg 2012 70 1480 5 10.1016/j.joms.2011.05.015 21824704

상세보기
10. Harsha G Reddy SG Talasila S Salaam SA Srinivasulu M Reddy VS Mandibular reconstruction using AO/ASIF stainless steel reconstruction plate: a retrospective study of 36 cases J Contemp Dent Pract 2012 13 75 9 10.5005/jp-journals-10024-1099 22430698

상세보기
11. Yamanaka Y Yajima H Kirita T Shimomura H Tamaki S Aoki K Mandibular reconstruction with vascularised fibular osteocutaneous flaps using prefabricated stereolithographic mandibular model J Plast Reconstr Aesthet Surg 2010 63 1751 3 10.1016/j.bjps.2010.03.001 20347409

상세보기
12. Zheng GS Su YX Liao GQ Chen ZF Wang L Jiao PF Mandible reconstruction assisted by preoperative virtual surgical simulation Oral Surg Oral Med Oral Pathol Oral Radiol 2012 113 604 11 10.1016/j.tripleo.2011.05.016 22676986

상세보기
13. Lopez-Arcas JM Arias J Del Castillo JL Burgueno M Navarrol I Moran MJ The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience J Oral Maxillofac Surg 2010 68 2377 84 10.1016/j.joms.2009.09.027 20591551

상세보기
14. Lin PY Lin KC Jeng SF Oromandibular reconstruction: the history, operative options and strategies, and our experience ISRN Surg 2011 2011 824251 10.5402/2011/824251 22229103

상세보기
15. SimonnEN MMA Shubi FM Kalyanyama BM Stoelinga PJ Reconstruction of the mandible after ablative surgery for the treatment of aggressive, benign odontogenic tumours in Tanzania: a preliminary study Int J Oral Maxillofac Surg 2006 35 421 6 10.1016/j.ijom.2005.10.009 16439100

상세보기
16. Khadka A Hu J Autogenous grafts for condylar reconstruction in treatment of TMJ ankylosis: current concepts and considerations for the future Int J Oral Maxillofac Surg 2012 41 94 102 10.1016/j.ijom.2011.10.018 22088390

상세보기
17. Wang G Li J Khadka A Hsu Y Li W Hu J CAD/CAM and rapid prototyped titanium for reconstruction of ramus defect and condylar fracture caused by mandibular reduction Oral Surg Oral Med Oral Pathol Oral Radiol 2012 113 356 61 10.1016/j.tripleo.2011.03.034 22676828

상세보기
18. Sink J Hamlar D Kademani D Khariwala SS Computer-aided stereolithography for presurgical planning in fibula free tissue reconstruction of the mandible J Reconstr Microsurg 2012 28 395 403 22711196

상세보기
19. Ciocca L Mazzoni S Fantini M Marchetti C Scotti R The design and rapid prototyping of surgical guides and bone plates to support iliac free flaps for mandible reconstruction Plast Reconstr Surg 2012 129 859 61 10.1097/PRS.0b013e31824a9f31

상세보기
20. Hou JS Chen M Pan CB Wang M Wang JG Zhang B Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible J Craniomaxillofac Surg 2012 40 432 37 10.1016/j.jcms.2012.02.022

상세보기
21. Kalbermatten DF Hauq M Schaefer DJ Wolfinger E Schumacher R Messmer P Computer aided designed neo-clavicle out of osteotomized free fibula: case report Br J Plast Surg 2004 57 668 72 10.1016/j.bjps.2004.05.013 15380700

상세보기
22. Ueda K Tajima S Oba S Omiya Y Byun SI Okada M Mandibular contour reconstruction with three-dimensional computer-assisted models Ann Plast Surg 2001 46 387 93 10.1097/00000637-200104000-00006 11324880

상세보기
23. Lopes N Oliveira DM Vajgel A Pita I Bezerra T Vasconcellos RJ A new approach for reconstruction of a severely atrophic mandible J Oral Maxillofac Surg 2009 67 2455 9 10.1016/j.joms.2009.04.090 19837317

상세보기
24. Vakharia KT Natoli NB Johnson TS Stereolithography-aided reconstruction of the mandible Plast Reconstr Surg 2012 129 194 5 10.1097/PRS.0b013e3182365d51

상세보기
25. Mahdian N Dostalova T Danek J Nedoma J Kohout J Hubacek M 3D reconstruction of TMJ after resection of the cyst and the stress-strain analyses Comput Methods Programs Biomed 2013 110 279 289 10.1016/j.cmpb.2012.12.001 23332173

상세보기

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증