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Computer-assisted navigation: its role in intraoperatively accurate mandibular reconstruction

  • Author Footnotes
    1 Jinyang Wu and Jian Sun contributed equally to this work and should be regarded as joint first authors.
    Jinyang Wu
    Footnotes
    1 Jinyang Wu and Jian Sun contributed equally to this work and should be regarded as joint first authors.
    Affiliations
    Resident, Department of Oral and Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Author Footnotes
    1 Jinyang Wu and Jian Sun contributed equally to this work and should be regarded as joint first authors.
    Jian Sun
    Footnotes
    1 Jinyang Wu and Jian Sun contributed equally to this work and should be regarded as joint first authors.
    Affiliations
    Professor, Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Steve Guofang Shen
    Affiliations
    Professor and chairman, Department of Oral and Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Bing Xu
    Affiliations
    Professor, Department of Oral and Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Jun Li
    Affiliations
    Associate Professor, Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Shilei Zhang
    Correspondence
    Reprint requests: Shilei Zhang, DDS, MD, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Zhi Zao Ju Road 639, Shanghai 200011, People's Republic of China
    Affiliations
    Professor, Department of Oral and Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    1 Jinyang Wu and Jian Sun contributed equally to this work and should be regarded as joint first authors.
Published:February 12, 2016DOI:https://doi.org/10.1016/j.oooo.2016.02.001

      Objective

      This article presents our experiences of computer-assisted navigation in mandibular reconstruction and evaluates its effectiveness.

      Study Design

      Eight patients who underwent navigation-guided mandibular reconstruction with a fibula free flap were reviewed. Under intraoperative navigation, the ideal positions of the mandibular angles and condyles were confirmed by the navigation probe. The surgical results were evaluated through postoperative panoramic radiographs, coronal computed tomography scans, and image fusion.

      Results

      Navigation-guided mandibular reconstructions were successfully completed on the basis of preoperative planning and simulation. The surgical discrepancy in the mandibular angle between the actual surgical results and the preoperative designs was 1.92 ± 0.97 mm. Panoramic radiographs and coronal computed tomography scans illustrated that all the condyles fitted into their glenoid fossae. All patients were satisfied with their functional and aesthetic outcomes.

      Conclusions

      Computer-assisted navigation is a viable technology for improving surgical outcomes in mandibular reconstruction, which can assist the surgeons by providing real-time three-dimensional surgical references during the operation.
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      References

        • Hidalgo P.A.
        Fibula free flap: a new method of mandible reconstruction.
        Plast Reconstr Surg. 1989; 84: 71-79
        • Hölzle F.
        • Kesting M.R.
        • Hölzle G.
        • et al.
        Clinical outcome and patient satisfaction after mandibular reconstruction with free fibula flaps.
        Int J Oral Maxillofac Surg. 2007; 36: 802-806
        • Sieg P.
        • Zieron J.O.
        • Bierwolf S.
        • Hakim S.G.
        Defect-related variations in mandibular reconstruction using fibula grafts. A review of 96 cases.
        Br J Oral Maxillofac Surg. 2002; 40: 322-329
        • Yu H.
        • Shen S.G.
        • Wang X.
        • Zhang L.
        • Zhang S.
        The indication and application of computer-assisted navigation in oral and maxillofacial surgery—Shanghai’s experience based on 104 cases.
        J Craniomaxillofac Surg. 2013; 41: 770-774
        • Balasundaram I.
        • Al-Hadad I.
        • Parmar S.
        Recent advances in reconstructive oral and maxillofacial surgery.
        Br J Oral Maxillofac Surg. 2012; 50: 695-705
        • Schmelzeisen R.
        • Gellrich N.C.
        • Schramm A.
        • Schön R.
        • Otten J.E.
        Navigation-guided resection of temporomandibular joint ankylosis promotes safety in skull base surgery.
        J Oral Maxillofac Surg. 2002; 60: 1275-1283
        • Gui H.
        • Wu J.
        • Shen S.G.
        • Bautista J.S.
        • Voss P.J.
        • Zhang S.
        Navigation-guided lateral gap arthroplasty as the treatment of temporomandibular joint ankylosis.
        J Oral Maxillofac Surg. 2014; 72: 128-138
        • Schramm A.
        • Gellrich N.C.
        • Gutwald R.
        • et al.
        Indications for computer-assisted treatment of cranio-maxillofacial tumors.
        Comput Aided Surg. 2000; 5: 343-352
        • Zhang S.
        • Gui H.
        • Lin Y.
        • Shen G.
        • Xu B.
        Navigation-guided correction of midfacial post-traumatic deformities (Shanghai experience with 40 cases).
        J Oral Maxillofac Surg. 2012; 70: 1426-1433
        • Rudman K.
        • Hoekzema C.
        • Rhee J.
        Computer-assisted innovations in craniofacial surgery.
        Facial Plast Surg. 2011; 27: 358-365
        • Gui H.
        • Yang H.
        • Shen S.G.
        • Xu B.
        • Zhang S.
        • Bautista J.S.
        Image-guided surgical navigation for removal of foreign bodies in the deep maxillofacial region.
        J Oral Maxillofac Surg. 2013; 71: 1563-1571
        • Jewer D.D.
        • Boyd J.B.
        • Manktelow R.T.
        • et al.
        Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification.
        Plast Reconstr Surg. 1989; 84: 391-403
        • López-Arcas J.M.
        • Arias J.
        • Del Castillo J.L.
        • et al.
        The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience.
        J Oral Maxillofac Surg. 2010; 68: 2377-2384
        • Hidalgo D.A.
        • Rekow A.
        A review of 60 consecutive fibula free flap mandible reconstructions.
        Plast Reconstr Surg. 1995; 96: 585-596
        • Shpitzer T.
        • Neligan P.C.
        • Gullane P.J.
        • et al.
        The free iliac crest and fibula flaps in vascularized oromandibular reconstruction: comparison and long-term evaluation.
        Head Neck. 1999; 21: 639-647
        • Chang S.Y.
        • Huang J.J.
        • Tsao C.K.
        • et al.
        Does ischemia time affect the outcome of free fibula flaps for head and neck reconstruction? A review of 116 cases.
        Plast Reconstr Surg. 2010; 126: 1988-1995
        • Engroff S.L.
        Fibula flap reconstruction of the condyle in disarticulation resections of the mandible: a case report and review of the technique.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100: 661-665
        • Moro A.
        • Cannas R.
        • Boniello R.
        • Gasparini G.
        • Pelo S.
        Techniques on modeling the vascularized free fibula flap in mandibular reconstruction.
        J Craniofac Surg. 2009; 20: 1571-1573
        • Yeung R.W.
        • Samman N.
        • Cheung L.K.
        • Zhang C.
        • Chow R.L.
        Stereomodel-assisted fibula flap harvest and mandibular reconstruction.
        J Oral Maxillofac Surg. 2007; 65: 1128-1134
        • Bell R.B.
        • Weimer K.A.
        • Dierks E.J.
        • Buehler M.
        • Lubek J.E.
        Computer planning and intraoperative navigation for palatomaxillary and mandibular reconstruction with fibular free flaps.
        J Oral Maxillofac Surg. 2011; 69: 724-732
        • Antony A.K.
        • Chen W.F.
        • Kolokythas A.
        • Weimer K.A.
        • Cohen M.N.
        Use of virtual surgery and stereolithography-guided osteotomy for mandibular reconstruction with the free fibula.
        Plast Reconstr Surg. 2011; 128: 1080-1084
        • Hou J.S.
        • Chen M.
        • Pan C.B.
        • et al.
        Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible.
        J Craniomaxillofac Surg. 2012; 40: e432-e437
        • Ciocca L.
        • Mazzoni S.
        • Fantini M.
        • Persiani F.
        • Marchetti C.
        • Scotti R.
        CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery.
        J Craniomaxillofac Surg. 2012; 40: e511-e515
        • Pham A.M.
        • Rafii A.A.
        • Metzger M.C.
        • Jamali A.
        • Strong E.B.
        Computer modeling and intraoperative navigation in maxillofacial surgery.
        Otolaryngol Head Neck Surg. 2007; 137: 624-631
        • Mazzoni S.
        • Badiali G.
        • Lancellotti L.
        • Babbi L.
        • Bianchi A.
        • Marchetti C.
        Simulation-guided navigation: a new approach to improve intraoperative three-dimensional reproducibility during orthognathic surgery.
        J Craniofac Surg. 2010; 21: 1698-1705
        • Yu H.
        • Wang X.
        • Zhang S.
        • Zhang L.
        • Xin P.
        • Shen S.G.
        Navigation-guided en bloc resection and defect reconstruction of craniomaxillary bony tumours.
        Int J Oral Maxillofac Surg. 2013; 42: 1409-1413
        • Bettschart C.
        • Kruse A.
        • Matthews F.
        • et al.
        Point-to-Point registration with mandibulo-maxillary splint in open and closed jaw position. Evaluation of registration accuracy for computer-aided surgery of the mandible.
        J Craniomaxillofac Surg. 2012; 40: 592-598
        • Casap N.
        • Wexler A.
        • Eliashar R.
        Computerized navigation for surgery of the lower jaw: comparison of 2 navigation systems.
        J Oral Maxillofac Surg. 2008; 66: 1467-1475