Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants
Abstract
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria for Study Subjects
2.2. Study Parameters and Evaluator Calibration
2.3. Statistical Analyses
2.4. Ethics Statement/Confirmation of Patients’ Permission
3. Results
Parameter | COU, n (%) | IOU, n (%) | p-Value | OR [95%-CI] | |
---|---|---|---|---|---|
Age, years (Mean ± SD) | 55.9 ± 14.6 | 60.6 ± 9.5 | 0.143 | 1.028 [0.991; 1.067] | |
Gender | Male | 67 (60.9) | 16 (69.6) | 0.430 | 1.467 [0.558; 3.859] |
Female | 43 (39.1) | 7 (30.4) | |||
Reconstruction site | Maxilla | 26 (23.6) | 4 (17.4) | 0.517 | 1.470 [0.459; 4.711] |
Mandibula | 84 (76.4) | 19 (82.6) | |||
Osteosynthesis type | Non-PSI | 63 (57.3) | 6 (26.1) | 0.006 | 3.798 [1.391; 10.370] |
CAD/CAM-PSI | 47 (42.7) | 17 (73.9) | |||
ASA ≥ 3 | Yes | 44 (40.0) | 11 (47.8) | 0.490 | 1.375 [0.558; 3.391] |
No | 66 (60.0) | 12 (52.2) | |||
Tobacco | Yes | 60 (54.5) | 17 (73.9) | 0.093 | 2.361 [0.866; 6.441] |
No | 50 (45.5) | 6 (26.1) | |||
Alcohol | Yes | 33 (30.0) | 13 (56.5) | 0.018 | 3.033 [1.209; 7.610] |
No | 77 (70.0) | 10 (43.5) | |||
Fibular segments | 1 | 42 (38.2) | 7 (30.4) | ||
2 | 44 (40.0) | 13 (56.5) | 0.267 | 1.773 [0.645; 4.874] | |
3 | 24 (21.8) | 3 (13.0) | 0.696 | 0.750 [0.177; 3.173] | |
Adjuvant radiotherapy | Yes | 43 (39.1) | 18 (78.3) | 0.001 | 5.609 [1.939; 16.227] |
No | 67 (60.9) | 5 (21.7) | |||
Composite flap | Yes | 87 (79.1) | 20 (87.0) | 0.391 | 1.762 [0.481; 6.451] |
No | 23 (20.9) | 3 (13.0) | |||
DS reconstruction site | Complete | 19 (17.3) | 4 (17.4) | ||
Partially | 75 (68.2) | 11 (47.8) | 0.571 | 0.697 [0.200; 2.432] | |
Edentulous | 16 (14.5) | 8 (34.8) | 0.217 | 2.375 [0.602; 9.367] | |
DS non-reconstruction | Complete | 21 (19.1) | 2 (8.7) | ||
site | Partially | 66 (60.0) | 12 (52.2) | 0.452 | 1.909 [0.395; 9.226] |
Edentulous | 23 (20.9) | 9 (39.1) | 0.092 | 4.109 [0.795; 21.232] | |
Plate exposure | Yes | 23 (20.9) | 8 (34.8) | 0.158 | 2.017 [0.762; 5.340] |
No | 87 (79.1) | 15 (65.2) | |||
Screw loosening | Yes | 13 (11.8) | 6 (26.1) | 0.083 | 2.633 [0.880; 7.880] |
No | 97 (88.2) | 17 (73.9) |
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Kansy, K.; Mueller, A.A.; Mücke, T.; Kopp, J.B.; Koersgen, F.; Wolff, K.D.; Zeilhofer, H.F.; Hölzle, F.; Pradel, W.; Schneider, M.; et al. Microsurgical reconstruction of the head and neck--current concepts of maxillofacial surgery in Europe. J. Cranio-Maxillofac. Surg. 2014, 42, 1610–1613. [Google Scholar] [CrossRef] [PubMed]
- Attia, S.; Wiltfang, J.; Pons-Kühnemann, J.; Wilbrand, J.F.; Streckbein, P.; Kähling, C.; Howaldt, H.P.; Schaaf, H. Survival of dental implants placed in vascularised fibula free flaps after jaw reconstruction. J. Cranio-Maxillofac. Surg. 2018, 46, 1205–1210. [Google Scholar] [CrossRef] [PubMed]
- Attia, S.; Wiltfang, J.; Streckbein, P.; Wilbrand, J.F.; El Khassawna, T.; Mausbach, K.; Howaldt, H.P.; Schaaf, H. Functional and aesthetic treatment outcomes after immediate jaw reconstruction using a fibula flap and dental implants. J. Cranio-Maxillofac. Surg. 2019, 47, 786–791. [Google Scholar] [CrossRef]
- Wilkman, T.; Husso, A.; Lassus, P. Clinical Comparison of Scapular, Fibular, and Iliac Crest Osseal Free Flaps in Maxillofacial Reconstructions. Scand. J. Surg. 2019, 108, 76–82. [Google Scholar] [CrossRef]
- Dowthwaite, S.A.; Theurer, J.; Belzile, M.; Fung, K.; Franklin, J.; Nichols, A.; Yoo, J. Comparison of fibular and scapular osseous free flaps for oromandibular reconstruction: A patient-centered approach to flap selection. JAMA Otolaryngol. Head Neck Surg. 2013, 139, 285–292. [Google Scholar] [CrossRef] [PubMed]
- Bak, M.; Jacobson, A.S.; Buchbinder, D.; Urken, M.L. Contemporary reconstruction of the mandible. Oral Oncol. 2010, 46, 71–76. [Google Scholar] [CrossRef] [PubMed]
- Patel, S.Y.; Kim, D.D.; Ghali, G.E. Maxillofacial Reconstruction Using Vascularized Fibula Free Flaps and Endosseous Implants. Oral Maxillofac. Surg. Clin. N. Am. 2019, 31, 259–284. [Google Scholar] [CrossRef]
- Vignesh, U.; Mehrotra, D.; Howlader, D.; Singh, P.K.; Gupta, S. Patient Specific Three-Dimensional Implant for Reconstruction of Complex Mandibular Defect. J. Craniofac. Surg. 2019, 30, e308–e311. [Google Scholar] [CrossRef]
- Kakarala, K.; Shnayder, Y.; Tsue, T.T.; Girod, D.A. Mandibular reconstruction. Oral Oncol. 2018, 77, 111–117. [Google Scholar] [CrossRef]
- Wilde, F.; Hanken, H.; Probst, F.; Schramm, A.; Heiland, M.; Cornelius, C.P. Multicenter study on the use of patient-specific CAD/CAM reconstruction plates for mandibular reconstruction. Int. J. Comput. Assist Radiol. Surg. 2015, 10, 2035–2051. [Google Scholar] [CrossRef]
- Wilde, F.; Winter, K.; Kletsch, K.; Lorenz, K.; Schramm, A. Mandible reconstruction using patient-specific pre-bent reconstruction plates: Comparison of standard and transfer key methods. Int. J. Comput. Assist Radiol. Surg. 2015, 10, 129–140. [Google Scholar] [CrossRef]
- Tang, N.S.J.; Ahmadi, I.; Ramakrishnan, A. Virtual surgical planning in fibula free flap head and neck reconstruction: A systematic review and meta-analysis. J. Plast. Reconstr. Aesthetic Surg. 2019, 72, 1465–1477. [Google Scholar] [CrossRef]
- Barr, M.L.; Haveles, C.S.; Rezzadeh, K.S.; Nolan, I.T.; Castro, R.; Lee, J.C.; Steinbacher, D.; Pfaff, M.J. Virtual Surgical Planning for Mandibular Reconstruction With the Fibula Free Flap: A Systematic Review and Meta-analysis. Ann. Plast. Surg. 2020, 84, 117–122. [Google Scholar] [CrossRef]
- Chang, E.I.; Jenkins, M.P.; Patel, S.A.; Topham, N.S. Long-Term Operative Outcomes of Preoperative Computed Tomography-Guided Virtual Surgical Planning for Osteocutaneous Free Flap Mandible Reconstruction. Plast. Reconstr. Surg. 2016, 137, 619–623. [Google Scholar] [CrossRef] [PubMed]
- Rendenbach, C.; Steffen, C.; Hanken, H.; Schluermann, K.; Henningsen, A.; Beck-Broichsitter, B.; Kreutzer, K.; Heiland, M.; Precht, C. Complication rates and clinical outcomes of osseous free flaps: A retrospective comparison of CAD/CAM versus conventional fixation in 128 patients. Int. J. Oral Maxillofac. Surg. 2019, 48, 1156–1162. [Google Scholar] [CrossRef] [PubMed]
- Knitschke, M.; Sonnabend, S.; Roller, F.C.; Pons-Kühnemann, J.; Schmermund, D.; Attia, S.; Streckbein, P.; Howaldt, H.-P.; Böttger, S. Osseous Union after Mandible Reconstruction with Fibula Free Flap Using Manually Bent Plates vs. Patient-Specific Implants: A Retrospective Analysis of 89 Patients. Curr. Oncol. 2022, 29, 3375–3392. [Google Scholar] [CrossRef]
- Jung, J.P.; Haunstein, K.; Muller, H.H.; Fischer, I.; Neff, A. Intensive Care as an Independent Risk Factor for Infection after Reconstruction and Augmentation with Autologous Bone Grafts in Craniomaxillofacial Surgery: A Retrospective Cohort Study. J. Clin. Med. 2021, 10, 2560. [Google Scholar] [CrossRef]
- Mehra, P.; Murad, H. Internal fixation of mandibular angle fractures: A comparison of 2 techniques. J. Oral Maxillofac. Surg. 2008, 66, 2254–2260. [Google Scholar] [CrossRef]
- Yeh, D.H.; Lee, D.J.; Sahovaler, A.; Fung, K.; MacNeil, D.; Nichols, A.C.; Yoo, J. Shouldering the load of mandible reconstruction: 81 cases of oromandibular reconstruction with the scapular tip free flap. Head Neck 2019, 41, 30–36. [Google Scholar] [CrossRef] [PubMed]
- Yla-Kotola, T.M.; Bartlett, E.; Goldstein, D.P.; Armstrong, K.; Gilbert, R.W.; Hofer, S.O. Union and bone resorption of free fibular flaps in mandibular reconstruction. J. Reconstr. Microsurg. 2013, 29, 427–432. [Google Scholar] [CrossRef] [PubMed]
- Fagin, A.P.; Gelesko, S.; Wax, M.K.; Petrisor, D. Morbidity and Functional Outcomes With Head and Neck Free Flap Reconstruction in Patients Aged 90 Years or Older. J. Oral Maxillofac. Surg. 2017, 75, 1549–1554. [Google Scholar] [CrossRef] [PubMed]
- Mitchell, C.A.; Goldman, R.A.; Curry, J.M.; Cognetti, D.M.; Krein, H.; Heffelfinger, R.; Luginbuhl, A. Morbidity and Survival in Elderly Patients Undergoing Free Flap Reconstruction: A Retrospective Cohort Study. Otolaryngol. Head Neck Surg. 2017, 157, 42–47. [Google Scholar] [CrossRef]
- Weaver, T.S.; Wester, J.L.; Gleysteen, J.P.; Peck, J.J.; Wax, M.K. Surgical outcomes in the elderly patient after osteocutaneous free flap transfer. Laryngoscope 2014, 124, 2484–2488. [Google Scholar] [CrossRef] [PubMed]
- Akashi, M.; Hashikawa, K.; Kakei, Y.; Sakakibara, A.; Hasegawa, T.; Minamikawa, T.; Komori, T. Sequential evaluation for bone union of transferred fibula flaps in reconstructed mandibles: Panoramic X-ray versus computed tomography. Int. J. Oral Maxillofac. Surg. 2015, 44, 942–947. [Google Scholar] [CrossRef] [PubMed]
- Steffen, C.; Fischer, H.; Sauerbrey, M.; Heintzelmann, T.; Voss, J.O.; Koerdt, S.; Checa, S.; Kreutzer, K.; Heiland, M.; Rendenbach, C. Increased rate of pseudarthrosis in the anterior intersegmental gap after mandibular reconstruction with fibula free flaps: A volumetric analysis. Dentomaxillofac. Radiol. 2022, 51, 20220131. [Google Scholar] [CrossRef] [PubMed]
- Hashemi, S.; Oda, M.; Onoue, K.; Basa, K.; Rubin, S.J.; Sakai, O.; Salama, A.; Ezzat, W.H. Determining the optimal osteotomy distance with the fibula free flap in mandibular reconstruction. Am. J. Otolaryngol. 2020, 41, 102436. [Google Scholar] [CrossRef]
- Gomez-Benito, M.J.; Garcia-Aznar, J.M.; Kuiper, J.H.; Doblare, M. Influence of fracture gap size on the pattern of long bone healing: A computational study. J. Theor. Biol. 2005, 235, 105–119. [Google Scholar] [CrossRef]
- Kreutzer, K.; Steffen, C.; Nahles, S.; Koerdt, S.; Heiland, M.; Rendenbach, C.; Beck-Broichsitter, B. Removal of patient-specific reconstruction plates after mandible reconstruction with a fibula free flap: Is the plate the problem? Int. J. Oral Maxillofac. Surg. 2021, 51, 182–190. [Google Scholar] [CrossRef]
- Claes, L.E.; Heigele, C.A.; Neidlinger-Wilke, C.; Kaspar, D.; Seidl, W.; Margevicius, K.J.; Augat, P. Effects of mechanical factors on the fracture healing process. Clin. Orthop. Relat. Res. 1998, 355, S132–S147. [Google Scholar] [CrossRef] [PubMed]
- Swendseid, B.; Kumar, A.; Sweeny, L.; Zhan, T.; Goldman, R.A.; Krein, H.; Heffelfinger, R.N.; Luginbuhl, A.J.; Curry, J.M. Natural History and Consequences of Nonunion in Mandibular and Maxillary Free Flaps. Otolaryngol. Head Neck Surg. 2020, 163, 956–962. [Google Scholar] [CrossRef] [PubMed]
- Marsell, R.; Einhorn, T.A. The biology of fracture healing. Injury 2011, 42, 551–555. [Google Scholar] [CrossRef] [PubMed]
- Shapiro, F. Cortical bone repair. The relationship of the lacunar-canalicular system and intercellular gap junctions to the repair process. J. Bone Joint Surg. Am. 1988, 70, 1067–1081. [Google Scholar] [CrossRef]
- Kaderly, R.E. Primary bone healing. Semin Vet. Med. Surg. Small Anim. 1991, 6, 21–25. [Google Scholar] [PubMed]
- Yoda, N.; Zheng, K.; Chen, J.; Liao, Z.; Koyama, S.; Peck, C.; Swain, M.; Sasaki, K.; Li, Q. Biomechanical analysis of bone remodeling following mandibular reconstruction using fibula free flap. Med. Eng. Phys. 2018, 56, 1–8. [Google Scholar] [CrossRef] [PubMed]
- Marx, R.E. Bone and bone graft healing. Oral Maxillofac. Surg. Clin. N. Am. 2007, 19, 455–466. [Google Scholar] [CrossRef]
- Fisher, J.S.; Kazam, J.J.; Fufa, D.; Bartolotta, R.J. Radiologic evaluation of fracture healing. Skelet. Radiol. 2019, 48, 349–361. [Google Scholar] [CrossRef]
- Prein, J.; Ehrenfeld, M.; Manson, P. Principles of Internal Fixation of the Craniomaxillofacial Skeleton; Thieme: Leipzig, Germany, 2012. [Google Scholar]
- Green, E.; Lubahn, J.D.; Evans, J. Risk factors, treatment, and outcomes associated with nonunion of the midshaft humerus fracture. J. Surg. Orthop. Adv. 2005, 14, 64–72. [Google Scholar] [PubMed]
- Pape, H.C.; Giannoudis, P.V.; Grimme, K.; van Griensven, M.; Krettek, C. Effects of intramedullary femoral fracture fixation: What is the impact of experimental studies in regards to the clinical knowledge? Shock 2002, 18, 291–300. [Google Scholar] [CrossRef] [PubMed]
- Perren, S.M. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: Choosing a new balance between stability and biology. J. Bone Joint Surg. Br. 2002, 84, 1093–1110. [Google Scholar] [CrossRef] [PubMed]
- Jubbal, K.T.; Zavlin, D.; Suliman, A. The effect of age on microsurgical free flap outcomes: An analysis of 5951 cases. Microsurgery 2017, 37, 858–864. [Google Scholar] [CrossRef] [PubMed]
- Sierakowski, A.; Nawar, A.; Parker, M.; Mathur, B. Free flap surgery in the elderly: Experience with 110 cases aged >/=70 years. J. Plast. Reconstr. Aesthetic Surg. 2017, 70, 189–195. [Google Scholar] [CrossRef] [PubMed]
- Ferrari, S.; Copelli, C.; Bianchi, B.; Ferri, A.; Poli, T.; Ferri, T.; Sesenna, E. Free flaps in elderly patients: Outcomes and complications in head and neck reconstruction after oncological resection. J. Cranio-Maxillofac. Surg. 2013, 41, 167–171. [Google Scholar] [CrossRef]
- Grammatica, A.; Piazza, C.; Paderno, A.; Taglietti, V.; Marengoni, A.; Nicolai, P. Free flaps in head and neck reconstruction after oncologic surgery: Expected outcomes in the elderly. Otolaryngol. Head Neck Surg. 2015, 152, 796–802. [Google Scholar] [CrossRef]
- Hwang, K.; Lee, J.P.; Yoo, S.Y.; Kim, H. Relationships of comorbidities and old age with postoperative complications of head and neck free flaps: A review. J. Plast. Reconstr. Aesthetic Surg. 2016, 69, 1627–1635. [Google Scholar] [CrossRef] [PubMed]
- West, J.D.; Tang, L.; Julian, A.; Das, S.; Chambers, T.; Kokot, N.C. Risk Factors for Plate Extrusion After Mandibular Reconstruction With Vascularized Free Flap. J. Oral Maxillofac. Surg. 2021, 79, 1760–1768. [Google Scholar] [CrossRef] [PubMed]
- Knitschke, M.; Sonnabend, S.; Bäcker, C.; Schmermund, D.; Böttger, S.; Howaldt, H.P.; Attia, S. Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years. Cances 2021, 13, 865. [Google Scholar] [CrossRef]
- Urken, M.L.; Buchbinder, D.; Costantino, P.D.; Sinha, U.; Okay, D.; Lawson, W.; Biller, H.F. Oromandibular reconstruction using microvascular composite flaps: Report of 210 cases. Arch. Otolaryngol. Head Neck Surg. 1998, 124, 46–55. [Google Scholar] [CrossRef] [PubMed]
- Wei, F.C.; Celik, N.; Yang, W.G.; Chen, I.H.; Chang, Y.M.; Chen, H.C. Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap. Plast. Reconstr. Surg. 2003, 112, 37–42. [Google Scholar] [CrossRef] [PubMed]
- Nicholson, R.E.; Schuller, D.E.; Forrest, L.A.; Mountain, R.E.; Ali, T.; Young, D. Factors involved in long- and short-term mandibular plate exposure. Arch. Otolaryngol. Head Neck Surg. 1997, 123, 217–222. [Google Scholar] [CrossRef]
- Arganbright, J.M.; Tsue, T.T.; Girod, D.A.; Militsakh, O.N.; Sykes, K.J.; Markey, J.; Shnayder, Y. Outcomes of the osteocutaneous radial forearm free flap for mandibular reconstruction. JAMA Otolaryngol. Head Neck Surg. 2013, 139, 168–172. [Google Scholar] [CrossRef] [PubMed]
- Prasad, J.; Sahovaler, A.; Theurer, J.; Yeh, D.H.; Fung, K.; MacNeil, S.D.; Yoo, J.; Nichols, A.C. Predictors of plate extrusion in oromandibular free flap reconstruction. Microsurgery 2018, 38, 682–689. [Google Scholar] [CrossRef] [PubMed]
- Zender, C.A.; Mehta, V.; Pittman, A.L.; Feustel, P.J.; Jaber, J.J. Etiologic causes of late osteocutaneous free flap failures in oral cavity cancer reconstruction. Laryngoscope 2012, 122, 1474–1479. [Google Scholar] [CrossRef]
- Sobti, N.; Ahmed, K.S.; Polanco, T.; Chilov, M.; Cohen, M.A.; Boyle, J.; Shahzad, F.; Matros, E.; Nelson, J.A.; Allen, R.J., Jr. Mini-plate versus reconstruction bar fixation for oncologic mandibular reconstruction with free fibula flaps: A systematic review and meta-analysis. J. Plast. Reconstr. Aesthetic Surg. 2022, 75, 2691–2701. [Google Scholar] [CrossRef] [PubMed]
- Maurer, P.; Eckert, A.W.; Kriwalsky, M.S.; Schubert, J. Scope and limitations of methods of mandibular reconstruction: A long-term follow-up. Br. J. Oral Maxillofac. Surg. 2010, 48, 100–104. [Google Scholar] [CrossRef] [PubMed]
- Haubner, F.; Ohmann, E.; Pohl, F.; Strutz, J.; Gassner, H.G. Wound healing after radiation therapy: Review of the literature. Radiat. Oncol. 2012, 7, 162. [Google Scholar] [CrossRef]
- van Gemert, J.T.; van Es, R.J.; Rosenberg, A.J.; van der Bilt, A.; Koole, R.; Van Cann, E.M. Free vascularized flaps for reconstruction of the mandible: Complications, success, and dental rehabilitation. J. Oral Maxillofac. Surg. 2012, 70, 1692–1698. [Google Scholar] [CrossRef]
- Kreutzer, K.; Steffen, C.; Koerdt, S.; Doll, C.; Ebker, T.; Nahles, S.; Flügge, T.; Heiland, M.; Beck-Broichsitter, B.; Rendenbach, C. Patient-Specific 3D-Printed Miniplates for Free Flap Fixation at the Mandible: A Feasibility Study. Front. Surg. 2022, 9, 778371. [Google Scholar] [CrossRef] [PubMed]
Parameter | All n = 133 | Non-PSI n = 69 | CAD/CAM PSI n = 64 | p-Value |
---|---|---|---|---|
Age (years), mean ± SD | 56.7 ± 14.0 | 56.73 ± 12.11 | 56.70 ± 15.85 | 0.990 |
Follow-up (months), median; IQI (Q1, Q3) | 47.0 (21.0, 98.5) | 94.0 (63.0, 133.0) | 25.5 (16.0, 41.3) | |
Gender, n (%) | ||||
Male | 83 (62.4) | 44 (63.8) | 39 (60.9) | 0.683 |
Female | 50 (37.6) | 25 (36.2) | 25 (39.1) | |
Diagnosis, n (%) | ||||
Benign tumor | 20 (15.0) | 7 (10.1) | 13 (20.3) | 0.250 |
Malignant tumor | 105 (78.9) | 58 (84.1) | 47 (73.4) | |
Other | 8 (6.1) | 4 (5.8) | 4 (6.3) | |
X-ray, n (%) | ||||
OPT | 347 (60.5) | 192 (71.9) | 155 (50.5) | 0.001 |
CBCT | 41 (7.1) | 12 (4.5) | 29 (9.4) | |
CT | 186 (32.4) | 63 (23.6) | 123 (40.1) | |
Reconstruction site: Maxilla, n (%) | 30 (22.6) | 12 (17.4) | 18 (28.1) | * 0.139 |
Uni-segmental | 19 (63.3) | 8 (66.7) | 11 (61.1) | 0.757 |
Bi-segmental | 11 (36.7) | 4 (33.3) | 7 (38.9) | |
Reconstruction site: Mandibula, n (%) | 103 (77.4) | 57 (82.6) | 46 (71.9) | |
Uni-segmental | 30 (29.1) | 23 (40.4) | 7 (15.2) | 0.015 |
Bi-segmental | 46 (44.7) | 23 (40.4) | 23 (50.0) | |
Tri-segmental | 27 (26.2) | 11 (19.3) | 16 (34.8) | |
Surgery | 72 (54.1) | 41 (59.4) | 31 (48.4) | 0.427 |
Adjuvant radio(chemo)therapy | 61 (45.9) | 28 (30.6) | 33 (51.6) | |
Dental status reconstruction site, n (%) | ||||
Complete | 23 (17.3) | 8 (11.6) | 15 (23.4) | 0.111 |
Partially edentulous | 86 (64.7) | 50 (72.5) | 36 (56.3) | |
Edentulous | 24 (18.0) | 11 (15.9) | 13 (20.3) | |
Dental status non-reconstruction site, n (%) | ||||
Complete | 23 (17.3) | 11 (15.9) | 12 (18.8) | 0.816 |
Partially edentulous | 78 (58.6) | 40 (58.0) | 38 (59.4) | |
Edentulous | 32 (24.1) | 18 (26.1) | 14 (21.9) |
Parameter | p-Value | OR | 95%-CI | |
---|---|---|---|---|
Osteosynthesis type | PSI | 0.02 | 3.518 | 1.223–10.124 |
Alcohol | Yes | 0.08 | 2.039 | 0.899–6.486 |
Adjuvant radiotherapy | Yes | 0.005 | 4.804 | 1.602–14.409 |
Complications | Non-PSI n = 69 | p-Value | PSI n = 64 | p-Value | ||
---|---|---|---|---|---|---|
COU, n (%) n = 63 | IOU, n (%) n = 6 | COU, n (%) n = 47 | IOU, n (%) n = 17 | |||
Revision and re-Osteosynthesis | 4 (6.3) | 1 (16.7) | 0.375 | 4 (8.5) | 0 | 0.280 |
Osteonecrosis | 1 (1.6) | 0 | 0.913 | 0 | 3 (17.6) | 0.016 |
Screw loosening | 9 (14.3) | 1 (16.7) | 0.624 | 4 (8.5) | 5 (29.4) | 0.048 |
Plate exposure | 13 (20.6) | 3 (50.0) | 0.132 | 10 (21.3) | 5 (29.4) | 0.356 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Knitschke, M.; Yonan, M.; Roller, F.C.; Pons-Kühnemann, J.; Attia, S.; Howaldt, H.-P.; Streckbein, P.; Böttger, S. Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants. Cancers 2022, 14, 5774. https://doi.org/10.3390/cancers14235774
Knitschke M, Yonan M, Roller FC, Pons-Kühnemann J, Attia S, Howaldt H-P, Streckbein P, Böttger S. Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants. Cancers. 2022; 14(23):5774. https://doi.org/10.3390/cancers14235774
Chicago/Turabian StyleKnitschke, Michael, Magdalena Yonan, Fritz Christian Roller, Jörn Pons-Kühnemann, Sameh Attia, Hans-Peter Howaldt, Philipp Streckbein, and Sebastian Böttger. 2022. "Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants" Cancers 14, no. 23: 5774. https://doi.org/10.3390/cancers14235774
APA StyleKnitschke, M., Yonan, M., Roller, F. C., Pons-Kühnemann, J., Attia, S., Howaldt, H.-P., Streckbein, P., & Böttger, S. (2022). Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants. Cancers, 14(23), 5774. https://doi.org/10.3390/cancers14235774