Special Issue "Innovation in Head and Neck Reconstructive Surgery"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (31 January 2021).

Special Issue Editors

Prof. Dr. Achille Tarsitano
E-Mail Website
Guest Editor
Senior Assistant Professor of Maxillo-Facial Surgery, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
Interests: maxillofacial surgery; head and neck surgery; head and neck oncology; new technologies in medicine; computer-assisted surgery; virtual surgery; CAD/CAM reconstructive surgery; 3D printing in medicine
Prof. Dr. Florian M. Thieringer
E-Mail Website
Guest Editor
Universitätsspital Basel, Basel, Switzerland
Interests: Oral and Maxillofacial Surgery; Dentistry; Surgery; Implantology; Carniofacial Surgery; Computer Assisted Surgery; Aesthetics; Public Health; Medical Devices; Healthcare Management

Special Issue Information

Dear Colleagues,

The field of head and neck reconstruction is exceptionally complex. Many of the anatomical structures requiring reconstruction have a crucial role in facial morphology and for functions such as speech, swallowing, and mastication. All these aspects strongly influence the patient’s daily quality of life. The lack of effective reconstruction techniques in the distant past left surgeons and patients with poor outcomes.

Over the past few years, the development of new technologies such as virtual surgical planning and 3D printing have been shown to result in better outcomes in terms of reconstructive accuracy, with good improvement in results as compared to traditional reconstruction techniques. The field of head and neck reconstruction is on the move. In fact, computer-assisted surgery with customized implants is becoming increasingly common for head and neck reconstruction, also associated with revascularized tissue transfer. These techniques allow surgeons to provide increasingly personalized reconstruction, improving the average results and reducing surgical time.

The present Special Issue aims to explore these new frontiers of reconstructive surgery as supported by 3D technology.

We would be honored to have robust contributions from eminent experts on head and neck reconstructive surgery in order to update the scientific literature on this fascinating topic.

Prof. Dr. Achille Tarsitano
Prof. Dr. Florian M. Thieringer
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • reconstructive surgery
  • head and neck surgery
  • 3D printing
  • new technologies
  • virtual surgical planning
  • computer-assisted surgery
  • personalized reconstructive surgery
  • augmented reality
  • microvascular reconstruction

Published Papers (16 papers)

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Article
Cold Ablation Robot-Guided Laser Osteotome (CARLO®): From Bench to Bedside
J. Clin. Med. 2021, 10(3), 450; https://doi.org/10.3390/jcm10030450 - 24 Jan 2021
Viewed by 669
Abstract
Background: In order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by [...] Read more.
Background: In order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools, a Swiss start-up company. We present our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO®). Methods: The CARLO® device employs a stand-alone 2.94-µm erbium-doped yttrium aluminum garnet (Er:YAG) laser mounted on a robotic arm. A 19-year-old patient provided informed consent to undergo bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO® device. The linear part of the Le Fort I osteotomy was performed autonomously by the CARLO® device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images. Results: The CARLO® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications. Conclusion: The newly developed stand-alone CARLO® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. However, the technical workflow concerning the positioning and fixation of the target marker and the implementation of active depth control still need to be improved. Further research to assess safety and accuracy is also necessary, especially at osteotomy sites where direct visual control is not possible. Finally, cost-effectiveness analysis comparing the use of the CARLO® device with gold-standard surgery protocols will help to define the role of the CARLO® device in the surgical landscape. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Heterotopic Ossification of the Vascular Pedicle after Maxillofacial Reconstructive Surgery Using Fibular Free Flap: Introducing New Classification and Retrospective Analysis
J. Clin. Med. 2021, 10(1), 109; https://doi.org/10.3390/jcm10010109 - 30 Dec 2020
Cited by 2 | Viewed by 478
Abstract
Heterotopic ossification (HO) is one of the described phenomena after maxillofacial reconstructive surgery using fibular free flap (FFF) at the reception-site. The aim of this study was to determine the radiological incidence and form of HO along the fibular vascular pedicle as well [...] Read more.
Heterotopic ossification (HO) is one of the described phenomena after maxillofacial reconstructive surgery using fibular free flap (FFF) at the reception-site. The aim of this study was to determine the radiological incidence and form of HO along the fibular vascular pedicle as well as the rate of clinical symptoms if present. CT-scans of 102 patients who underwent jaw reconstructive surgery by using FFF from January 2005 to December 2019 were evaluated concerning the presence of HO. Subsequently, the patient files were evaluated to identify the cases with clinical signs and complications related to the presence of HO. A radiological classification of four different HO types was developed. Out of 102 patients, 29 (28.43%) presented radiological findings of HO. Clinical symptoms were recorded in 10 cases (9.8%) (dysphagia (n = 5), trismus (n = 3), bony masses (n = 2)) and from these only five (4.9%) needed surgical removal of calcified structures. HO occurs significantly in younger patients (mean 52.3 year). In maxillary reconstructions, HO was radiologically visible six months earlier than after mandibular reconstruction. Furthermore, HO is observed after every third maxilla and every fourth mandible reconstruction. This study developed for the first time a classification of four distinct HO patterns. HO types 1 and 2 were mostly observed after mandible reconstruction and type 4 predominantly after maxilla reconstruction. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Fibula Graft Cutting Devices: Are 3D-Printed Cutting Guides More Precise than a Universal, Reusable Osteotomy Jig?
J. Clin. Med. 2020, 9(12), 4119; https://doi.org/10.3390/jcm9124119 - 20 Dec 2020
Viewed by 654
Abstract
Individual cutting guides for the reconstruction of lower jaw defects with fibular grafts are often used. However, the application of these osteotomy tools is costly and time intensive. The aim of this study was to compare the precision of osteotomies using a 3D-printed [...] Read more.
Individual cutting guides for the reconstruction of lower jaw defects with fibular grafts are often used. However, the application of these osteotomy tools is costly and time intensive. The aim of this study was to compare the precision of osteotomies using a 3D-printed guide with those using a universal, reusable, and more cost-efficient Multi-Use Cutting Jig (MUC-Jig). In this non-blinded experimental study, 10 cranio-maxillofacial surgeons performed four graft removals each in a randomized order using the same osteotomy angle, both proximally (sagittal cut) and distally (coronal cut), of a graft (45°, 30°, 15°, or 0°), first with the MUC-Jig then with the 3D-printed cutting guide. The 40 fibula transplants (Tx) of each method (n = 80) were then analyzed concerning their Tx length and osteotomy angles and compared to the original planning data. Furthermore, the surgeons’ subjective perception and the duration of the two procedures were analyzed. The mean relative length and mean relative angle deviation between the MUC-Jig (−0.08 ± 1.12 mm; −0.69° ± 3.15°) and the template (0.22 ± 0.90 mm; 0.36° ± 2.56°) group differed significantly (p = 0.002; p = < 0.001), but the absolute deviations did not (p = 0.206; p = 0.980). Consequently, clinically comparable osteotomy results can be achieved with both methods, but from an economic point of view the MUC-Jig is a more cost-efficient solution. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Modified Clavien–Dindo Classification and Outcome Prediction in Free Flap Reconstruction among Patients with Head and Neck Cancer
J. Clin. Med. 2020, 9(11), 3770; https://doi.org/10.3390/jcm9113770 - 22 Nov 2020
Viewed by 570
Abstract
Because of limitations caused by unique complications of free flap reconstruction, the Clavien–Dindo classification was modified to include grade “IIIc” for “partial or total free flap failure.” From 2013 to 2018, 116 patients who had undergone free flap reconstruction for head and neck [...] Read more.
Because of limitations caused by unique complications of free flap reconstruction, the Clavien–Dindo classification was modified to include grade “IIIc” for “partial or total free flap failure.” From 2013 to 2018, 116 patients who had undergone free flap reconstruction for head and neck cancer with grade III or higher postoperative complications were grouped using the “Modified” Clavien–Dindo classification. Alcoholism displayed significant predictive effects between grade IIIb and IIIc (72.7% vs. 50%, p = 0.028). Significant differences were observed between grade IIIb and IIIc in the duration of hospital stay (23.1 ± 10.1 vs. 28.6 ± 11.9 days, p = 0.015), duration of intensive care unit stay (6.0 ± 3.4 vs. 8.7 ± 4.3 days, p = 0.001), reoperation times during the current hospitalization (1.4 ± 0.8 vs. 2.0 ± 1.0 times, p < 0.001), and wound infection rate (29.9% vs. 62.5%, p = 0.002). The severity levels were significantly positively correlated with reoperation times during the current hospitalization (p < 0.001), ICU stay (p = 0.001), and hospital stay (p < 0.001). The modified Clavien–Dindo classification with grade IIIc describes the perioperative complications of head and neck free flap reconstruction to predict clinical outcomes based on severity. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
The Wearable VOSTARS System for Augmented Reality-Guided Surgery: Preclinical Phantom Evaluation for High-Precision Maxillofacial Tasks
J. Clin. Med. 2020, 9(11), 3562; https://doi.org/10.3390/jcm9113562 - 05 Nov 2020
Cited by 2 | Viewed by 722
Abstract
Background: In the context of guided surgery, augmented reality (AR) represents a groundbreaking improvement. The Video and Optical See-Through Augmented Reality Surgical System (VOSTARS) is a new AR wearable head-mounted display (HMD), recently developed as an advanced navigation tool for maxillofacial and plastic [...] Read more.
Background: In the context of guided surgery, augmented reality (AR) represents a groundbreaking improvement. The Video and Optical See-Through Augmented Reality Surgical System (VOSTARS) is a new AR wearable head-mounted display (HMD), recently developed as an advanced navigation tool for maxillofacial and plastic surgery and other non-endoscopic surgeries. In this study, we report results of phantom tests with VOSTARS aimed to evaluate its feasibility and accuracy in performing maxillofacial surgical tasks. Methods: An early prototype of VOSTARS was used. Le Fort 1 osteotomy was selected as the experimental task to be performed under VOSTARS guidance. A dedicated set-up was prepared, including the design of a maxillofacial phantom, an ad hoc tracker anchored to the occlusal splint, and cutting templates for accuracy assessment. Both qualitative and quantitative assessments were carried out. Results: VOSTARS, used in combination with the designed maxilla tracker, showed excellent tracking robustness under operating room lighting. Accuracy tests showed that 100% of Le Fort 1 trajectories were traced with an accuracy of ±1.0 mm, and on average, 88% of the trajectory’s length was within ±0.5 mm accuracy. Conclusions: Our preliminary results suggest that the VOSTARS system can be a feasible and accurate solution for guiding maxillofacial surgical tasks, paving the way to its validation in clinical trials and for a wide spectrum of maxillofacial applications. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Use of CAD–CAM Bridging Mandibular Prosthesis in Osteonecrosis of the Jaw: The Experience of Our School
J. Clin. Med. 2020, 9(11), 3516; https://doi.org/10.3390/jcm9113516 - 30 Oct 2020
Cited by 1 | Viewed by 504
Abstract
Osteonecrosis of the jaw (ONJ) is a disease that affects the jaw. It is mainly related to radiation or bisphosphonates therapy, and the symptoms and signs consist of pain, bone exposure, inflammation of the surrounding soft tissue swelling, and secondary infection or drainage. [...] Read more.
Osteonecrosis of the jaw (ONJ) is a disease that affects the jaw. It is mainly related to radiation or bisphosphonates therapy, and the symptoms and signs consist of pain, bone exposure, inflammation of the surrounding soft tissue swelling, and secondary infection or drainage. In the case of advanced disease of the mandibular area, the treatment of choice is mandibular resection and reconstruction. In the present study, we report a case series of patients affected by ONJ and treated with a customised bridging mandibular prosthesis-only technique. From 2016 to 2018, we treated five consecutive patients affected by ONJ: three patients were affected by biphosphonate-related osteonecrosis of the mandible (BRONJ) and two were affected by osteoradionecrosis of the mandible (ORNJ). Three patients needed a soft tissue free flap to permit optimal wound closure, intra- and/or extraorally. All reconstructive procedures were carried out successfully, with no major or minor microvascular complication. The average postoperative follow-up was 24.8 (range 10–41) months. Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customised bridging mandibular prosthesis (CBMP), whether or not associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
3D Exoscope-Assisted Microvascular Anastomosis: An Evaluation on Latex Vessel Models
J. Clin. Med. 2020, 9(10), 3373; https://doi.org/10.3390/jcm9103373 - 21 Oct 2020
Cited by 2 | Viewed by 536
Abstract
Background. Over the last few years, advances in technologies and digital imaging have led to the introduction of systems that enable a new approach to microsurgery and supermicrosurgery. The exoscope is a new magnification system that provides a 3D image of the surgical [...] Read more.
Background. Over the last few years, advances in technologies and digital imaging have led to the introduction of systems that enable a new approach to microsurgery and supermicrosurgery. The exoscope is a new magnification system that provides a 3D image of the surgical field: microsurgical procedures can be performed with the aid of this instrument. Here, we describe our preliminary experience with a high-definition 3D exoscope (VITOM®, Karl Storz, Tuttlingen, Germany), evaluating the characteristics of the instrument, and also its use as a magnification device for microanastomosis training. Methods. Six microsurgeons with various levels of experience were asked to perform three end-to-end anastomoses and two end-to-side anastomoses on latex vessel models, using, as a magnification system, the VITOM® 3D 4K exoscope. None of the surgeons involved had previous experience with the exoscope, with robotic surgery, with endoscopic surgery, nor with training simulators. Results. The results of the reported evaluation of the tool’s qualities, (VITOM Quality Assessment Tool) included: a good focusing of the surgical field; high image quality; strong luminance; good magnification; clear stereoscopy; and excellent freedom of movement. The exoscope proved to be user-friendly. A constant reduction in the time needed to perform the microsurgical anastomosis at each exercise was recorded. Among other advantages were the easy switching from the magnified image to the macroscopic view, superior ergonomics allowing a relaxed posture while performing the anastomosis, adequate space, and a convenient setting for the assistants to view the operating field. Conclusions. Our study showed that the exoscope VITOM 3D can be successfully used as a magnification tool for microsurgical anastomosis on synthetic vessels, and that it can also be helpful during training courses in microsurgery. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Computer-Aided Rehabilitation Supported by Zygomatic Implants: A Cohort Study Comparing Atrophic with Oncologic Patients after Five Years of Follow-Up
J. Clin. Med. 2020, 9(10), 3254; https://doi.org/10.3390/jcm9103254 - 12 Oct 2020
Cited by 3 | Viewed by 594
Abstract
The aim of this study was to evaluate the survival and clinical success rate, complications, and patients’ quality of life after computer-aided rehabilitation supported by zygomatic implants in cases of severe maxillary atrophy (ten patients) and in bone defects in oncologic patients (ten [...] Read more.
The aim of this study was to evaluate the survival and clinical success rate, complications, and patients’ quality of life after computer-aided rehabilitation supported by zygomatic implants in cases of severe maxillary atrophy (ten patients) and in bone defects in oncologic patients (ten patients). All patients underwent computer-aided planning and surgery. Seventy-three zygomatic implants were placed. The mean follow-up period was 39.9 months. Implant survival and clinical success rate, the effectiveness of planning the implant length, biological and prosthetic complications, and the quality of life were evaluated. The five-year implant survival rate for patients with maxillary atrophy and oncologic patients was 97.4% and 96.7%, respectively. The prosthetic survival rate was 100%. Two implant failures occurred in the first year. One implant failure was observed in each group. Minor biological and prosthetic complications occurred in both groups without significant differences. All complications were managed without affecting the treatment. The quality of life increased by 71.3% in the atrophic group and by 82.9% in the oncologic group. Zygomatic implant rehabilitation seems to be a reliable technique for patients with maxillary atrophy and for oncologic patients. The three-dimensional computer-aided approach allows the surgeon to plan the surgery and increase its predictability. Early prosthesis loading certainly allows for better functional outcomes. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Quality Characteristics and Clinical Relevance of In-House 3D-Printed Customized Polyetheretherketone (PEEK) Implants for Craniofacial Reconstruction
J. Clin. Med. 2020, 9(9), 2818; https://doi.org/10.3390/jcm9092818 - 31 Aug 2020
Cited by 7 | Viewed by 1159
Abstract
Additive manufacturing (AM) of patient-specific implants (PSIs) is gradually moving towards in-house or point-of-care (POC) manufacturing. Polyetheretherketone (PEEK) has been used in cranioplasty cases as a reliable alternative to other alloplastic materials. As only a few fused filament fabrication (FFF) printers are suitable [...] Read more.
Additive manufacturing (AM) of patient-specific implants (PSIs) is gradually moving towards in-house or point-of-care (POC) manufacturing. Polyetheretherketone (PEEK) has been used in cranioplasty cases as a reliable alternative to other alloplastic materials. As only a few fused filament fabrication (FFF) printers are suitable for in-house manufacturing, the quality characteristics of the implants fabricated by FFF technology are still under investigated. This paper aimed to investigate PEEK PSIs fabricated in-house for craniofacial reconstruction, discussing the key challenges during the FFF printing process. Two exemplary cases of class III (Group 1) and class IV (Group 2) craniofacial defects were selected for the fabrication of PEEK PSIs. Taguchi’s L9 orthogonal array was selected for the following nonthermal printing process parameters, i.e., layer thickness, infill rate, number of shells, and infill pattern, and an assessment of the dimensional accuracy of the fabricated implants was made. The root mean square (RMS) values revealed higher deviations in Group 1 PSIs (0.790 mm) compared to Group 2 PSIs (0.241 mm). Horizontal lines, or the characteristic FFF stair-stepping effect, were more perceptible across the surface of Group 1 PSIs. Although Group 2 PSIs revealed no discoloration, Group 1 PSIs displayed different zones of crystallinity. These results suggest that the dimensional accuracy of PSIs were within the clinically acceptable range; however, attention must be paid towards a requirement of optimum thermal management during the printing process to fabricate implants of uniform crystallinity. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Comparison of Changes in the Condylar Volume and Morphology in Skeletal Class III Deformities Undergoing Orthognathic Surgery Using a Customized versus Conventional Miniplate: A Retrospective Analysis
J. Clin. Med. 2020, 9(9), 2794; https://doi.org/10.3390/jcm9092794 - 30 Aug 2020
Viewed by 800
Abstract
With the great leap in the development of three-dimensional computer-assisted surgical technology, surgeons can use a variety of assistive methods to achieve better results and evaluate surgical outcomes in detail. This retrospective study aimed to evaluate the postoperative stability after bilateral sagittal split [...] Read more.
With the great leap in the development of three-dimensional computer-assisted surgical technology, surgeons can use a variety of assistive methods to achieve better results and evaluate surgical outcomes in detail. This retrospective study aimed to evaluate the postoperative stability after bilateral sagittal split ramus osteotomy by volume rendering methods and to evaluate how postoperative stability differs depending on the type of surgical plate. Of the patients who underwent BSSRO, ten patients in each group (non-customized miniplate and customized miniplate) who met the inclusion criteria were selected. Preoperative and postoperative cone-beam computed tomography data were collected, and condylar morphological and landmark measurements were obtained using Checkpoint and OnDemand software, respectively. The postoperative condylar morphological dataset revealed no significant difference (p > 0.05) between the two groups. No significant difference (p > 0.05) was observed between the two groups in horizontal, vertical, or angular landmark measurements used to quantify operational stability. These results indicate that there is no difference in the surgical outcome between the patient-specific system and the conventional method, which will allow clinicians to take advantage of the patient-specific system for this surgical procedure, with favorable results, as with the conventional method. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap
J. Clin. Med. 2020, 9(7), 2211; https://doi.org/10.3390/jcm9072211 - 13 Jul 2020
Cited by 1 | Viewed by 528
Abstract
Head and neck reconstructive surgeons have recently explored new perspectives in bone restoration using periosteum carrier flaps. Following this idea, we explored the possibility of harvesting a galeo-pericranial flap. The present work studies the vascular supply of the pericranial temporo-parietal region in order [...] Read more.
Head and neck reconstructive surgeons have recently explored new perspectives in bone restoration using periosteum carrier flaps. Following this idea, we explored the possibility of harvesting a galeo-pericranial flap. The present work studies the vascular supply of the pericranial temporo-parietal region in order to assess the possibility of harvesting a galeo-pericranial flap based on the superficial temporalis vascularization. Anatomical dissections were performed at the Anatomical Institute of the University of Bologna on eight donor cadavers. Then we performed the harvesting of the flap in vivo on eight patients. We introduced augmented reality (AR) to facilitate anatomical visualisation during free flap harvesting. Augmented reality merges virtual and actual objects, allowing direct observation of patient anatomy and the surgical field. No post-operative major or minor complications occurred. We encountered no post-operative functional issues on the donor or recipient sites, and good clinical healing was observed in all patients. In conclusion, we believe that the galea-pericranium flap could represent a new donor site for the harvesting of a periosteum carrier flap. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Three-Dimensional Analysis of Isolated Orbital Floor Fractures Pre- and Post-Reconstruction with Standard Titanium Meshes and “Hybrid” Patient-Specific Implants
J. Clin. Med. 2020, 9(5), 1579; https://doi.org/10.3390/jcm9051579 - 22 May 2020
Cited by 3 | Viewed by 1560
Abstract
The aim of this study was to compare the efficacy of the intraoperative bending of titanium mesh with the efficacy of pre-contoured “hybrid” patient-specific titanium mesh for the surgical repair of isolated orbital floor fractures. In-house 3D-printed anatomical models were used as bending [...] Read more.
The aim of this study was to compare the efficacy of the intraoperative bending of titanium mesh with the efficacy of pre-contoured “hybrid” patient-specific titanium mesh for the surgical repair of isolated orbital floor fractures. In-house 3D-printed anatomical models were used as bending guides. The main outcome measures were preoperative and postoperative orbital volume and surgery time. We performed a retrospective cohort study including 22 patients who had undergone surgery between May 2016 and November 2018. The first twelve patients underwent conventional reconstruction with intraoperative free-hand bending of an orbital floor mesh plate. The subsequent ten patients received pre-contoured plates based on 3D-printed orbital models that were produced by mirroring the non-fractured orbit of the patient using a medical imaging software. We compared the preoperative and postoperative absolute volume difference (unfractured orbit, fractured orbit), the fracture area, the fracture collapse, and the effective surgery time between the two groups. In comparison to the intraoperative bending of titanium mesh, the application of preformed plates based on a 3D-printed orbital model resulted in a non-significant absolute volume difference in the intervention group (p = 0.276) and statistically significant volume difference in the conventional group (p = 0.002). Further, there was a significant reduction of the surgery time (57.3 ± 23.4 min versus 99.8 ± 28.9 min, p = 0.001). The results of this study suggest that the use of 3D-printed orbital models leads to a more accurate reconstruction and a time reduction during surgery. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Effects of Steam Sterilization on 3D Printed Biocompatible Resin Materials for Surgical Guides—An Accuracy Assessment Study
J. Clin. Med. 2020, 9(5), 1506; https://doi.org/10.3390/jcm9051506 - 17 May 2020
Cited by 10 | Viewed by 1109
Abstract
Computer-assisted surgery with three-dimensional (3D) printed surgical guides provides more accurate results than free-hand surgery. Steam sterilization could be one of the factors that affect the dimensions of surgical guide resin materials, leading to inaccuracies during surgeries. The purpose of this study was [...] Read more.
Computer-assisted surgery with three-dimensional (3D) printed surgical guides provides more accurate results than free-hand surgery. Steam sterilization could be one of the factors that affect the dimensions of surgical guide resin materials, leading to inaccuracies during surgeries. The purpose of this study was to evaluate the effects of steam sterilization on the dimensional accuracy of indication-specific hollow cube test bodies, manufactured in-house using Class IIa biocompatible resin materials (proprietary and third-party). To evaluate the pre- and post-sterilization dimensional accuracy, root mean square (RMS) values were calculated. The results indicate that, in all the groups, steam sterilization resulted in an overall linear expansion of the photopolymeric resin material, with an increase in outer dimensions and a decrease in inner dimensions. The effects on the dimensional accuracy of test bodies were not statistically significant in all the groups, except PolyJet Glossy (p > 0.05). The overall pre- and post-sterilization RMS values were below 100 and 200 µm, respectively. The highest accuracies were seen in proprietary resin materials, i.e., PolyJet Glossy and SLA-LT, in pre- and post-sterilization measurements, respectively. The dimensional accuracy of third-party resin materials, i.e., SLA-Luxa and SLA-NextDent, were within a comparable range as proprietary materials and can serve as an economical alternative. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Article
Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap
J. Clin. Med. 2020, 9(3), 884; https://doi.org/10.3390/jcm9030884 - 24 Mar 2020
Cited by 5 | Viewed by 1130 | Correction
Abstract
Introduction. The objective of this study was to evaluate a surgical technique and to present the results of delayed reconstruction of palatomaxillary defects using fibula free flap (FFF). Methods. A review was conducted for nine patients who underwent palatomaxillary reconstruction using FFF. Primary [...] Read more.
Introduction. The objective of this study was to evaluate a surgical technique and to present the results of delayed reconstruction of palatomaxillary defects using fibula free flap (FFF). Methods. A review was conducted for nine patients who underwent palatomaxillary reconstruction using FFF. Primary disease, type of reconstruction, defect area, fibula segment length and number of osteotomies, radiotherapy, and implant installation after FFF reconstruction were analyzed. Results. All nine patients underwent delayed reconstruction. The fibula shaft was osteotomized into two segments in seven patients and three segments in one patient with bilateral Brown’s revised classification IV/d defect. One case was planned by using a computer-aided design computer-aided manufacturing (CAD/CAM) system with a navigation system. The mean length of the grafted fibula bone was 68.06 mm. Dental implant treatment was performed in six patients. Six patients received radiation therapy, and there were no specific complications related to the radiation therapy. In one case, the defect was reconstructed with FFF flow-through from a radial forearm free flap. Conclusion. This clinical study demonstrated that the fibula flap is an ideal donor-free flap in a palatomaxillary defect. Delayed reconstruction using an FFF can reduce the complication and failure rates. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Review

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Review
Accuracy of Computer-Assisted Surgery in Maxillary Reconstruction: A Systematic Review
J. Clin. Med. 2021, 10(6), 1226; https://doi.org/10.3390/jcm10061226 - 16 Mar 2021
Viewed by 357
Abstract
Computer-assisted surgery (CAS) in maxillary reconstruction has proven its value regarding more predictable postoperative results. However, the accuracy evaluation methods differ between studies, and no meta-analysis has been performed yet. A systematic review was performed in the PubMed, Embase, and Cochrane Library databases, [...] Read more.
Computer-assisted surgery (CAS) in maxillary reconstruction has proven its value regarding more predictable postoperative results. However, the accuracy evaluation methods differ between studies, and no meta-analysis has been performed yet. A systematic review was performed in the PubMed, Embase, and Cochrane Library databases, using a Patient, Intervention, Comparison and Outcome (PICO) method: (P) patients in need of maxillary reconstruction using free osteocutaneous tissue transfer, (I) reconstructed according to a virtual plan in CAS software, (C) compared to the actual postoperative result, and (O) postoperatively measured by a quantitative accuracy assessment) search strategy, and was reported according to the PRISMA statement. We reviewed all of the studies that quantitatively assessed the accuracy of maxillary reconstructions using CAS. Twelve studies matched the inclusion criteria, reporting 67 maxillary reconstructions. All of the included studies compared postoperative 3D models to preoperative 3D models (revised to the virtual plan). The postoperative accuracy measurements mainly focused on the position of the fibular bony segments. Only approximate comparisons of postoperative accuracy between studies were feasible because of small differences in the postoperative measurement methods; the accuracy of the bony segment positioning ranged between 0.44 mm and 7.8 mm, and between 2.90° and 6.96°. A postoperative evaluation guideline to create uniformity in evaluation methods needs to be considered so as to allow for valid comparisons of postoperative results and to facilitate meta-analyses in the future. With the proper validation of the postoperative results, future research might explore more definitive evidence regarding the management and superiority of CAS in maxillary and midface reconstruction. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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Correction
Correction: Byun, S.-H. et al. Delayed Reconstruction of Palatomaxillary Defect Using Fibula Free Flap. J. Clin. Med. 2020, 9, 884
J. Clin. Med. 2020, 9(6), 1712; https://doi.org/10.3390/jcm9061712 - 02 Jun 2020
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Abstract
The authors sincerely apologize for the imperfections made during the collection of data and wish to make the following correction to the previous paper [...] Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)
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