New Technologies for Personalized Medicine in Head and Neck Oncologic and 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 (15 July 2023) | Viewed by 26060

Special Issue Editors


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Guest Editor
1. Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
2. Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA
Interests: head and neck cancer; reconstructive surgery; thyroid cancer; thyroid and parathyroid disease; thyroidectomy; tongue cancer; tonsil cancer

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Guest Editor
Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, 28040 Madrid, Spain
Interests: head and neck oncology; microsurgery; head and neck reconstruction; dental implants; free flaps; orthognatic surgery; dental implants in oncologic patients; surgical treatment of sleep apnea

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Guest Editor
Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain
Interests: dental implants; bone regeneration; head and neck surgery; orthognathic surgery; temporomandibular joint pathology; salivary gland tumors; oral cavity cancer

Special Issue Information

Dear Colleagues,

Oncologic and reconstructive surgery of the head and neck has undergone significant developments in the last decade. New technologies such as virtual surgical planning, 3D printing, dynamic navigation and CAD/CAM technologies have revolutionized the functional and aesthetic results in oncologic and reconstructive surgery, contributing to achieve greater precision in tumor resection and reconstructions for a personalized surgery.

VSP, 3D printing, CAD/CAM and intraoperative navigation have become essential tools for planning complicated surgeries, such as tumor resection of the head and neck and reconstruction of defects, thus saving valuable time in these kinds of operations, decreasing complications and increasing the accuracy of the final outcomes.

In addition, functional rehabilitation of oncologic patients with dental implants has contributed to achieve a significant improvement in the quality of life of these patients, returning oncologic patients to a similar quality of life to what they had before.

This Special Issue aims to cover recent advances in the development and application of these technologies in head and neck oncologic and reconstructive surgery, bringing researchers working on virtual surgical planning, medical 3D printing, CAD/CAM, dynamic navigation and dental implants together to push forward the clinical, translational and basic research of this promising new technology.

Prof. Dr. Mark L. Urken
Prof. Dr. Carlos Navarro Cuéllar
Dr. José Luis Cebríán-Carretero
Guest Editors

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Keywords

  • virtual surgical planning
  • 3D printing
  • CAD/CAM
  • intraoperative navigation
  • dental implants
  • quality of life

Published Papers (12 papers)

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Editorial

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4 pages, 227 KiB  
Editorial
New Technologies for Personalized Medicine in Head and Neck Oncologic and Reconstructive Surgery
by José Luis Cebrián Carretero and Carlos Navarro Cuéllar
J. Clin. Med. 2022, 11(15), 4261; https://doi.org/10.3390/jcm11154261 - 22 Jul 2022
Viewed by 1077
Abstract
The search for standardized protocols has been a constant concern in Head and Neck Reconstructive Surgery [...] Full article

Research

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8 pages, 2855 KiB  
Communication
Full Digital Workflow for Mandibular Ameloblastoma Management: Showcase for Technical Description
by Vincenzo Abbate, Giulia Togo, Umberto Committeri, Fernando Zarone, Gilberto Sammartino, Alessandra Valletta, Andrea Elefante, Luigi Califano and Giovanni Dell’Aversana Orabona
J. Clin. Med. 2023, 12(17), 5526; https://doi.org/10.3390/jcm12175526 - 25 Aug 2023
Cited by 1 | Viewed by 1687
Abstract
This is a showcase for technical description of a full digital workflow aimed to reconstruct and prosthetically rehabilitate the mandible after surgical resection. The surgery was performed following a computer-aided design and computer-aided manufacturing (CAD-CAM) guided workflow, using 3D reconstruction of the mandible [...] Read more.
This is a showcase for technical description of a full digital workflow aimed to reconstruct and prosthetically rehabilitate the mandible after surgical resection. The surgery was performed following a computer-aided design and computer-aided manufacturing (CAD-CAM) guided workflow, using 3D reconstruction of the mandible and the fibula. After 2 years, when the ossification of the flap was reached and verified by a computed tomography (CT) scan, surgery was performed using a two-step implant rehabilitation, with successful outcomes. Full article
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12 pages, 562 KiB  
Article
Assessment of Quality of Life in Head-and-Neck Oncologic Patients with Intraoral Soft-Tissue Defects Reconstructed with Buccinator Myomucosal Flap
by Marc Agea Martínez, Raúl Antúnez-Conde, Carlos Navarro Cuéllar, Manuel Tousidonis Rial, Ignacio Navarro Cuéllar, Ana María López López, Dafne Gascón Alonso, Ángela Sada Urmeneta and José J. Zamorano-León
J. Clin. Med. 2022, 11(24), 7458; https://doi.org/10.3390/jcm11247458 - 15 Dec 2022
Cited by 2 | Viewed by 1413
Abstract
The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a [...] Read more.
The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth. Full article
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8 pages, 634 KiB  
Article
Benefits of Patient-Specific Reconstruction Plates in Mandibular Reconstruction Surgical Simulation and Resident Education
by Khanh Linh Tran, Matthew Lee Mong, James Scott Durham and Eitan Prisman
J. Clin. Med. 2022, 11(18), 5306; https://doi.org/10.3390/jcm11185306 - 9 Sep 2022
Cited by 3 | Viewed by 1662
Abstract
Poorly contoured mandibular reconstruction plates are associated with postoperative complications. Recently, a technique emerged whereby preoperative patient-specific reconstructive plates (PSRP) are developed in the hopes of eliminating errors in the plate-bending process. This study’s objective is to determine if reconstructions performed with PSRP [...] Read more.
Poorly contoured mandibular reconstruction plates are associated with postoperative complications. Recently, a technique emerged whereby preoperative patient-specific reconstructive plates (PSRP) are developed in the hopes of eliminating errors in the plate-bending process. This study’s objective is to determine if reconstructions performed with PSRP are more accurate than manually contoured plates. Ten Otolaryngology residents each performed two ex vivo mandibular reconstructions, first using a PSRP followed by a manually contoured plate. Reconstruction time, CT scans, and accuracy measurements were collected. Paired Student’s t-test was performed. There was a significant difference between reconstructions with PSRP and manually contoured plates in: plate-mandible distance (0.39 ± 0.21 vs. 0.75 ± 0.31 mm, p = 0.0128), inter-fibular segment gap (0.90 ± 0.32 vs. 2.24 ± 1.03 mm, p = 0.0095), mandible-fibula gap (1.02 ± 0.39 vs. 2.87 ± 2.38 mm, p = 0.0260), average reconstruction deviation (1.11 ± 0.32 vs. 1.67 ± 0.47 mm, p = 0.0228), mandibular angle width difference (5.13 ± 4.32 vs. 11.79 ± 4.27 mm, p = 0.0221), and reconstruction time (16.67 ± 4.18 vs. 33.78 ± 8.45 min, p = 0.0006). Lower plate-mandible distance has been demonstrated to correlate with decreased plate extrusion rates. Similarly, improved bony apposition promotes bony union. PSRP appears to provide a more accurate scaffold to guide the surgeons in assembling donor bone segments, which could potentially improve patient outcome and reduce surgical time. Additionally, in-house PSRP can serve as a low-cost surgical simulation tool for resident education. Full article
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13 pages, 734 KiB  
Article
Personalized Surgery Service in a Tertiary Hospital: A Method to Increase Effectiveness, Precision, Safety and Quality in Maxillofacial Surgery Using Custom-Made 3D Prostheses and Implants
by Jorge Pamias-Romero, Joan Masnou-Pratdesaba, Manel Sáez-Barba, Alba de-Pablo-García-Cuenca, Sahyly Siurana-Montilva, Anna Sala-Cunill, Victòria Valls-Comamala, Rosa Pujol-Pina and Coro Bescós-Atín
J. Clin. Med. 2022, 11(16), 4791; https://doi.org/10.3390/jcm11164791 - 16 Aug 2022
Cited by 4 | Viewed by 1383
Abstract
Personalized surgery (PS) involves virtual planning (VP) and the use of 3D printing technology to design and manufacture custom-made elements to be used during surgery. The widespread use of PS has fostered a paradigm shift in the surgical process. A recent analysis performed [...] Read more.
Personalized surgery (PS) involves virtual planning (VP) and the use of 3D printing technology to design and manufacture custom-made elements to be used during surgery. The widespread use of PS has fostered a paradigm shift in the surgical process. A recent analysis performed in our hospital—along with several studies published in the literature—showed that the extensive use of PS does not preclude the lack of standardization in the process. This means that despite the widely accepted use of this technology, standard individual roles and responsibilities have not been properly defined, and this could hinder the logistics and cost savings in the PS process. The aim of our study was to describe the method followed and the outcomes obtained for the creation of a PS service for the Oral and Maxillofacial Surgery Unit that resolves the current absence of internal structure, allows for the integration of all professionals involved and improves the efficiency and quality of the PS process. We performed a literature search on the implementation of PS techniques in tertiary hospitals and observed a lack of studies on the creation of PS units or services in such hospitals. Therefore, we believe that our work is innovative and has the potential to contribute to the implementation of PS units in other hospitals. Full article
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14 pages, 1700 KiB  
Article
Advances and Innovations in Ablative Head and Neck Oncologic Surgery Using Mixed Reality Technologies in Personalized Medicine
by Nadia Karnatz, Henriette L. Möllmann, Max Wilkat, Aida Parviz and Majeed Rana
J. Clin. Med. 2022, 11(16), 4767; https://doi.org/10.3390/jcm11164767 - 16 Aug 2022
Cited by 3 | Viewed by 2323
Abstract
The benefit of computer-assisted planning in head and neck ablative and reconstructive surgery has been extensively documented over the last decade. This approach has been proven to offer a more secure surgical procedure. In the treatment of cancer of the head and neck, [...] Read more.
The benefit of computer-assisted planning in head and neck ablative and reconstructive surgery has been extensively documented over the last decade. This approach has been proven to offer a more secure surgical procedure. In the treatment of cancer of the head and neck, computer-assisted surgery can be used to visualize and estimate the location and extent of the tumor mass. Nowadays, some software tools even allow the visualization of the structures of interest in a mixed reality environment. However, the precise integration of mixed reality systems into a daily clinical routine is still a challenge. To date, this technology is not yet fully integrated into clinical settings such as the tumor board, surgical planning for head and neck tumors, or medical and surgical education. As a consequence, the handling of these systems is still of an experimental nature, and decision-making based on the presented data is not yet widely used. The aim of this paper is to present a novel, user-friendly 3D planning and mixed reality software and its potential application for ablative and reconstructive head and neck surgery. Full article
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12 pages, 2101 KiB  
Article
Virtual Surgical Planning and Customized Subperiosteal Titanium Maxillary Implant (CSTMI) for Three Dimensional Reconstruction and Dental Implants of Maxillary Defects after Oncological Resection: Case Series
by Jose Luís Cebrián Carretero, José Luis Del Castillo Pardo de Vera, Néstor Montesdeoca García, Pablo Garrido Martínez, Marta María Pampín Martínez, Iñigo Aragón Niño, Ignacio Navarro Cuéllar and Carlos Navarro Cuéllar
J. Clin. Med. 2022, 11(15), 4594; https://doi.org/10.3390/jcm11154594 - 6 Aug 2022
Cited by 7 | Viewed by 2970
Abstract
Maxillectomies cause malocclusion, masticatory disorders, swallowing disorders and poor nasolabial projection, with consequent esthetic and functional sequelae. Reconstruction can be achieved with conventional approaches, such as closure of the maxillary defect by microvascular free flap surgery or prosthetic obturation. Four patients with segmental [...] Read more.
Maxillectomies cause malocclusion, masticatory disorders, swallowing disorders and poor nasolabial projection, with consequent esthetic and functional sequelae. Reconstruction can be achieved with conventional approaches, such as closure of the maxillary defect by microvascular free flap surgery or prosthetic obturation. Four patients with segmental maxillary defects that had been reconstructed with customized subperiosteal titanium maxillary implants (CSTMI) through virtual surgical planning (VSP), STL models and CAD/CAM titanium mesh were included. The smallest maxillary defect was 4.1 cm and the largest defect was 9.6 cm, with an average of 7.1 cm. The reconstructed maxillary vertical dimension ranged from 9.3 mm to 17.4 mm, with a mean of 13.17 mm. The transverse dimension of the maxilla at the crestal level was attempted to be reconstructed based on the pre-excision CT scan, and these measurements ranged from 6.5 mm in the premaxilla area to 14.6 mm at the posterior level. All patients were rehabilitated with a fixed prosthesis on subperiosteal implants with good esthetic and functional results. In conclusion, we believe that customized subperiosteal titanium maxillary implants (CSTMI) are a safe alternative for maxillary defects reconstruction, allowing for simultaneous dental rehabilitation while restoring midface projection. Nonetheless, prospective and randomized trials are required with long-term follow-up, to assess its long-term performance and safety. Full article
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11 pages, 2428 KiB  
Article
Mechanical Fatigue Performance of Patient-Specific Polymer Plates in Oncologic Mandible Reconstruction
by Julian Lommen, Lara Schorn, Christoph Sproll, Norbert R. Kübler, Luis Fernando Nicolini, Ricarda Merfort, Ayimire Dilimulati, Frank Hildebrand, Majeed Rana and Johannes Greven
J. Clin. Med. 2022, 11(12), 3308; https://doi.org/10.3390/jcm11123308 - 9 Jun 2022
Cited by 3 | Viewed by 2064
Abstract
Mandible defects are conventionally reconstructed using titanium plates. However, titanium causes metallic artifacts which impair radiological imaging. This study aims at evaluating mechanical fatigue of radiolucent fiber-reinforced polyetheretherketone (f-PEEK), polyetheretherketone (PEEK), polyetherketoneketone (PEKK), and polyphenylsulfone (PPSU) polymer plates for mandible reconstruction. A total [...] Read more.
Mandible defects are conventionally reconstructed using titanium plates. However, titanium causes metallic artifacts which impair radiological imaging. This study aims at evaluating mechanical fatigue of radiolucent fiber-reinforced polyetheretherketone (f-PEEK), polyetheretherketone (PEEK), polyetherketoneketone (PEKK), and polyphenylsulfone (PPSU) polymer plates for mandible reconstruction. A total of 30 plates (titanium [n = 6], f-PEEK [n = 6], PEEK [n = 6], PEKK [n = 6], PPSU [n = 6]) were implanted in synthetic mandibulectomized polyurethane mandibles. Servo-pneumatic mechanical testing with cyclic application of 30–300 N at 3 Hz was conducted. Bite forces were 70% on the unresected and 30% on the resected side. Total number of cycles was set to 250,000. Testing was aborted in case of plate or screw failure. Axial load to failure was tested with a speed of 1 mm/s. Kruskal–Wallis and Dunn’s post hoc tests were used. Titanium, f-PEEK, and PEEK showed no failure in fatigue testing and PPSU (p < 0.001) failed against titanium, f-PEEK, PEEK, and PEKK. Titanium allowed the highest load to failure compared to f-PEEK (p = 0.049), PEEK (p = 0.008), PEKK (p < 0.001), and PPSU (p = 0.007). f-PEEK, PEEK, and PEKK withstood expected physiological bite force. Although titanium plates provided the highest fatigue strength, f-PEEK and PEEK plates showed no failure over 250,000 chewing cycles indicating sufficient mechanical strength for mandible reconstruction. Full article
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15 pages, 4350 KiB  
Article
Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol
by Davide Sozzi, Andrea Filippi, Gabriele Canzi, Elena De Ponti, Alberto Bozzetti and Giorgio Novelli
J. Clin. Med. 2022, 11(7), 2060; https://doi.org/10.3390/jcm11072060 - 6 Apr 2022
Cited by 6 | Viewed by 1804
Abstract
Aim: the purpose of this work is to present an innovative protocol for virtual planning and surgical navigation in post-oncological mandibular reconstruction through fibula free flap. In order to analyze its applicability, an evaluation of accuracy for the surgical protocol has been [...] Read more.
Aim: the purpose of this work is to present an innovative protocol for virtual planning and surgical navigation in post-oncological mandibular reconstruction through fibula free flap. In order to analyze its applicability, an evaluation of accuracy for the surgical protocol has been performed. Methods: 21 patients surgically treated for mandibular neoplasm have been included in the analysis. The Brainlab Vector Vision 3.0® software for surgical navigation has been used for preoperative surgical planning and intra-operative navigation. A post-operative accuracy evaluation has been performed matching the position of mandibular landmarks between pre-operative and post-operative CT scans. Results: the maximal discrepancy observed was included between −3.4 mm and +3.2 mm, assuming negative values for under correction and positive values for overcorrection. An average grade of accuracy included between 0.06 ± 0.58 mm and 0.43 ± 0.68 mm has been observed for every mandibular landmark examined, except for mandibular angles that showed a mean discrepancy value included between 1.36 ± 1.73 mm and 1.46 ± 1.02 mm when compared to preoperative measurements. Conclusion: a satisfying level of accuracy has been observed in the protocol presented, which appears to be more versatile if compared to closed custom-made systems. The technique described may represent a valid option for selected patients, but it cannot be considered for routine activity because of the complexity of the method, the mobility of the jaw, the necessity of surgical navigator and the long surgical learning curve that is required. Full article
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Review

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19 pages, 1248 KiB  
Review
The Exoscope in Neurosurgery: An Overview of the Current Literature of Intraoperative Use in Brain and Spine Surgery
by Nicola Montemurro, Alba Scerrati, Luca Ricciardi and Gianluca Trevisi
J. Clin. Med. 2022, 11(1), 223; https://doi.org/10.3390/jcm11010223 - 31 Dec 2021
Cited by 86 | Viewed by 5300
Abstract
Background: Exoscopes are a safe and effective alternative or adjunct to the existing binocular surgical microscope for brain tumor, skull base surgery, aneurysm clipping and both cervical and lumbar complex spine surgery that probably will open a new era in the field of [...] Read more.
Background: Exoscopes are a safe and effective alternative or adjunct to the existing binocular surgical microscope for brain tumor, skull base surgery, aneurysm clipping and both cervical and lumbar complex spine surgery that probably will open a new era in the field of new tools and techniques in neurosurgery. Methods: A Pubmed and Ovid EMBASE search was performed to identify papers that include surgical experiences with the exoscope in neurosurgery. PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) were followed. Results: A total of 86 articles and 1711 cases were included and analyzed in this review. Among 86 papers included in this review 74 (86%) were published in the last 5 years. Out of 1711 surgical procedures, 1534 (89.6%) were performed in the operative room, whereas 177 (10.9%) were performed in the laboratory on cadavers. In more detail, 1251 (72.7%) were reported as brain surgeries, whereas 274 (16%) and 9 (0.5%) were reported as spine and peripheral nerve surgeries, respectively. Considering only the clinical series (40 studies and 1328 patients), the overall surgical complication rate was 2.6% during the use of the exoscope. These patients experienced complication profiles similar to those that underwent the same treatments with the OM. The overall switch incidence rate from exoscope to OM during surgery was 5.8%. Conclusions: The exoscope seems to be a safe alternative compared to an operative microscope for the most common brain and spinal procedures, with several advantages that have been reached, such as an easier simplicity of use and a better 3D vision and magnification of the surgical field. Moreover, it offers the opportunity of better interaction with other members of the surgical staff. All these points set the first step for subsequent and short-term changes in the field of neurosurgery and offer new educational possibilities for young neurosurgery and medical students. Full article
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Other

14 pages, 2389 KiB  
Case Report
Custom CAD/CAM Peek Implants for Complex Orbitocranial Reconstruction: Our Experience with 15 Patients
by Cristina Cárdenas-Serres, Fernando Almeida-Parra, Anna María Simón-Flors, Patricia de Leyva-Moreno, Álvaro Ranz-Colio, Luis Ley-Urzaiz and Julio Acero-Sanz
J. Clin. Med. 2024, 13(3), 695; https://doi.org/10.3390/jcm13030695 - 25 Jan 2024
Viewed by 836
Abstract
Bone defects within the cranio-orbital complex present unique challenges in terms of surgical planning and reconstruction. This article presents a novel approach using PEEK material and advanced surgical technologies to address these challenges. A retrospective analysis of 15 patients who underwent craniofacial reconstruction [...] Read more.
Bone defects within the cranio-orbital complex present unique challenges in terms of surgical planning and reconstruction. This article presents a novel approach using PEEK material and advanced surgical technologies to address these challenges. A retrospective analysis of 15 patients who underwent craniofacial reconstruction using patient-specific polyetheretherketone (PEEK) implants between 2016 and 2021 was carried out. Comprehensive preoperative planning was performed, utilizing advanced imaging techniques and specialized software for virtual surgical planning. Patient-specific PEEK PSIs were designed and manufactured based on the preoperative plan. Intraoperative navigation was used to guide the surgical procedure, enabling precise osteotomy and optimal implant placement. This article describes the step-by-step process and the tools utilized in each phase. The etiologies were as follows: meningioma in seven cases, benign lesions in five cases, malignant tumors in two cases, and trauma sequelae in one case. In all cases, 3D-printed PEEK implants were utilized to achieve precise reconstruction. No major complications were described. In one case, an implant replacement was needed with successful outcomes. Our study demonstrates the feasibility and effectiveness of using PEEK patient-specific implants for personalized craniofacial reconstruction. The combination of advanced imaging, virtual planning, and CAD-CAM technology contributes to improved surgical outcomes in terms of oncologic margin control, functional restoration, and aesthetic results. Full article
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34 pages, 1347 KiB  
Systematic Review
Applications of CAD/CAM Technology for Craniofacial Implants Placement and Manufacturing of Auricular Prostheses—Systematic Review
by Waqas Tanveer, Angela Ridwan-Pramana, Pedro Molinero-Mourelle and Tymour Forouzanfar
J. Clin. Med. 2023, 12(18), 5950; https://doi.org/10.3390/jcm12185950 - 13 Sep 2023
Viewed by 2072
Abstract
This systematic review was aimed at gathering the clinical and technical applications of CAD/CAM technology for craniofacial implant placement and processing of auricular prostheses based on clinical cases. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, an electronic [...] Read more.
This systematic review was aimed at gathering the clinical and technical applications of CAD/CAM technology for craniofacial implant placement and processing of auricular prostheses based on clinical cases. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, an electronic data search was performed. Human clinical studies utilizing digital planning, designing, and printing systems for craniofacial implant placement and processing of auricular prostheses for prosthetic rehabilitation of auricular defects were included. Following a data search, a total of 36 clinical human studies were included, which were digitally planned and executed through various virtual software to rehabilitate auricular defects. Preoperative data were collected mainly through computed tomography scans (CT scans) (55 cases); meanwhile, the most common laser scanners were the 3dMDface System (3dMD LLC, Atlanta, Georgia, USA) (6 cases) and the 3 Shape scanner (3 Shape, Copenhagen, Denmark) (6 cases). The most common digital design software are Mimics Software (Mimics Innovation Suite, Materialize, Leuven, Belgium) (18 cases), Freeform software (Freeform, NC, USA) (13 cases), and 3 Shape software (3 Shape, Copenhagen, Denmark) (12 cases). Surgical templates were designed and utilized in 35 cases to place 88 craniofacial implants in auricular defect areas. The most common craniofacial implants were Vistafix craniofacial implants (Entific Medical Systems, Goteborg, Sweden) in 22 cases. A surgical navigation system was used to place 20 craniofacial implants in the mastoid bone. Digital applications of CAD/CAM technology include, but are not limited to, study models, mirrored replicas of intact ears, molds, retentive attachments, customized implants, substructures, and silicone prostheses. The included studies demonstrated a predictable clinical outcome, reduced the patient’s visits, and completed the prosthetic rehabilitation in reasonable time and at reasonable cost. However, equipment costs and trained technical staff were highlighted as possible limitations to the use of CAD/CAM systems. Full article
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