Virtual planning of complex head and neck reconstruction results in satisfactory match between real outcomes and virtual models

Abstract

Objectives

The reconstruction of large facial bony defects using microvascular transplants requires extensive surgery to achieve full rehabilitation of form and function. The purpose of this study is to measure the agreement between virtual plans and the actual results of maxillofacial reconstruction.

Materials and methods

This retrospective cohort study included 30 subjects receiving maxillofacial reconstruction with a preoperative virtual planning. Parameters including defect size, position, angle and volume of the transplanted segments were compared between the virtual plan and the real outcome using paired t test.

Results

A total of 63 bone segments were transplanted. The mean differences between the virtual planning and the postoperative situation were for the defect sizes 1.17 mm (95 % confidence interval (CI) (−.21 to 2.56 mm); p = 0.094), for the resection planes 1.69 mm (95 % CI (1.26–2.11); p = 0.033) and 10.16° (95 % CI (8.36°–11.96°); p < 0.001) and for the planes of the donor segments 10.81° (95 % CI (9.44°–12.17°); p < 0.001) The orientation of the segments differed by 6.68° (95 % CI (5.7°–7.66°); p < 0.001) from the virtual plan; the length of the segments differed by −0.12 mm (95 % CI (0.89–0.65 mm); not significant (n.s.)), respectively, while the volume differed by 73.3 % (95 % CI (69.4–77.6 %); p < 0.001). The distance between the transplanted segments and the remaining bone was 1.49 mm (95 % CI (1.24–1.74); p < 0.001) and between the segments 1.49 mm (95 % CI (1.16–1.81); p < 0.001).

Conclusions

Virtual plans for mandibular and maxillofacial reconstruction can be realised with excellent match.

Clinical relevance

These highly satisfactory postoperative results are the basis for an optimal functional and aesthetic reconstruction in a single surgical procedure. The technique should be further investigated in larger study populations and should be further improved.

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Acknowledgments

The authors gratefully acknowledge the help and support of Mathias Gruenig, Daniel Mesmer, Herbert Friesen (DePuySynthes, Oberdorf, Switzerland), Joris Bellinckx and Pieter-Jan Belmans (Materialise NV, Leuven, Belgium).

Conflict of interest

Max Heiland, MD, DMD, PhD, received remuneration rates for presentations and reimbursements for participation fees of congresses and travelling from Synthes (DePuySynthes, Oberdorf, Switzerland) and Materialise (Materialise NV, Leuven, Belgium). All other authors have no conflict of interest or financial disclosure to declare.

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Correspondence to Henning Hanken.

Additional information

Henning Hanken and Clemens Schablowsky contributed equally.

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Hanken, H., Schablowsky, C., Smeets, R. et al. Virtual planning of complex head and neck reconstruction results in satisfactory match between real outcomes and virtual models. Clin Oral Invest 19, 647–656 (2015). https://doi.org/10.1007/s00784-014-1291-5

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Keywords

  • CAD/CAM
  • Computer-aided design
  • Computer-aided manufacturing
  • Virtual planning
  • Microvascular bone flap
  • Fibula free flap
  • Iliac crest flap
  • Cutting guide
  • Prebent plate
  • Retrospective study