INITIAL APPLICATION OF COMPUTER ASSISTED NAVIGATION SYSTEM IN RECONSTRUCTION OF MANDIBULAR DEFECTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XUXu ^1,2 , ZHUHuiyong ¹ , LIZhiyong ¹ , HUANGXu ¹ , ZHAOWenquan ¹ , YOUJia ³ , WANGHuiming ¹ ,  LIUJianhua ¹

1. Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310003, P. R. China;
2. Department of Stomatology, the People's Hospital of Quzhou;
3. College of Mechanical Engineering, Zhejiang University of Technology;

Corresponding?author：

LIUJianhua, Email: timliu@mail.hz.zj.cn

Keywords：

Computer assisted navigation system; Mandibular defect; Repair and reconstruction

DOI：

10.7507/1002-1892.20150144

Video：

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Objective To evaluate the value of computer assisted navigation system (CANS) in the reconstruction of mandibular defects. Methods Between April 2012 and September 2014, 8 patients with mandibular defects were included in this study. There were 5 males and 3 females with an age range of 22-50 years (mean, 34.5 years), including 4 cases of ameloblastoma, 3 cases of odontogenic keratocyst, and 1 case of condylar osteoma. According to the CRABS (condyle, ramus, angle, body, symphysis) classification criteria based on the location of mandibular defect, there were 1 case of right CRAB type, 1 case of left RABS type, 1 case of left CR type, 1 case of right RAB type, 1 case of left C type, 1 case of right RABS+left S type, and 2 cases of right AB type. With the biteplate fixing mandible, maxillofacial CT and the donor site CT scan were done. Computer assisted design was made by using Surgicase CMF5.0 software and BrainLab Iplan software, included delineating the osteotomy lines for resection, ascertaining the normal anatomic structures for defect reconstruction, and determining the reconstructive morphology. With guide plates and the guidance of BrainLab navigation system, an en bloc tumor resection and simultaneous defect reconstruction were performed under the precise localization of mandibular angle and condyle. Preoperative and postoperative CT images were superimposed in Geomagic studio12.0 software system, and both were compared by three-dimensional (3D) objects and 2D slices. The complications and signs of recurrence were observed. Results Under the guidance of navigation, preoperative facial symmetry design, surgery simulation, and simultaneous navigation operation were performed successfully. The postoperative CT and postoperative 3D error analysis showed osteotomy lines and reconstruction contour had good matching with the preoperative planning. The error of important corresponding points (mandibular angle and external pole of condyle) in the reconstruction of mandibular defects were (1.83±0.19) mm and (1.61±0.24) mm. The patients were followed up 2-6 months (mean, 3.5 months). No complication was observed in the other patients except the patients undergoing rib transplantation who had mild limitation of mouth opening. Good facial symmetry was obtained, and no tumor recurrence was found. Conclusion CANS can effectively increase the surgical precision in the reconstruction of mandibular defects and reduce complications, and recover facial symmetry. It is regarded as a valuable technique in this potentially complicated procedure.

Citation： XUXu, ZHUHuiyong, LIZhiyong, HUANGXu, ZHAOWenquan, YOUJia, WANGHuiming, LIUJianhua. INITIAL APPLICATION OF COMPUTER ASSISTED NAVIGATION SYSTEM IN RECONSTRUCTION OF MANDIBULAR DEFECTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 661-666. doi: 10.7507/1002-1892.20150144 Copy

1.	Eckardt A, Swennen G, Teltzrow T. Melanotic neuroectodermal tumor of infancy involving the mandible:7-year follow-up after hemimandibulectomy and costochondral graft reconstruction. J Craniofac Surg, 2001, 12(4):349-354.
2.	Dimitroulis G. Mandibular reconstruction following ablative tumour surgery:an overview of treatment planning. Aust N Z J Surg, 2000, 70(2):120-126.
3.	Shvyrkov MB, Shamsudinov AKh, Sumarokov DD, et al. Non-free osteoplasty of the mandible in maxillofacial gunshot wounds:mandibular by reconstruction by compression-osteodistraction. Br J Oral Maxillofac Surg, 1999, 37(4):261-267.
4.	Bell RB. Computer planning and intraoperative navigation in cranio-maxillofacial surgery. Oral Maxillofac Surg Clin North Am, 2010, 22(1):135-156.
5.	Balasundaram I, Al-Hadad I, Parmar S. Recent advances in reconstructive oral and maxillofacial surgery. Br J Oral Maxillofac Surg, 2012, 50(8):695-705.
6.	Hassfeld S, Mühling J. Computer assisted oral and maxillofacial surgery-a review and an assessment of technology. Int J Oral Maxillofac Surg, 2001, 30(1):2-13.
7.	吳錦陽, 桂海軍, 張詩雷, 等. 計算機輔助導航技術在顳下頜關節側方成形術中的應用. 組織工程與重建外科雜志, 2014, 10(1):43-46.
8.	于洪波, 王旭東, 張詩雷, 等. 計算機輔助導航技術在上頜骨腫瘤切除及缺損重建中的應用. 中國口腔頜面外科雜志, 2013, 11(6):472-476.
9.	于洪波, 張詩雷, 王旭東, 等. 計算機輔助導航技術在口腔頜面外科中的應用——104例病例分析. 上海口腔醫學, 2012, 21(4):416-421.
10.	廖貴清, 蘇宇雄. 下頜骨缺損分類. 廣東牙病防治, 2008, 16(2):57-59.
11.	Luebbers HT, Messmer P, Obwegeser JA, et al. Comparison of different registration methods for surgical navigation in cranio-maxillofacial surgery. J Craniomaxillofac Surg, 2008, 36(2):109-116.
12.	Eggers G, Mühling J, Marmulla R. Image-to-patient registration techniques in head surgery. Int J Oral Maxillofac Surg, 2006, 35(12):1081-1095.
13.	Chiu WK, Luk WK, Cheung LK. Three-dimensional accuracy of implant placement in a computer-assissted navigation system. Int J Oral Maxillofac Implants, 2006, 21(3):465-470.
14.	蔡志剛. 數字化外科技術在下頜骨缺損修復重建中的應用. 中華口腔醫學雜志, 2012, 47(8):474-478.
15.	Bell RB, Weimer KA, Dierks EJ, et al. Computer planning and intraoperative navigation for palatomaxillary and mandibular reconstruction with fibular free flaps. J Oral Maxillofac Surg, 2011, 69(3):724-732.
16.	劉筱菁, 賀洋, 鞏璽, 等. 計算機導航技術在口腔頜面部創傷整復中的應用. 中華口腔醫學雜志, 2012, 47(11):645-650.
17.	于洪波, 沈國芳, 張詩雷, 等. 計算機輔助導航外科在顳下頜關節成形術中的應用. 上海口腔醫學, 2008, 17(5):452-456.
18.	Marmulla R, Mühling J, Lüth T, et al. Advanced surface-recording techniques for computer-assisted oral and maxillofacial surgery. Br J Oral Maxillofac Surg, 2004, 42(6):511-519.
19.	高濤, 富建明, 樓勇貞, 等. 應用計算機輔助手術導航系統治療單側顴骨復合體骨折. 中華口腔醫學雜志, 2012, 47(4):238-240.
20.	Schep NW, Broeders IA, van der Werken C. Computer assisted orthopaedic and trauma surgery. State of the art and future perspectives, Injury, 2003, 34(4):299-306.

1. Eckardt A, Swennen G, Teltzrow T. Melanotic neuroectodermal tumor of infancy involving the mandible:7-year follow-up after hemimandibulectomy and costochondral graft reconstruction. J Craniofac Surg, 2001, 12(4):349-354.
2. Dimitroulis G. Mandibular reconstruction following ablative tumour surgery:an overview of treatment planning. Aust N Z J Surg, 2000, 70(2):120-126.
3. Shvyrkov MB, Shamsudinov AKh, Sumarokov DD, et al. Non-free osteoplasty of the mandible in maxillofacial gunshot wounds:mandibular by reconstruction by compression-osteodistraction. Br J Oral Maxillofac Surg, 1999, 37(4):261-267.
4. Bell RB. Computer planning and intraoperative navigation in cranio-maxillofacial surgery. Oral Maxillofac Surg Clin North Am, 2010, 22(1):135-156.
5. Balasundaram I, Al-Hadad I, Parmar S. Recent advances in reconstructive oral and maxillofacial surgery. Br J Oral Maxillofac Surg, 2012, 50(8):695-705.
6. Hassfeld S, Mühling J. Computer assisted oral and maxillofacial surgery-a review and an assessment of technology. Int J Oral Maxillofac Surg, 2001, 30(1):2-13.
7. 吳錦陽, 桂海軍, 張詩雷, 等. 計算機輔助導航技術在顳下頜關節側方成形術中的應用. 組織工程與重建外科雜志, 2014, 10(1):43-46.
8. 于洪波, 王旭東, 張詩雷, 等. 計算機輔助導航技術在上頜骨腫瘤切除及缺損重建中的應用. 中國口腔頜面外科雜志, 2013, 11(6):472-476.
9. 于洪波, 張詩雷, 王旭東, 等. 計算機輔助導航技術在口腔頜面外科中的應用——104例病例分析. 上海口腔醫學, 2012, 21(4):416-421.
10. 廖貴清, 蘇宇雄. 下頜骨缺損分類. 廣東牙病防治, 2008, 16(2):57-59.
11. Luebbers HT, Messmer P, Obwegeser JA, et al. Comparison of different registration methods for surgical navigation in cranio-maxillofacial surgery. J Craniomaxillofac Surg, 2008, 36(2):109-116.
12. Eggers G, Mühling J, Marmulla R. Image-to-patient registration techniques in head surgery. Int J Oral Maxillofac Surg, 2006, 35(12):1081-1095.
13. Chiu WK, Luk WK, Cheung LK. Three-dimensional accuracy of implant placement in a computer-assissted navigation system. Int J Oral Maxillofac Implants, 2006, 21(3):465-470.
14. 蔡志剛. 數字化外科技術在下頜骨缺損修復重建中的應用. 中華口腔醫學雜志, 2012, 47(8):474-478.
15. Bell RB, Weimer KA, Dierks EJ, et al. Computer planning and intraoperative navigation for palatomaxillary and mandibular reconstruction with fibular free flaps. J Oral Maxillofac Surg, 2011, 69(3):724-732.
16. 劉筱菁, 賀洋, 鞏璽, 等. 計算機導航技術在口腔頜面部創傷整復中的應用. 中華口腔醫學雜志, 2012, 47(11):645-650.
17. 于洪波, 沈國芳, 張詩雷, 等. 計算機輔助導航外科在顳下頜關節成形術中的應用. 上海口腔醫學, 2008, 17(5):452-456.
18. Marmulla R, Mühling J, Lüth T, et al. Advanced surface-recording techniques for computer-assisted oral and maxillofacial surgery. Br J Oral Maxillofac Surg, 2004, 42(6):511-519.
19. 高濤, 富建明, 樓勇貞, 等. 應用計算機輔助手術導航系統治療單側顴骨復合體骨折. 中華口腔醫學雜志, 2012, 47(4):238-240.
20. Schep NW, Broeders IA, van der Werken C. Computer assisted orthopaedic and trauma surgery. State of the art and future perspectives, Injury, 2003, 34(4):299-306.

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INITIAL APPLICATION OF COMPUTER ASSISTED NAVIGATION SYSTEM IN RECONSTRUCTION OF MANDIBULAR DEFECTS

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