Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial.
BACKGROUND
Computer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome.


METHODS
Twenty patients were randomly assigned to computer-assisted or conventional mandibular reconstruction with vascularized iliac crest bone graft in a prospective study design.Virtual surgical planning was based on preoperative CT-data using specific surgical planning software. A rapid prototyping guide transferred the virtual surgery plan to the operation site. During surgery the transplant ischemic time, reconstruction time, time for shaping the transplant and amount of bone removed were measured. Additionally, the difference in the intercondylar distance before and after surgery was calculated.


RESULTS
Computer-assisted surgery shortened the time of transplant ischemia (P < 0.005) and defect reconstruction (P < 0.001) compared to conventional surgery. The time to saw and shape the transplant at the donor site was shorter using conventional surgery (P < 0.005); therefore, the overall time for surgery didn't change (P = 0.527). In the computer-assisted group, the amount of bone harvested equaled the defect size, whereas the transplant size in the conventional group exceeded the defect site by 16.8 ± 5.6 mm (P < 0.001) on average. The intercondylar distance before compared to after surgery was less affected in the computer-assisted than in the conventional group (P < 0.001).


CONCLUSIONS
The presented study shows that computer-assisted surgery can help reduce the time for mandibular defect reconstruction and consequently the transplant ischemic time. In the computer-assisted group, the iliac crest donor site defect was downsized and the postoperative condyle position was less altered, reducing possible risks of postoperative complications and donor site morbidity.


BACKGROUND
DRKS00005181.
Nassim
N
Ayoub
Alireza
A
Ghassemi
Majeed
M
Rana
Marcus
M
Gerressen
Dieter
D
Riediger
Frank
F
Hölzle
Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany. amodabber@ukaachen.de.
Ali
A
Modabber
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000009:adverse effects; D064595:Composite Tissue Allografts / Q000637:transplantation*; D005260:Female; D005858:Germany; D006801:Humans; D007085:Ilium / Q000098:blood supply* / Q000637:transplantation*; D021621:Imaging, Three-Dimensional; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D061646:Operative Time; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012984:Software; D025321:Surgery, Computer-Assisted; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult