title: Virtual planning of complex head and neck reconstruction results in satisfactory match between real outcomes and virtual models.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany, h.hanken@uke.de.
authors.forename: Henning
authors.initials: H
authors.lastname: Hanken
authors.forename: Clemens
authors.initials: C
authors.lastname: Schablowsky
authors.forename: Ralf
authors.initials: R
authors.lastname: Smeets
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.forename: Susanne
authors.initials: S
authors.lastname: Sehner
authors.forename: Björn
authors.initials: B
authors.lastname: Riecke
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Nourwali
authors.forename: Oliver
authors.initials: O
authors.lastname: Vorwig
authors.forename: Alexander
authors.initials: A
authors.lastname: Gröbe
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Dam
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D016025:Bone Transplantation; D017076:Computer-Aided Design; D005260:Female; D005360:Fibula / Q000637:transplantation; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008297:Male; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008439:Maxillary Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013515:Surgery, Oral; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014584:User-Computer Interface
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