title: Short-term outcomes of mandibular reconstruction in oncological patients using a CAD/CAM prosthesis including a condyle supporting a fibular free flap.
abstract: OBJECTIVE
  Condylar reconstruction and replacement using alloplastic materials currently attracts much surgical interest. The major challenge is to functionally reconstruct the anatomical region; this is crucial in terms of correct mandibular function. The goal of the present study was to evaluate the clinical outcomes of and complications experienced by a series of oncological patients who underwent computer-aided design/computer-aided manufacturing (CAD/CAM) condylar reconstruction following resection-disarticulation of the mandible.
  
  
  METHODS
  We included nine patients who underwent disarticulation resection surgery to treat benign and malignant mandibular tumors involving the condylar region. All resections preserved the articular meniscus and featured placement of a CAD/CAM reconstructive plate supporting a fibular, microvascular free flap. The head of the prosthetic condyle reproduced the anatomical morphology of the native condyle. Patients were clinically evaluated in terms of occlusion stability, mandibular functional recovery, static and dynamic pain, and preservation of the normal mandibular contour. Planning and postoperative computed tomography (CT) scans were superimposed to assess the accuracy of reconstruction.
  
  
  RESULTS
  No patient experienced plate exposure and, on direct clinical examination, no patient complained of joint pain. No patient developed plate loosening. No resorption of the glenoid fossa was evident when pre- and postoperative bone thicknesses were compared by CT. Preoperative occlusion was preserved in all dentate patients. One patient exhibited condylar displacement. In terms of reconstructive accuracy, the average postoperative deviation of the condyle from the preoperative position was 3.8 mm (range: 1.3-6.7 mm).
  
  
  CONCLUSIONS
  The clinical outcomes of our series of oncological patients who underwent reconstruction using CAD/CAM plates including condyles were encouraging. The utility of our protocol needs to be confirmed in larger patient series.
authors.affiliation: Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. C. Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy. Electronic address: achille.tarsitano2@unibo.it.
authors.forename: Achille
authors.initials: A
authors.lastname: Tarsitano
authors.affiliation: Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. C. Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Battaglia
authors.affiliation: Maxillofacial Surgery Unit (Head: Prof. P. Cascone), Sapienza University of Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Ramieri
authors.affiliation: Maxillofacial Surgery Unit (Head: Prof. P. Cascone), Sapienza University of Rome, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Cascone
authors.affiliation: Section of Prosthodontics, Department of Biomedical and Neuromotor Sciences (Head: Prof. R. Scotti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ciocca
authors.affiliation: Section of Prosthodontics, Department of Biomedical and Neuromotor Sciences (Head: Prof. R. Scotti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Scotti
authors.affiliation: Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. C. Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marchetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D017076:Computer-Aided Design; D005260:Female; D005360:Fibula / Q000637:transplantation*; D058752:Free Tissue Flaps / Q000601:surgery*; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D011474:Prosthesis Design / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Computer-aided design; Computer-aided manufacturing; Condylar prosthesis; Mandibular reconstruction; Temporomandibular joint reconstruction