title: Functional Outcome of CAD/CAM-Assisted versus Conventional Microvascular, Fibular Free Flap Reconstruction of the Mandible: A Retrospective Study of 30 Cases.
abstract: BackgroundDifferent advantages of virtually planned and guided mandibular reconstructions have been described. Functional analyses and comparisons with conventionally reconstructed patients.MethodsWe retrospectively analyzed 30 cases of mandibular reconstructions that involved virtually planned or conventional microvascular, fibular free flaps that occurred between April 2011 and December 2014 at a single center. The results were also compared with a healthy cohort of 30 participants. Axiographic measurements were performed postoperatively, and uni- and multivariate regressions analyses were performed to determine the association between possible predictor variables on functional outcome.ResultsOperation time, hospital stay, number of osteotomies, incidence of postoperative temporomandibular joint pain, noise, and tension did not differ significantly between the conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) groups (eachp> 0.05). Mouth opening and protrusion and laterotrusion also did not differ significantly (eachp> 0.05) but were significantly reduced compared with the healthy group. Univariate analysis showed a significant influence of postoperative irradiation on mouth opening and laterotrusion in the conventional group (p= 0.047 andp= 0.028). In addition, multivariate analysis showed a significant influence of indication and number of osteotomies on laterotrusion (p= 0.005 andp= 0.043). Uni and multivariate analyses revealed a significant influence of indication, preoperative irradiation, and number of osteotomies on protrusion and mouth opening in the CAD/CAM group (p= 0.016,p= 0.044, andp= 0.028).ConclusionCAD/CAM-assisted reconstructions of the mandible give comparable functional results with those of the conventional technique, but no functional superiority has been established. Nevertheless, the integration of virtual planning and guided surgery is definitely of significant value but should be indicated individually case by case.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Ritschl
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fichter
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Florian D
authors.initials: FD
authors.lastname: Güll
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Department of Prosthodontics, Dental School of the Ludwig-Maximilians, University of Munich, Germany.
authors.forename: Jean Marc Pho
authors.initials: JMP
authors.lastname: Duc
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Kesting
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Denys J
authors.initials: DJ
authors.lastname: Loeffelbein
mesh_terms: D017076:Computer-Aided Design; D004435:Eating / Q000502:physiology; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008336:Mandibular Diseases / Q000503:physiopathology / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology; D025321:Surgery, Computer-Assisted / Q000379:methods