Correction of post mandibular resection-reconstruction defects using stereolithographic model technology

Introduction : Reconstruction aims to achieve adequate form and function to maintain proper aesthetics and symmetry of the face. Mandibular reconstruction poses a challenge to the surgeon due to its complicated geometry, muscle attachment, the form and position of condyles in the glenoid fossa, and occlusion.

Aim : To address the efficacy of Stereolithographic model technology in precise adaptation of reconstruction plate with reasonable symmetry, decreasing surgical time and plate handling intra-operatively thus preserving hardware strength.

Material and methods : 10 patients selected, three cases of segmental mandibular resection and three of disarticulation resection without reconstruction plate nor bone grafting. Another Two cases were presented with exposed reconstruction plate and two with poorly contoured fibula grafting leading to significant dissatisfactory symmetry. Pre-operative OPG and multislice CT scan were performed for all patients. Computer-guided virtual surgical planning was prepared from the CT scan image of DICOM-format, where the affected segment was subtracted and then reformatted with a mirror image from the contralateral normal side. Prebending of the reconstruction plate was done on the prefabricated model and transferred to the surgical field. Immediate replacement of the condylar segment was done with costochondral graft. Post-operative assessment was performed immediately and six months to evaluate the inter-incisal mouth opening, occlusion, facial symmetry, and condylar or graft position in the glenoid fossa.

Results : Clinical results showed no complications in all patients except one patient who developed submandibular. There was no open bite, normal range of mouth opening and mandibular movements, and the occlusion and facial form was restored. Radiographic results showed normal position of the replaced condyle in the glenoid fossa.

Conclusion : Use of virtual surgical planning and stereolithographic model remarkably decrease surgical time, blood loss, exposure to general anaesthesia, shorter wound exposure with reasonable mandibular symmetry.

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Correction of post mandibular resection-reconstruction defects using stereolithographic model technology
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