Article
The use of 3D-printing modelling technology to assist secondary reconstruction of the mandible after ablative surgery and failure of primary reconstruction
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Authors
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Kolja Freier
- Universitätsklinikum Heidelberg, Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Heidelberg
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Robin Seeberger
- Universitätsklinikum Heidelberg, Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Heidelberg
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Andreas Ruett
- Universitätsklinikum Heidelberg, Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Heidelberg
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Jürgen Hoffmann
- Universitätsklinikum Heidelberg, Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Heidelberg
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Oliver Thiele
- Universitätsklinikum Heidelberg, Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Heidelberg
| Published: | April 23, 2012 |
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Outline
Text
Introduction: Primary bony reconstruction of the mandible after ablative surgery using vascularized transplants was established during the last decades to reconstruct function and aesthetics of the lower face. Although, applying vascularized transplants are generally safe surgical procedures, a failure of such a reconstructive approach results in tremendous malfunction and devastating esthetic appearance of the patient. Furthermore, due to the loss of maxillo-mandibular relation after resection of the condylar processus or in edentulous jaws, secondary reconstruction of mandibular defects in heavily pretreated patients remains a challenging problem. To address this issue, rapid prototyping technologies have been recently introduced. With this technology, physical models from computer-aided design via 3-dimensional (3D) printers can be constructed. In the present case series, we demonstrate the application of prefabricated mandibular models to aid in the secondary reconstruction of extensive mandibular defects.
Materials and methods: 9 patients were included in this retrospective analysis. 8 of them had mandibula resection due to squamous cell carcinoma, 1 due to ameloblastoma. In all patients, previous primary reconstruction with titanium reconstruction plate and/or soft tissue flaps and/or autogenous bone grafting failed. Of each individual patient, 3-dimensional models of the jaws according to the initial CT scan in advance of first surgery were fabricated. Preoperatively, bridging titanium plates were contoured.
Results: Mandibular reconstruction was peformed in 5 cases with fibular and in 4 cases with iliac crest flaps. For additional soft tissue management, antero-lateral thigh flaps were transferred in 3 patients. All flaps survived and healed uneventfully. According to post-operative X-rays, adequate bone stock for dental rehabilitation and good lateral and vertical projection of the neomandible was achieved in all patients.
Conclusion: The 3D-rapid prototyping technology provides precise models of the maxillo-mandibular projection, when failure of primary reconstruction occurs. In combination with microvascular reconstruction techniques, it is a valuable tool to address complex maxillo facial defects.
