Virtual surgical planning and intraoperative navigation for mandibular reconstruction: from accurate to minimal invasive_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SUN Jian

Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Research Center of Stomatology, Shanghai, 200011, P.R.China;

Corresponding author：

SUN Jian, Email: jianjian60@yahoo.com

Keywords：

Mandibular reconstruction; vascularized fibula osteomyocutaneous flap; virtual surgical planning; intraoperative navigation; accurate; intraoral anastomosis

DOI：

10.7507/1002-1892.201806027

Video：

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Simultaneous restoration of function and appearance should be performed in mandibular reconstruction. Option of reconstructive techniques is determined by cause, location, extent, and classification of the mandibular defects. Vascularize bone graft is one of the most popular technique in current clinical practice of mandibular reconstruction. Fibula is the most common donor site for mandibular reconstruction. The disadvantage of low height of neo-mandible reconstructed by single fibular segment can be solved by vascularized double barrel fibula graft. Using virtual surgical planning and intraoperative navigation for mandibular reconstruction leads to simplify surgical procedure, reduce operating time and injury, and decrease donor site morbidity so that accurate mandibular reconstruction could be completed. Direction of minimal invasive surgery for mandibular reconstruction will be developed by intraoral approach and intraoral anastomosis.

Citation： SUN Jian. Virtual surgical planning and intraoperative navigation for mandibular reconstruction: from accurate to minimal invasive. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(7): 821-826. doi: 10.7507/1002-1892.201806027 Copy

1.	孙坚. 口腔颌面-头颈部功能性重建. 南京: 江苏科学技术出版社, 2012: 230-232.
2.	Hidalgo DA. Fibula free flap: A new method of mandible reconstruction. Plast Reconstr Surg, 1989, 84(1): 71-77.
3.	Horiuchi K, Hattori A, Inada I, et al. Mandibular reconstruction using the double barrel fibular graft. Microsurgery, 1995, 16(7): 450-454.
4.	Bähr W, Stoll P, Wächter R. Use of the " double barrel” free vascularized fibular in mandibular reconstruction. J Oral Maxillofac Surg, 1998, 56(1): 38-44.
5.	Guerra MF, Gías LN, Campo FJ, et al. The partial double- barrel free vascularized fibular graft: A solution for long mandibular defects. Plast Reconstr Surg, 2000, 105(4): 1902-1903.
6.	孙坚, 沈毅, 李军, 等. 腓骨肌 (皮) 瓣平行折叠结合人工关节重建下颌骨缺损. 中国口腔颌面外科杂志, 2007, 5(4): 248-253.
7.	Shen Y, Sun J, Li J, et al. Long-term results of partial double-barrel vascularized fibula graft in symphysis for extensive mandibular reconstruction. J Oral Maxillofac Surg, 2012, 70(4): 983-991.
8.	Shen Y, Guo XH, Sun J, et al. Double-barrel vascularised fibula graft in mandibular reconstruction: a 10-year experience with an algorithm. J Plast Reconstr Aesthet Surg, 2013, 66(3): 364-371.
9.	Smolka K, Kraehenbuehl M, Eggensperger N, et al. Fibula free flap reconstruction of the mandible in cancer patients evaluation of a combined surgical and prosthodontic treatment concept. Oral Oncol, 2008, 44(6): 571-581.
10.	Zhang C, Zhang Z. Reconstruction of mandible with fibular flap and dental implant distractor: a new approach. Chin Med J (Engl), 2002, 115(12): 1877-1880.
11.	张陈平, 张志愿, 季彤, 等. 腓骨肌瓣结合牙种植牵引器在下颌骨功能性重建中的应用. 中国耳鼻咽喉头颈外科, 2004, 11(5): 281-284.
12.	Klesper B, Lazar F, Siessegger M, et al. Vertical distraction osteogenesis of fibula transplants for mandibular reconstruction-a preliminary study. J Craniomaxillofac Surg, 2002, 30(5): 280-285.
13.	Hayter JP, Cawood JI. Oral rehabilitation with endosteal implants and free flaps. Int J Oral Maxillofac Surg, 1996, 25(1): 3-12.
14.	Lee JH, Kim WS, Choi WS, et al. Concomitant reconstruction of mandibular basal and alveolar bone with a free fibular flap. Int J Oral Maxillofac Surg, 2004, 33(2): 150-156.
15.	Rohner D, Jaquiéry C, Kunz C, et al. Maxillofacial reconstruction with prefabricated osseous free flap: A 3-year experience with 24 patients. Plast Reconstr Surg, 2003, 112(3): 748-757.
16.	Strackee SD, Kroon FHM, Spierings PTJ, et al. Development of a modeling and osteotomy jig system for reconstruction of mandible with a free vascularized fibular flap. Plast Reconstr Surg, 2004, 114(7): 1851-1858.
17.	Moro A, Cannas R, Boniello R, et al. Techniques on modeling the vascularized free fibula flap in mandibular reconstruction. J Craniofac Surg, 2009, 20(5): 1571-1573.
18.	Wang TH, Tseng CS, Hsieh CY, et al. Using computer-aided design paper model for mandibular reconstruction: a preliminary report. J Oral Maxillofac Surg, 2009, 67(11): 2534-2540.
19.	Cohen A, Laviv A, Berman P, et al. Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(5): 661-666.
20.	Yamanaka Y, Yajima H, Kirita T, et al. Mandibular reconstruction with vascularised fibular osteocutaneous flaps using prefabricated stereolithographic mandibular model. J Plast Reconstr Aesthet Surg, 2010, 63(10): 1751-1753.
21.	李军, 孙坚, 马宏涛. 个体化钛支架在构筑颌骨三维形态中的应用价值. 口腔颌面外科杂志, 2003, 13(1): 17-20.
22.	Eckardt A, Swennen GR. Virtual planning of composite mandibular reconstruction with free fibula bone graft. J Craniofac Surg, 2005, 16(6): 1137-1140.
23.	Hallermann W, Olsen S, Bardyn T, et al. A new method for computer-aided operation planning for extensive mandibular reconstruction. Plast Reconstr Surg, 2006, 117(7): 2431-2437.
24.	Cheng HT, Wu CI, Tseng CS, et al. The occlusion-adjusted prefabricated 3D mirror image templates by computer simulation: the image-guided navigation system application in difficult cases of head and neck reconstruction. Ann Plast Surg, 2009, 63(5): 517-521.
25.	Hirsch DL, Garfein ES, Christensen AM, et al. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg, 2009, 67(10): 2115-2122.
26.	Juergens P, Krol Z, Zeilhofer HF, et al. Computer simulation and rapid prototyping for the reconstruction of the mandible. J Oral Maxillofac Surg, 2009, 67(10): 2167-2170.
27.	Leiggener C, Messo E, Thor A, et al. A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular reconstruction with free fibula osseous flaps. Int J Oral Maxillofac Surg, 2009, 38(2): 187-192.
28.	Sharaf B, Levine JP, Hirsch DL, et al. Importance of computer-aided design and manufacturing technology in the multidisciplinary approach to head and neck reconstruction. J Craniofac Surg, 2010, 21(4): 1277-1280.
29.	孙坚, 沈毅, 李军, 等. 应用 SimPlant 软件精确匹配与缺损外形吻合的髂骨肌瓣行下颌骨重建. 组织工程与重建外科杂志, 2009, 5(6): 318-321.
30.	Shen Y, Sun J, Li J, et al. A revised approach for mandibular reconstruction with vascularized iliac crest flap by virtual surgical planning. Plast Reconstr Surg, 2012, 129(3): 565e-566e.
31.	Shen Y, Sun J, Li J, et al. Using computer simulation and stereomodel for accurate mandibular reconstruction with vascularized iliac crest flap. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 114(2): 175-182.
32.	李军, 沈毅, 孙坚. 虚拟手术辅助的血管化髂骨肌瓣行下颌骨精确重建. 实用肿瘤杂志, 2015, 30(1): 12-17.
33.	王良, 李军, 沈毅, 等. 虚拟手术辅助的血管化腓骨肌(皮)瓣行下颌骨精确重建. 中国耳鼻咽喉颅底外科杂志, 2016, 22(3): 220-224.
34.	孙坚, 沈毅. 虚拟手术辅助下的颌骨肿瘤切除及缺损精确重建. 口腔疾病防治, 2018, 26(1): 2-9.
35.	Liu XJ, Gui L, Mao C, et al. Applying computer techniques in maxillofacial reconstruction using a fibula flap: a messenger and an evaluation method. J Craniofac Surg, 2009, 20(2): 372-377.
36.	Zheng GS, Su YX, Liao GQ, et al. Mandible reconstruction assisted by preoperative virtual surgical simulation. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 113(5): 604-611.
37.	Cornelius CP, Giessler GA, Wilde F, et al. Iterations of computer- and template assisted mandibular or maxillary reconstruction with free flaps containing the lateral scapular border-Evolution of a biplanar plug-on cutting guide. J Craniomaxillofac Surg, 2016, 44(3): 229-241.
38.	Wu J, Sun J, Shen SG, et al. Computer-assisted navigation: its role in intraoperatively accurate mandibular reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol, 2016, 122(2): 134-142.
39.	Gaggl A, Bürger H, Virnik SA, et al. An intraoral anastomosing technique for microvascular bone flaps in alveolar ridge reconstruction: first clinical results. Int J Oral Maxillofac Surg, 2009, 38(9): 921-927.
40.	Nkenke E, Agaimy A, St Pierre M, et al. Intraoral microvascular anastomosis for segmental mandibular reconstruction following removal of an ameloblastoma. J Craniofac Surg, 2013, 24(3): e265-270.
41.	Nkenke E, Agaimy A, von Wilmowsky C, et al. Mandibular reconstruction using intraoral microvascular anastomosis following removal of an ameloblastoma. J Oral Maxillofac Surg, 2013, 71(11): 1983-1992.
42.	Brandtner C, Bürger H, Hachleitner J, et al. The intraoral anastomosing technique in reconstructive surgery of the face-A consecutive case series of 70 patients. J Craniomaxillofac Surg, 2015, 43(9): 1763-1768.
43.	Sosin M, Sinada GG, Rodriguez ED, et al. Intraoral microvascular anastomosis of an iliac free flap for maxillary fibrous dysplasia. J Oral Maxillofac Surg, 2015, 73(10): 2068.e1-5.
44.	Stalder MW, Sosin M, Urbinelli LJ, et al. Avoiding facial incisions with midface free tissue transfer. Plast Reconstr Surg Glob Open, 2017, 5(2): e1218.
45.	Roy AA, Efanov JI, Mercier-Couture G, et al. Zygomatico-maxillary reconstruction with computer-aided manufacturing of a free DCIA osseous flap and intraoral anastomoses. Plast Reconstr Surg Glob Open, 2017, 5(2): e1226.
46.	孙坚, 沈毅, 吕明明, 等. 经口内入路切除下颌骨良性肿瘤及同期血管化腓骨肌瓣下颌骨精确重建: 首创报道. 中国口腔颌面外科杂志, 2018, 16(3): 193-198.

1. 孙坚. 口腔颌面-头颈部功能性重建. 南京: 江苏科学技术出版社, 2012: 230-232.
2. Hidalgo DA. Fibula free flap: A new method of mandible reconstruction. Plast Reconstr Surg, 1989, 84(1): 71-77.
3. Horiuchi K, Hattori A, Inada I, et al. Mandibular reconstruction using the double barrel fibular graft. Microsurgery, 1995, 16(7): 450-454.
4. Bähr W, Stoll P, Wächter R. Use of the " double barrel” free vascularized fibular in mandibular reconstruction. J Oral Maxillofac Surg, 1998, 56(1): 38-44.
5. Guerra MF, Gías LN, Campo FJ, et al. The partial double- barrel free vascularized fibular graft: A solution for long mandibular defects. Plast Reconstr Surg, 2000, 105(4): 1902-1903.
6. 孙坚, 沈毅, 李军, 等. 腓骨肌 (皮) 瓣平行折叠结合人工关节重建下颌骨缺损. 中国口腔颌面外科杂志, 2007, 5(4): 248-253.
7. Shen Y, Sun J, Li J, et al. Long-term results of partial double-barrel vascularized fibula graft in symphysis for extensive mandibular reconstruction. J Oral Maxillofac Surg, 2012, 70(4): 983-991.
8. Shen Y, Guo XH, Sun J, et al. Double-barrel vascularised fibula graft in mandibular reconstruction: a 10-year experience with an algorithm. J Plast Reconstr Aesthet Surg, 2013, 66(3): 364-371.
9. Smolka K, Kraehenbuehl M, Eggensperger N, et al. Fibula free flap reconstruction of the mandible in cancer patients evaluation of a combined surgical and prosthodontic treatment concept. Oral Oncol, 2008, 44(6): 571-581.
10. Zhang C, Zhang Z. Reconstruction of mandible with fibular flap and dental implant distractor: a new approach. Chin Med J (Engl), 2002, 115(12): 1877-1880.
11. 张陈平, 张志愿, 季彤, 等. 腓骨肌瓣结合牙种植牵引器在下颌骨功能性重建中的应用. 中国耳鼻咽喉头颈外科, 2004, 11(5): 281-284.
12. Klesper B, Lazar F, Siessegger M, et al. Vertical distraction osteogenesis of fibula transplants for mandibular reconstruction-a preliminary study. J Craniomaxillofac Surg, 2002, 30(5): 280-285.
13. Hayter JP, Cawood JI. Oral rehabilitation with endosteal implants and free flaps. Int J Oral Maxillofac Surg, 1996, 25(1): 3-12.
14. Lee JH, Kim WS, Choi WS, et al. Concomitant reconstruction of mandibular basal and alveolar bone with a free fibular flap. Int J Oral Maxillofac Surg, 2004, 33(2): 150-156.
15. Rohner D, Jaquiéry C, Kunz C, et al. Maxillofacial reconstruction with prefabricated osseous free flap: A 3-year experience with 24 patients. Plast Reconstr Surg, 2003, 112(3): 748-757.
16. Strackee SD, Kroon FHM, Spierings PTJ, et al. Development of a modeling and osteotomy jig system for reconstruction of mandible with a free vascularized fibular flap. Plast Reconstr Surg, 2004, 114(7): 1851-1858.
17. Moro A, Cannas R, Boniello R, et al. Techniques on modeling the vascularized free fibula flap in mandibular reconstruction. J Craniofac Surg, 2009, 20(5): 1571-1573.
18. Wang TH, Tseng CS, Hsieh CY, et al. Using computer-aided design paper model for mandibular reconstruction: a preliminary report. J Oral Maxillofac Surg, 2009, 67(11): 2534-2540.
19. Cohen A, Laviv A, Berman P, et al. Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(5): 661-666.
20. Yamanaka Y, Yajima H, Kirita T, et al. Mandibular reconstruction with vascularised fibular osteocutaneous flaps using prefabricated stereolithographic mandibular model. J Plast Reconstr Aesthet Surg, 2010, 63(10): 1751-1753.
21. 李军, 孙坚, 马宏涛. 个体化钛支架在构筑颌骨三维形态中的应用价值. 口腔颌面外科杂志, 2003, 13(1): 17-20.
22. Eckardt A, Swennen GR. Virtual planning of composite mandibular reconstruction with free fibula bone graft. J Craniofac Surg, 2005, 16(6): 1137-1140.
23. Hallermann W, Olsen S, Bardyn T, et al. A new method for computer-aided operation planning for extensive mandibular reconstruction. Plast Reconstr Surg, 2006, 117(7): 2431-2437.
24. Cheng HT, Wu CI, Tseng CS, et al. The occlusion-adjusted prefabricated 3D mirror image templates by computer simulation: the image-guided navigation system application in difficult cases of head and neck reconstruction. Ann Plast Surg, 2009, 63(5): 517-521.
25. Hirsch DL, Garfein ES, Christensen AM, et al. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg, 2009, 67(10): 2115-2122.
26. Juergens P, Krol Z, Zeilhofer HF, et al. Computer simulation and rapid prototyping for the reconstruction of the mandible. J Oral Maxillofac Surg, 2009, 67(10): 2167-2170.
27. Leiggener C, Messo E, Thor A, et al. A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular reconstruction with free fibula osseous flaps. Int J Oral Maxillofac Surg, 2009, 38(2): 187-192.
28. Sharaf B, Levine JP, Hirsch DL, et al. Importance of computer-aided design and manufacturing technology in the multidisciplinary approach to head and neck reconstruction. J Craniofac Surg, 2010, 21(4): 1277-1280.
29. 孙坚, 沈毅, 李军, 等. 应用 SimPlant 软件精确匹配与缺损外形吻合的髂骨肌瓣行下颌骨重建. 组织工程与重建外科杂志, 2009, 5(6): 318-321.
30. Shen Y, Sun J, Li J, et al. A revised approach for mandibular reconstruction with vascularized iliac crest flap by virtual surgical planning. Plast Reconstr Surg, 2012, 129(3): 565e-566e.
31. Shen Y, Sun J, Li J, et al. Using computer simulation and stereomodel for accurate mandibular reconstruction with vascularized iliac crest flap. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 114(2): 175-182.
32. 李军, 沈毅, 孙坚. 虚拟手术辅助的血管化髂骨肌瓣行下颌骨精确重建. 实用肿瘤杂志, 2015, 30(1): 12-17.
33. 王良, 李军, 沈毅, 等. 虚拟手术辅助的血管化腓骨肌(皮)瓣行下颌骨精确重建. 中国耳鼻咽喉颅底外科杂志, 2016, 22(3): 220-224.
34. 孙坚, 沈毅. 虚拟手术辅助下的颌骨肿瘤切除及缺损精确重建. 口腔疾病防治, 2018, 26(1): 2-9.
35. Liu XJ, Gui L, Mao C, et al. Applying computer techniques in maxillofacial reconstruction using a fibula flap: a messenger and an evaluation method. J Craniofac Surg, 2009, 20(2): 372-377.
36. Zheng GS, Su YX, Liao GQ, et al. Mandible reconstruction assisted by preoperative virtual surgical simulation. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 113(5): 604-611.
37. Cornelius CP, Giessler GA, Wilde F, et al. Iterations of computer- and template assisted mandibular or maxillary reconstruction with free flaps containing the lateral scapular border-Evolution of a biplanar plug-on cutting guide. J Craniomaxillofac Surg, 2016, 44(3): 229-241.
38. Wu J, Sun J, Shen SG, et al. Computer-assisted navigation: its role in intraoperatively accurate mandibular reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol, 2016, 122(2): 134-142.
39. Gaggl A, Bürger H, Virnik SA, et al. An intraoral anastomosing technique for microvascular bone flaps in alveolar ridge reconstruction: first clinical results. Int J Oral Maxillofac Surg, 2009, 38(9): 921-927.
40. Nkenke E, Agaimy A, St Pierre M, et al. Intraoral microvascular anastomosis for segmental mandibular reconstruction following removal of an ameloblastoma. J Craniofac Surg, 2013, 24(3): e265-270.
41. Nkenke E, Agaimy A, von Wilmowsky C, et al. Mandibular reconstruction using intraoral microvascular anastomosis following removal of an ameloblastoma. J Oral Maxillofac Surg, 2013, 71(11): 1983-1992.
42. Brandtner C, Bürger H, Hachleitner J, et al. The intraoral anastomosing technique in reconstructive surgery of the face-A consecutive case series of 70 patients. J Craniomaxillofac Surg, 2015, 43(9): 1763-1768.
43. Sosin M, Sinada GG, Rodriguez ED, et al. Intraoral microvascular anastomosis of an iliac free flap for maxillary fibrous dysplasia. J Oral Maxillofac Surg, 2015, 73(10): 2068.e1-5.
44. Stalder MW, Sosin M, Urbinelli LJ, et al. Avoiding facial incisions with midface free tissue transfer. Plast Reconstr Surg Glob Open, 2017, 5(2): e1218.
45. Roy AA, Efanov JI, Mercier-Couture G, et al. Zygomatico-maxillary reconstruction with computer-aided manufacturing of a free DCIA osseous flap and intraoral anastomoses. Plast Reconstr Surg Glob Open, 2017, 5(2): e1226.
46. 孙坚, 沈毅, 吕明明, 等. 经口内入路切除下颌骨良性肿瘤及同期血管化腓骨肌瓣下颌骨精确重建: 首创报道. 中国口腔颌面外科杂志, 2018, 16(3): 193-198.

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