Journal of Prevention and Treatment for Stomatological Diseases ›› 2019, Vol. 27 ›› Issue (9): 561-568.doi: 10.12016/j.issn.2096-1456.2019.09.004

• Cinical Study • Previous Articles     Next Articles

Application of virtual surgical planning in the surgical treatment of osteoradionecrosis of mandible

OU Zhanpeng,ZHANG Hanqing,LI Qunxing,LIN Xinyu,FAN Song(),LI Jinsong()   

  1. Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
  • Received:2019-04-21 Revised:2019-05-28 Online:2019-09-20 Published:2019-09-20
  • Contact: Song FAN,Jinsong LI E-mail:fansong88888@163.com;lijinsong1967@163.com

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Abstract:

Objective To analyze the value of virtual surgical planning in the surgical treatment of osteoradionecrosis of the mandible and to provide a reference for clinical practice.Methods From September 2017 to June 2018, 13 patients with mandibular osteoradionecrosis were evaluated preoperatively using the 3D virtual surgery software CMF Proplan 2.0. The surgical guide was designed and 3D printed. Bone resection, fibula shaping and bone graft localization were completed during the operation. In some cases, implants were implanted at the same time, and denture restoration was completed 3 to 6 months after surgery. Patients’ general information, perioperative data, and efficacy evaluation were analyzed.Results All patients underwent surgery successfully. The survival rate of the free fibula musculocutaneous flap was 100% (13/13), and one patient had complications (partial necrosis at the edge of the flap). The follow-up period was 7 to 15 months, and the median time was 10 months. All patients achieved a healing effect. The number of cases with an increase in mouth opening ≥ 1 cm, 0.5 cm ≤ mouth opening increase < 1 cm, and mouth opening increase < 0.5 cm were 5, 6, and 2, respectively. An imaging examination showed that 12 patients had good bone healing, and 1 patient did not completely heal 7 months after operation. The denture restoration was 92.3% (12/13), of which 3 cases were implanted and repaired at the same time. The average chewing efficiency was 56.11% ± 7.12% (42.03%-67.83%).Conclusion Virtual surgical planning is an effective method for the surgical treatment of mandibular osteoradionecrosis, which can reduce the risk of surgery and more effectively perform mandibular shape and function repair.

Key words: osteoradionecrosis of mandible, surgical treatment, virtual surgery planning, 3D printing, free fibular flap, implant prosthesis

CLC Number: 

  • R78

Table 1

Clinical characteristics of patients"

序号 性别 年龄 身体质量
指数（kg/ m2）		 放（化）疗后诊断下颌骨
放射性骨坏死时间（年）		 放疗剂量
（Gy）		 原发肿瘤 Schwartz和
Kagan分期
1 男 48 18.50 4 60 口咽癌 Ⅲ期
2 女 49 23.34 9 72 口咽癌 Ⅲ期
3 男 63 20.01 4 64 舌癌 Ⅲ期
4 男 50 19.37 3 60 鼻咽癌 Ⅲ期
5 男 44 20.31 5 68 鼻咽癌 Ⅲ期
6 男 46 19.03 4 66 鼻咽癌 Ⅲ期
7 男 43 19.54 3 60 鼻咽癌 Ⅲ期
8 男 56 19.38 4 72 鼻咽癌 Ⅲ期
9 男 50 17.57 5 72 鼻咽癌 Ⅲ期
10 男 59 17.04 7 76 鼻咽癌 Ⅲ期
11 男 45 19.22 4 68 鼻咽癌 Ⅲ期
12 男 51 20.47 4 62 口咽癌 Ⅲ期
13 男 45 17.44 5 56 鼻咽癌 Ⅲ期

Figure 1

Design flow chart of virtual surgical planning of osteoradionecrosis of the mandible"

Table 2

Comparison of the advantages and disadvantages between virtual surgical planning and traditional surgical assessment for the treatment of osteoradionecrosis of the mandible"

手术 术前评估 手术方案设计 术前准备时间 软硬件要求 手术时间 切除精度 义齿修复类型
虚拟手术设计 全面、直观 详细、具体 较长 计算机虚拟手术
软件、3D打印机		 较短 较高 可设计同期骨内种植体植入,术后完成义齿修复
传统手术评估 缺少对受区血管、供区
血管蒂评估,欠直观		 较笼统 较短 无特别要求 较长 较低 可摘活动义齿修复

Figure 2

Preoperative views and imaging findings and assessment of blood vessels in a neck recipient"

Figure 3

Virtual surgical planning scheme 1"

Figure 4

Virtual surgical planning scheme 2"

Figure 5

Preoperative, intraoperative and postoperative clinical photos and imaging examination"

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