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Virtual surgical planning in complex composite maxillofacial reconstruction.

Adam Saad1, Ryan Winters, M Whitten Wise

  • 1New Orleans, La. From the Division of Plastic Surgery, Louisiana State University Health Sciences Center; and the Department of Otolaryngology, Tulane School of Medicine.

Plastic and Reconstructive Surgery
|August 30, 2013
PubMed
Summary

Virtual surgical planning enhances complex maxillofacial reconstruction. This technique, using prebent plates and jigs, reliably achieves successful outcomes in patients with extensive injuries requiring multiple free flaps.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Plastic Surgery
  • Biomedical Engineering

Background:

  • Complex maxillofacial reconstruction presents significant challenges, particularly with extensive injury zones and malpositioned native mandible.
  • Traditional methods often struggle with distorted facial skeletal structures and require multiple free flaps.

Purpose of the Study:

  • To evaluate the efficacy of virtual surgical planning in complex maxillofacial reconstructions.
  • To present early experiences with virtual planning in challenging patient cases.

Main Methods:

  • A retrospective review of 10 patients undergoing complex maxillofacial reconstruction using virtual surgical planning (Synthes Proplan CMF).
  • Virtual planning involved CT scans for maxillofacial area and donor site, with creation of custom jigs, cutting guides, and prebent plates.
  • Procedures included osteocutaneous flap harvesting, osteotomy using jigs, and flap inset, followed by postoperative CT evaluation.

Main Results:

  • No intraoperative complications were reported in the 10 reviewed cases.
  • Postoperative CT scans demonstrated excellent contour of the osseous flaps.
  • All patients achieved functional mandibular range of motion post-reconstruction.

Conclusions:

  • Virtual surgical planning is a reliable and successful method for complex maxillofacial reconstruction involving multiple free flaps.
  • Prefabricated jigs and precontoured plates significantly facilitate osteocutaneous flap molding and inset, contributing to procedural success.