Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trialReportar como inadecuado




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Trials

, 15:114

First Online: 09 April 2014Received: 03 October 2013Accepted: 21 March 2014DOI: 10.1186-1745-6215-15-114

Cite this article as: Ayoub, N., Ghassemi, A., Rana, M. et al. Trials 2014 15: 114. doi:10.1186-1745-6215-15-114

Abstract

BackgroundComputer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome.

MethodsTwenty patients were randomly assigned to computer-assisted or conventional mandibular reconstruction with vascularized iliac crest bone graft in a prospective study design.

Virtual surgical planning was based on preoperative CT-data using specific surgical planning software. A rapid prototyping guide transferred the virtual surgery plan to the operation site. During surgery the transplant ischemic time, reconstruction time, time for shaping the transplant and amount of bone removed were measured. Additionally, the difference in the intercondylar distance before and after surgery was calculated.

ResultsComputer-assisted surgery shortened the time of transplant ischemia P < 0.005 and defect reconstruction P < 0.001 compared to conventional surgery. The time to saw and shape the transplant at the donor site was shorter using conventional surgery P < 0.005; therefore, the overall time for surgery didn’t change P = 0.527. In the computer-assisted group, the amount of bone harvested equaled the defect size, whereas the transplant size in the conventional group exceeded the defect site by 16.8 ± 5.6 mm P < 0.001 on average. The intercondylar distance before compared to after surgery was less affected in the computer-assisted than in the conventional group P < 0.001.

ConclusionsThe presented study shows that computer-assisted surgery can help reduce the time for mandibular defect reconstruction and consequently the transplant ischemic time. In the computer-assisted group, the iliac crest donor site defect was downsized and the postoperative condyle position was less altered, reducing possible risks of postoperative complications and donor site morbidity.

Trial RegistrationDRKS00005181

KeywordsComputer-assisted surgery Mandibular reconstruction Vascularized iliac crest bone graft Surgical guide Virtual planning AbbreviationsAarteria

CTcomputed tomography

DICOMdigital imaging and communications in medicine

ffemale

ICUintensive care unit

mmale

mmmillimeter

Vvena.

Electronic supplementary materialThe online version of this article doi:10.1186-1745-6215-15-114 contains supplementary material, which is available to authorized users.

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Autor: Nassim Ayoub - Alireza Ghassemi - Majeed Rana - Marcus Gerressen - Dieter Riediger - Frank Hölzle - Ali Modabber

Fuente: https://link.springer.com/







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