Computer-assisted resection of mandibular cancer and repair with fibula free flap. Case report
Ioannis CHATZISTEFANOU, Ioannis TILAVERIDIS, Vasileios BANIKAS, Dimitrios DELIGIANNIDIS, Antonios SARAMANTOS, Mariam DIMAKOU, Petros KOURIDAKIS, Apostolos MICHAILIDIS, Georgios GKOUVAS, Christos MAGOPOULOS
Department of Oral and Maxillofacial Surgery, 424 General Military Hospital of Thessaloniki (Head: Dr. Christos Magopoulos)
Hellenic Archives of Oral & Maxillofacial Surgery (2021) 2, 109-117
DOI https://dx.doi.org/10.54936/haoms222109117
SUMMARY: Oral cancer is a disease, in the treatment of which the surgical resection of the lesion plays a lead- ing role. Oncological resections in the maxillofacial area create large deficits that affect the functionality and aesthetics of the patient to a large extent, while many times make oncological resection impossible due to their inability to restore. The mandibular deficits are particularly difficult, with the free osteocutaneous fibular flap being the gold standard in repairing large mandibular deficits. In recent years, technology has offered significant as- sistance in the successful restoration of functional and aesthetic disorders through the virtual planning of the operation. In this paper we present a case of oral cancer whose resection and reconstruction with fibula free flap were done after digital design and under the guidance of special cutting guides. To our knowledge, this case of computer-guided reconstruction with FFF represents the first description of such a technique for mandibular reconstruction in the available greek medico-dental literature.
KEY WORDS: Oral cancer, Fibula flap, Virtual surgical planning, Case report.
REFERENCES
Awad ME, Altman A, Elrefai R, Shipman P, Looney S, Elsalanty M. The use of vascularized fibula flap in mandibular reconstruction; A comprehensive systematic review and meta-analysis of the ob- servational studies. J Craniomaxillofac Surg. 2019;47(4):629-641.
Barr ML, Haveles CS, Rezzadeh KS, et al. Virtual Surgical Planning for Mandibular Reconstruction With the Fibula Free Flap: A System- atic Review and Meta-analysis. Ann Plast Surg. 2020;84(1):117- 122. doi:10.1097/SAP.0000000000002006
Brown JS, Lowe D, Kanatas A, Schache A. Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg. 2017;55(2):113-126. doi:10.1016/j. bjoms.2016.12.010
COVIDSurg Collaborative. Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observation- al cohort study [published online ahead of print, 2020 Dec 21]. Cancer. 2020;10.1002/cncr.33320. doi:10.1002/cncr.33320
Dziemianczyk-Pakiela D, Groth D, Toloczko-Iwaniuk N, et al. Per- oneal artery-vein index as a potential factor of thrombosis occur- rence in free osteocutaneous fibula flap. J Craniomaxillofac Surg. 2016;44(9):1314-1319. doi:10.1016/j.jcms.2016.07.006
Forner D, Noel CW, Wu V, et al. Nonsurgical management of resect- able oral cavity cancer in the wake of COVID-19: A rapid review and meta-analysis. Oral Oncol. 2020;109:104849. doi:10.1016/j. oraloncology.2020.104849
Hidalgo DA. Fibula free flap: a new method of mandible reconstruc- tion. PlastReconstr Surg. 1989;84(1):71-79.
Kim RY, Sokoya M, Ducic Y, Williams F. Free-Flap Reconstruction of the Mandible. SeminPlast Surg. 2019;33(1):46-53. doi:10.1055/s- 0039-1677791
Kiong KL, Guo T, Yao CMKL, et al. Changing practice patterns in head and neck oncologic surgery in the early COVID-19 era. Head Neck. 2020;42(6):1179-1186. doi:10.1002/hed.26202
Leiggener CS, Krol Z, Gawelin P, Buitrago-Téllez CH, Zeilhofer HF, Hirsch JM. A computer-based comparative quantitative analysis of surgical outcome of mandibular reconstructions with free fibu- la microvascular flaps. J Plast Surg Hand Surg. 2015;49(2):95-101. doi:10.3109/2000656X.2014.920711
Ling XF, Peng X. What is the price to pay for a free fibula flap? A sys- tematic review of donor-site morbidity following free fibula flap surgery. PlastReconstr Surg. 2012;129(3):657-674. doi:10.1097/ PRS.0b013e3182402d9a
Lonie S, Herle P, Paddle A, Pradhan N, Birch T, Shayan R. Mandibu- lar reconstruction: meta-analysis of iliac- versus fibula-free flaps. ANZ J Surg. 2016;86(5):337-342. doi:10.1111/ans.13274
Modabber A, Ayoub N, Möhlhenrich SC, et al. The accuracy of com- puter-assisted primary mandibular reconstruction with vascular- ized bone flaps: iliac crest bone flap versus osteomyocutaneous fibula flap. Med Devices (Auckl). 2014;7:211-217. Published 2014 Jun 16. doi:10.2147/MDER.S62698
National Comprehensive Cancer Network. Head and Neck Cancers (Version 3.2021). https://www.nccn.org/professionals/physician_
gls/pdf/head-and-neck.pdf. Updated April 27, 2021.
Okay D, Al Shetawi AH, Moubayed SP, Mourad M, Buchbinder D, Urken ML. Worldwide 10-Year Systematic Review of Treat- ment Trends in Fibula Free Flap for Mandibular Reconstruction. J Oral Maxillofac Surg. 2016;74(12):2526-2531. doi:10.1016/j. joms.2016.06.170
Pucci R, Weyh A, Smotherman C, Valentini V, Bunnell A, Fernandes
R. Accuracy of virtual planned surgery versus conventional free- hand surgery for reconstruction of the mandible with osteocu- taneous free flaps. Int J Oral Maxillofac Surg. 2020;49(9):1153- 1161. doi:10.1016/j.ijom.2020.02.018
Schrag C, Chang YM, Tsai CY, Wei FC. Complete rehabilitation of the mandible following segmental resection. J Surg Oncol. 2006;94(6):538-545. doi:10.1002/jso.20491
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOB- OCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209- 249. doi:10.3322/caac.21660
Tang NSJ, Ahmadi I, Ramakrishnan A. Virtual surgical planning in fibula free flap head and neck reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2019;72(9):1465- 1477. doi:10.1016/j.bjps.2019.06.013
Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clini- cal extension of microvascular techniques. PlastReconstr Surg. 1975;55(5):533-544. doi:10.1097/00006534-197505000-00002
Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular com- posite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Oto- laryngol Head Neck Surg. 1991;117(7):733-744. doi:10.1001/ archotol.1991.01870190045010
Villaret AB, Cappiello J, Piazza C, Pedruzzi B, Nicolai P. Quality of life in patients treated for cancer of the oral cavity requiring reconstruction: a prospective study. Acta Otorhinolaryngol Ital. 2008;28(3):120-125.
Warshavsky A, Fliss DM, Frenkel G, et al. Quality of life after mandibulectomy: the impact of the resected subsite. Int J Oral Maxillofac Surg. 2019;48(10):1273-1278. doi:10.1016/j. ijom.2019.02.013
Department of Oral and Maxillofacial Surgery, 424 General Military Hospital of Thessaloniki (Head: Dr. Christos Magopoulos)
Hellenic Archives of Oral & Maxillofacial Surgery (2021) 2, 109-117
DOI https://dx.doi.org/10.54936/haoms222109117
SUMMARY: Oral cancer is a disease, in the treatment of which the surgical resection of the lesion plays a lead- ing role. Oncological resections in the maxillofacial area create large deficits that affect the functionality and aesthetics of the patient to a large extent, while many times make oncological resection impossible due to their inability to restore. The mandibular deficits are particularly difficult, with the free osteocutaneous fibular flap being the gold standard in repairing large mandibular deficits. In recent years, technology has offered significant as- sistance in the successful restoration of functional and aesthetic disorders through the virtual planning of the operation. In this paper we present a case of oral cancer whose resection and reconstruction with fibula free flap were done after digital design and under the guidance of special cutting guides. To our knowledge, this case of computer-guided reconstruction with FFF represents the first description of such a technique for mandibular reconstruction in the available greek medico-dental literature.
KEY WORDS: Oral cancer, Fibula flap, Virtual surgical planning, Case report.
REFERENCES
Awad ME, Altman A, Elrefai R, Shipman P, Looney S, Elsalanty M. The use of vascularized fibula flap in mandibular reconstruction; A comprehensive systematic review and meta-analysis of the ob- servational studies. J Craniomaxillofac Surg. 2019;47(4):629-641.
Barr ML, Haveles CS, Rezzadeh KS, et al. Virtual Surgical Planning for Mandibular Reconstruction With the Fibula Free Flap: A System- atic Review and Meta-analysis. Ann Plast Surg. 2020;84(1):117- 122. doi:10.1097/SAP.0000000000002006
Brown JS, Lowe D, Kanatas A, Schache A. Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg. 2017;55(2):113-126. doi:10.1016/j. bjoms.2016.12.010
COVIDSurg Collaborative. Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observation- al cohort study [published online ahead of print, 2020 Dec 21]. Cancer. 2020;10.1002/cncr.33320. doi:10.1002/cncr.33320
Dziemianczyk-Pakiela D, Groth D, Toloczko-Iwaniuk N, et al. Per- oneal artery-vein index as a potential factor of thrombosis occur- rence in free osteocutaneous fibula flap. J Craniomaxillofac Surg. 2016;44(9):1314-1319. doi:10.1016/j.jcms.2016.07.006
Forner D, Noel CW, Wu V, et al. Nonsurgical management of resect- able oral cavity cancer in the wake of COVID-19: A rapid review and meta-analysis. Oral Oncol. 2020;109:104849. doi:10.1016/j. oraloncology.2020.104849
Hidalgo DA. Fibula free flap: a new method of mandible reconstruc- tion. PlastReconstr Surg. 1989;84(1):71-79.
Kim RY, Sokoya M, Ducic Y, Williams F. Free-Flap Reconstruction of the Mandible. SeminPlast Surg. 2019;33(1):46-53. doi:10.1055/s- 0039-1677791
Kiong KL, Guo T, Yao CMKL, et al. Changing practice patterns in head and neck oncologic surgery in the early COVID-19 era. Head Neck. 2020;42(6):1179-1186. doi:10.1002/hed.26202
Leiggener CS, Krol Z, Gawelin P, Buitrago-Téllez CH, Zeilhofer HF, Hirsch JM. A computer-based comparative quantitative analysis of surgical outcome of mandibular reconstructions with free fibu- la microvascular flaps. J Plast Surg Hand Surg. 2015;49(2):95-101. doi:10.3109/2000656X.2014.920711
Ling XF, Peng X. What is the price to pay for a free fibula flap? A sys- tematic review of donor-site morbidity following free fibula flap surgery. PlastReconstr Surg. 2012;129(3):657-674. doi:10.1097/ PRS.0b013e3182402d9a
Lonie S, Herle P, Paddle A, Pradhan N, Birch T, Shayan R. Mandibu- lar reconstruction: meta-analysis of iliac- versus fibula-free flaps. ANZ J Surg. 2016;86(5):337-342. doi:10.1111/ans.13274
Modabber A, Ayoub N, Möhlhenrich SC, et al. The accuracy of com- puter-assisted primary mandibular reconstruction with vascular- ized bone flaps: iliac crest bone flap versus osteomyocutaneous fibula flap. Med Devices (Auckl). 2014;7:211-217. Published 2014 Jun 16. doi:10.2147/MDER.S62698
National Comprehensive Cancer Network. Head and Neck Cancers (Version 3.2021). https://www.nccn.org/professionals/physician_
gls/pdf/head-and-neck.pdf. Updated April 27, 2021.
Okay D, Al Shetawi AH, Moubayed SP, Mourad M, Buchbinder D, Urken ML. Worldwide 10-Year Systematic Review of Treat- ment Trends in Fibula Free Flap for Mandibular Reconstruction. J Oral Maxillofac Surg. 2016;74(12):2526-2531. doi:10.1016/j. joms.2016.06.170
Pucci R, Weyh A, Smotherman C, Valentini V, Bunnell A, Fernandes
R. Accuracy of virtual planned surgery versus conventional free- hand surgery for reconstruction of the mandible with osteocu- taneous free flaps. Int J Oral Maxillofac Surg. 2020;49(9):1153- 1161. doi:10.1016/j.ijom.2020.02.018
Schrag C, Chang YM, Tsai CY, Wei FC. Complete rehabilitation of the mandible following segmental resection. J Surg Oncol. 2006;94(6):538-545. doi:10.1002/jso.20491
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOB- OCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209- 249. doi:10.3322/caac.21660
Tang NSJ, Ahmadi I, Ramakrishnan A. Virtual surgical planning in fibula free flap head and neck reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2019;72(9):1465- 1477. doi:10.1016/j.bjps.2019.06.013
Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clini- cal extension of microvascular techniques. PlastReconstr Surg. 1975;55(5):533-544. doi:10.1097/00006534-197505000-00002
Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular com- posite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Oto- laryngol Head Neck Surg. 1991;117(7):733-744. doi:10.1001/ archotol.1991.01870190045010
Villaret AB, Cappiello J, Piazza C, Pedruzzi B, Nicolai P. Quality of life in patients treated for cancer of the oral cavity requiring reconstruction: a prospective study. Acta Otorhinolaryngol Ital. 2008;28(3):120-125.
Warshavsky A, Fliss DM, Frenkel G, et al. Quality of life after mandibulectomy: the impact of the resected subsite. Int J Oral Maxillofac Surg. 2019;48(10):1273-1278. doi:10.1016/j. ijom.2019.02.013
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