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J Craniomaxillofac Surg. 2016 Sep;44(9):1320-6. doi: 10.1016/j.jcms.2016.07.013. Epub 2016 Jul 21.

Surgical reconstruction of maxillary defects using a computer-assisted design/computer-assisted manufacturing-produced titanium mesh supporting a free flap.

Author information

1
Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. C. Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy. Electronic address: achille.tarsitano2@unibo.it.
2
Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. C. Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
3
Section of Prosthodontics, Department of Biomedical and Neuromotor Sciences (Head: Prof. R. Scotti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
4
Plastic and Reconstructive Surgery Unit (Head: Dr. R. Cipriani), Policlinico S. Orsola, Bologna, Italy.

Abstract

The maxilla provides support to the overlying structures and contributes significantly to the overall facial appearance and to critical functions such as mastication, speech, and deglutition. Many different techniques have been used over the years to achieve this reconstructive goal. Modern computer-assisted surgery affords new methods for planning resections, as well as optimising reconstructive outcomes and functional rehabilitation. The aim of this study was to describe our experience with, and technique for, the functional, structural, and aesthetic reconstruction of maxillary bone defects using a computer-assisted design (CAD)/computer-assisted manufacturing (CAM)-printed titanium mesh to provide structural support for free flap reconstruction. Four patients who underwent reconstruction with a CAD/CAM-printed titanium mesh were included in this study. The preoperative computed tomography (CT) data set used for virtual planning was superimposed onto the postoperative CT scan to calculate the difference between the virtually planned position and the postoperative position of the titanium mesh. The orbital floor and alveolus were the most frequent sites of deviation, and good reproducibility could be obtained with less than 1 mm of deviation between planning and results in most regions. Printed titanium meshes obtained with CAD/CAM technology and used to structurally support free flaps provide a valuable method for the achievement of good aesthetic, structural, and functional outcomes in maxillary reconstruction. Reconstructive accuracy using this technique is reasonably high. Further studies with a larger number of patients would be useful to confirm these results.

KEYWORDS:

Computer-assisted design; Computer-assisted manufacturing; Computer-assisted surgery; Free flap; Maxillary reconstruction; Reconstructive surgery

PMID:
27519658
DOI:
10.1016/j.jcms.2016.07.013
[Indexed for MEDLINE]

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