Speaker: Prof Antonio Tullio
Authors: Dott. Francesco Giovacchini, Dott.ssa Valeria Mitro, Dott. Massimiliano Gilli, Dott. Gabriele Monarchi, Prof. Antonio Tullio, University of Perugia
The first free flaps jaws reconstructions were performed in 1980-1990 in oncologic patients. The importance of a correct surgery planning with a computer simulation of the bone flaps segments positioning was immediately clear.
The following step was the print and the intraoperatively use of custom-made devices as guides to faithfully reproduce the virtual reconstructive project.
In 1990 started the CAD-CAM (Computer-Aided-Design Computer-Aided-Manufactoring) era.
Materials and methods
There were selected 3 cases of jaws malignant tumors (1 maxillar and 2 mandibular tumors), and a case of post-traumatic enophtalmos. In all cases the bone reconstruction was planned using 3D stereolithography models.
In the First case, it was harvested a free fibula osteocutaneous free flap and placed in double-barrel to reconstruct the anterior mandibular segment. Finally it was virtually projected the positioning of five implants in the new mandible, and placed using a customized template. It the second case we reconstruct the right mandibular angle and bodyby another osteocutaneaous fibula free flap. Patient is still waiting for the implantal rehabilitation. In the third case we used the fibula free flap to reconstruct the whole maxilla. They were placed using a custom-made template five dental implants.
The fourth patient was treated by reconstruction of the orbital floor and volumetry by iliac crest graft. The bone graft was harvested and fashioned on a 3D stereolithography model before fixation.
In all three cases we used stereolithography models based on TC scans. Models were used to simulate the correct bone segments positioning and to bend the plates.
New technologies are very useful in the jaws reconstruction. They allow to reduce the operative time and to improve the accuracy during the harvesting. They provide customized devices available during surgery, minimizing the possibility of error.