Since 2009, the cutting edge technique for mandibular reconstruction is the virtual surgical planning (VSP), providing a three dimentional(3D)-printed osteotomy guides and pre-bent mandibular reconstruction plates. As the VSP shifts the decision making and creative mandibular sculpting process into the preoperative period, it reduces the time taken in the operating room by eliminating the necessity to adapt a fixation plate to the mandible prior to resection and allows accurate contouring of the neo-mandible with precise osteotomies before the pedicle is divided thereby reducing the free flap ischemia time in microsurgical reconstruction. However, it has to keep in mind that in oncologic surgery the main issue is to assure safety margins. Oncologic safety margins can be achieved using the VSP procedure, but that result needs an increased pre-operative collaboration between the resection and reconstructive teams. Infact, just a cooperative team approach allows to plan the resection and maximize chances for disease-free resection margins.

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Mandibular Reconstruction with Free Bone Flaps

  • Federico Apolloni,
  • Marco Olivo,
  • Stefano Paulli,
  • Laura De Leonardis,
  • Ugo Baciliero,
  • Stefano Spanio di Spilimbergo

摘要

Since 2009, the cutting edge technique for mandibular reconstruction is the virtual surgical planning (VSP), providing a three dimentional(3D)-printed osteotomy guides and pre-bent mandibular reconstruction plates. As the VSP shifts the decision making and creative mandibular sculpting process into the preoperative period, it reduces the time taken in the operating room by eliminating the necessity to adapt a fixation plate to the mandible prior to resection and allows accurate contouring of the neo-mandible with precise osteotomies before the pedicle is divided thereby reducing the free flap ischemia time in microsurgical reconstruction. However, it has to keep in mind that in oncologic surgery the main issue is to assure safety margins. Oncologic safety margins can be achieved using the VSP procedure, but that result needs an increased pre-operative collaboration between the resection and reconstructive teams. Infact, just a cooperative team approach allows to plan the resection and maximize chances for disease-free resection margins.