The Use of the Synthes ProPlan CMF So4ware in Planning Mandibular Reconstruc=on Using a Free Osseocutaneous Fibula Flap Dr I B Anderson, Mr K M A Rahman, Mr M D Kernohan, Mr O A Ahmed, Mr M Ragbir and Mr JR Adams Department of Plas=c Surgery & Department of Oral & Maxillofacial Surgery, Newcastle upon Tyne Hospitals NHS Founda=on Trust, United Kingdom. Aim Pre-‐opera/ve planning images with precise measurements on resec/on, osteotomies and screw holes • To assess our ini=al experience with the Synthes ProPlan CMF So4ware in planning mandibular reconstruc=on with free osseocutaneous fibula flaps Case Series Ag Se Diagnosis e x 40 F Grossly atrophic mandible with #s 49 M SCC base of tongue Introduc/on Stage Defect N/A Anterior Mandible T4N2c Mo T4aN2 bM0 M Recurrent SCC submental & T4aN2c buccal regions M0 M SCC Right angle of mandible T4aN0 to lingula M0 F Leiyomyosarcoma Rt lateral Grade pyterygoid 2 F Osteonecrosis 2° to N/A osteopetrosis of mandible F SCC Anterior Mandible T4N0M 0 Anterior Mandible • The free osseocutaneous fibula flap is our preferred op=on for the bony reconstruc=on of the mandible and maxilla 41 M SCC Right mandible Right Mandible • Tradi=onal methods for calcula=ng osteotomies of the fibula sha4 are performed intra-‐opera=vely using malleable guides and rulers 76 Anterior Mandible 56 • Analysis of high resolu=on CT scans, computer so4ware systems and 3D prin=ng facilitates this process allowing for pre-‐opera=ve planning and the produc=on of custom-‐designed plates and osteotomy guides • We present the experience of our department over a one year year period. 75 65 Provided kit with osteotomy / screw hole guides, customised plate & 3D model Methods • 8 Pa=ents were iden=fied using our ins=tu=on’s prospec=vely collected free flap database which u=lised the Synthes ProPlan CMF system for free fibular mandibular reconstruc=on Technique • All images uploaded to secure to Sythes ProPlan team server based in Belgium • 1 hour online discussion between surgeon and manufacturer to plan surgery including osteotomy sites on both mandible and fibula, plate design and screw holes • Precise osteotomy guides, 3D model, 3D planning images and custom milled plates produced and sent to surgeon for use. These allowed for accurate segments of bone for harves=ng, precise osteotomy sites and fixa=on points for the custom-‐made plate. Guides also assisted with precise resec=on of mandibular segment based on imaging of disease Whole Mandible Anterior Mandible • Accurate & predictable reconstruc=on • Saves 30-‐60min • Mill plates thinner and stronger • Simplifies resec=on • Improves accuracy of resec=on margins • Custom designed plates • A case note review was performed of the iden=fied pa=ents • Pre-‐opera=ve CT scanning performed as rou=ne with 5mm slices. CT scan of intended fibula for harves=ng also imaged Intra-‐oral wound dehiscence Right mandible with sparing of TMJ Right Mandible Advantages • Each case had specific issues requiring complex planning • All pa=ents discussed in the Northern Head & Neck Cancer Unit mul=disciplinary team and subsequently seen by both Maxillofacial and Plas=c Surgery teams 55 Complica/ons Intra-‐opera/ve photos with guide on mandible & fibula Cost (UK prices) Average Head & Neck Reconstruc/on £25 – 50 000 • Standard plates £600 -‐ £800 each • 3D Model £280 • Pa=ent specific plates £1 400 • ProPlan CMF System package / pt £1 200 • Difference of £120 – £380 • Difference chargeable in UK to payment provider Conclusions • So4ware provides simple, reproducible method to aid mandibular reconstruc=on • Allows execu=on of pre-‐planned procedures, simplifies the osteotomies, reduces the risk of surgical error and opera=ve =me
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