The use of computer-aided design and manufacturing (CAD/CAM) techniques for planning jaw reconstructions for patients with head and neck cancer undergoing free fibula reconstruction of the lower jaw may potentially shorten the duration of the surgery and reduce removal rates due to complications, according to the results of a study published in Plastic and Reconstructive Surgery.
"Our experience suggests that CAD/CAM techniques offer several benefits in patients undergoing free fibula reconstruction of the lower jaw, including a reduced risk of long-term complications requiring hardware removal," stated corresponding study author Mario G. Solari, MD, of the Departments of Plastic Surgery and Otolaryngology at the University of Pittsburgh.
Study Methods and Results
The study authors noted that CAD/CAM has revolutionized preoperative virtual surgical planning for head and neck reconstructions over the past decade, allowing surgeons to create 3D-printed surgical guides and preformed hardware for use in the reconstruction.
Investigators sought to determine if the benefits of CAD/CAM in surgical planning also impacted surgical and patient outcomes. They conducted a study comparing the short- and long-term outcomes of conventional vs CAD/CAM approaches for mandibular reconstruction with free fibula flaps.
The study included 215 patients undergoing free flap reconstruction between 2012 and 2021, including 79 using conventional techniques and 136 using CAD/CAM; the CAD/CAM cohort was younger than the conventional cohort.
The operation was a mean 54 minutes shorter with the use of CAD/CAM (P = .014). Rates of many short-term complication rates, including total and partial flap loss, were similar between the two cohorts. There was also no significant difference between the cohorts in days spent in the hospital.
Significantly lower rates of early wound dehiscence were observed in the CAD/CAM cohort (7.4% vs 16.5%; P = .037). The CAD/CAM cohort also showed a lower hardware remove rate (28.8% vs 13.9%; P = .011) after excluding the patients with major surgical complications in the first 30 days.
"Given the added cost with the use of CAD/CAM, future studies focusing on cost-effectiveness of this approach with respect to long-term outcomes and hardware maintenance will be important to justify the clinical significance of our results," the study authors concluded.
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
