Reconstruction of orofacial defects after ablative surgery for maxilla facial tumors poses a major challenge to the surgeon. The five year oral and esophageal cancer survival rate for all ages is 60.5 years. The relative survival rate is inversely proportional to age at detection, being 48.1% at age 75+ and increasing to 79.0% for ages below 45 (1). Resection of the pathology leaves the patient with one or more defects affecting speech, mastication, deglutition and airway support apart from facial disfigurement. Primary resection surgeries aim at eliminating the pathology. Orofacial reconstruction procedures may be performed along with the primary surgery or secondarily at a second stage.
These typically aim at restoration of both aesthetics and function. Surgical treatment staging and outcome are also affected by the requirement for pre and or post-operative radiation as part of the treatment protocol. Advances in microvascular surgery lead to the possibility of better treatment outcomes by using Osteocutaneous flaps from common remote donor sites such as the fibula, iliac crest, and scapula. Surgeons have been planning and performing these surgeries for many years but are still looking out for methods to improve treatment outcomes. Success of these surgeries depends on adequate resection from the donor site as well as timely reshaping and grafting at the recipient site to reduce ischemic complications apart from the surgeon’s skill and patient response.
Advances in computer imaging and precise manufacturing processes (especially additive manufacturing) have led to systems and processes providing surgeons with a very effective tool in their armamentarium for the best surgical outcomes. The process begins with receiving a CT per prescribed protocol. 2D image data sets from CT scan of the donor and recipient sites are then converted by trained personnel into a 3D model. The 3D model forms the basis for the surgical planning alongside the surgeons’ input through a web meeting. The surgeon then receives a kit with the appropriate guides, models and the surgical plan assisting in the execution of the surgery.
In the case of a surgeon, it should have one or more of the following advantages: improved aesthetic or functional results, reduced surgical time, more predictability, less lead time and reduction of overall treatment cost.
Any new approach for a current treatment protocol requires justification to be accepted by the end user. In the case of a surgeon, it should have one or more of the following advantages: improved aesthetic or functional results, reduced surgical time, more predictability, less lead time and reduction of overall treatment cost. Surgical planning adds additional upfront cost and time which is offset by reducing surgical and anesthetic time in the OR and reduced risk of failure due to ischemic changes in the donor tissue or infection (2). Other advantages include more predictable aesthetics and improved functional outcome in dental rehabilitation due to advanced planning and correct positioning of the basal bone. Currently, there is a critical primary industry need for better reimbursement of surgical planning. The advantages listed above far outweigh the cost when it comes to better surgical outcomes and reduced risk.
Dr. Jayanthi Parthasarathy, BDS, MS, PhD
Director of Biomedical Engineering | MedCAD