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Mandible reconstruction using patient-specific pre-bent reconstruction plates: comparison of standard and transfer key methods

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

 Mandible reconstruction with reconstruction plates requires bending the plates during the operation and fixation using the “standard method” (ST-method). The ST-method is limited when a pathological process has perforated the mandibular outer cortex. A transfer key method (TK-method) was developed where plates are pre-bent using a patient-specific mandible model and positioned on the mandible with the help of transfer keys. The ST-method and TK-method were compared in a clinical trial.

Methods

 Mandibular reconstruction was performed on 42 patients in this study: 22 were performed using the TK-method and 20 using the ST-method. Pre- and postoperative CT scans were evaluated by measuring the distances between six corresponding landmarks on the mandibular condyles and rami. The difference between pre- and postoperative distances was used to evaluate reconstruction accuracy.

Results

 The median deviation of the unsigned/ absolute values of all six distances was 1.07 mm for the TK-method and 1.67 mm for the ST-method. The TK-method showed significantly better results. For the signed values, the median deviation of the six distances was \(-\)0.6 mm for the TK-method and \(-\)1.47 mm for the ST-method, indicating that the mandibles became narrower with both methods. This width difference was not statistically significant.

Conclusion

 The TK-method was more accurate than the ST-method in a clinical trial. The TK-method was effective and accurate for mandible reconstruction using pre-bent fixation plates.

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Acknowledgments

Frank Wilde, Karsten Winter, Katharina Kletsch, Kai Lorenz and Alexander Schramm declare that they have no conflict of interest. The presented study was in accordance with the ethical standards of the ethics committee of the University of Ulm, Germany (64/10—UBB/se), and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm and Academic Hospital Ulm University, Oberer Eselsberg 40, 89081 , Ulm, Germany

    Frank Wilde & Alexander Schramm

  2. Translational Centre for Regenerative Medicine (TRM-Leipzig), Philipp-Rosenthal-Straße 55, 04103 , Leipzig, Germany

    Karsten Winter

  3. Department of Dentistry, Ulm University, Albert-Einstein-Allee 11, 89081 , Ulm, Germany

    Katharina Kletsch

  4. Department of Otolaryngology, Head and Neck Surgery, Military Hospital Ulm and Academic Hospital Ulm University, Oberer Eselsberg 40, 89081 , Ulm, Germany

    Kai Lorenz

Authors
  1. Frank Wilde
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  2. Karsten Winter
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  3. Katharina Kletsch
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  4. Kai Lorenz
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  5. Alexander Schramm
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Correspondence to Frank Wilde.

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Wilde, F., Winter, K., Kletsch, K. et al. Mandible reconstruction using patient-specific pre-bent reconstruction plates: comparison of standard and transfer key methods. Int J CARS 10, 129–140 (2015). https://doi.org/10.1007/s11548-014-1065-1

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  • DOI: https://doi.org/10.1007/s11548-014-1065-1

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