Association of Virtual Surgical Planning With External Incis
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Maxillectomy can commonly be performed through a transoral approach, but maxillectomy defect reconstruction can be difficult to precise design, contour, and inset through this approach. This study suggests that virtual surgical planning (VSP) may help with planning, execution, placement, and fixation for complex free flap maxillectomy defect reconstruction through a transoral minimally invasive approach.

The objective of the study was to evaluate whether the use of virtual surgical planning (VSP) and 3-dimensional (3-D) modeling is associated with a decrease in the requirement of lateral rhinotomy (LR) for patients undergoing total and partial maxillectomy reconstruction.

This retrospective cohort study was conducted among patients undergoing subtotal or total maxillectomy with microvascular free flap reconstruction with or without VSP and 3-D modeling at a single tertiary care academic medical center between January 1, 2008, and October 3, 2019.

Fifteen patients underwent maxillectomy with free flap reconstruction without VSP. Eight patients in this group underwent total maxillectomy, and 4 patients in this group underwent partial maxillectomy. Twenty-three patients underwent maxillectomy with free flap reconstruction and VSP and 3-D modeling. Twelve of these patients underwent total maxillectomy, and 11 underwent partial maxillectomy. Lateral rhinotomy was necessary for 1 patient in the VSP group vs 12 patients in the pre-VSP group. There were no LR complications in the VSP group vs 6 in the pre-VSP group.

Among both groups, 14 patients underwent fibula free flap, 22 patients underwent subscapular system free flap, and 2 patients underwent cutaneous or osteocutaneous radial forearm free flap. There were no flap failures in the LR group and 1 flap failure in the group without LR.

Conclusively, this cohort study suggests that the use of VSP and 3-D modeling for maxillectomy reconstruction is associated with the decrease in the need for external incisions without compromising reconstructive flap utility.

Source: https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2778215
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