Rehabilitation of Mandibulectomy with Patient-Specific Instrument: A Case Report
-
Alireza Parhiz
,
Morad Karimpour
,
Farzam Farahmand
,
Shahrzad Damercheli
,
Mohammad Hosein Amirzade Iranaq
Abstract
We present a treatment option for extensive mandibular resection using CAD/CAM technology. This option allows for the patient’s immediate and complete rehabilitation and has advantages over autografts. A 73-year-old female patient was diagnosed with Central Giant Cell Granuloma (CGCG). The proposed treatment plan involved an angle-to-angle resection of the mandible along with free flap surgery using an autologous iliac graft; however, the patient declined this option. As a final treatment plan, the possibility of utilizing a customized titanium prosthesis as a patient-specific implant (PSI) was considered. The patient was discharged in good general condition, and remarkably, full function was recovered within 24 hours. Additionally, the patient was able to speak and eat after just 5 hours, a testament to the swift recovery this treatment option offers. The primary benefits of this method are immediate results and swift, accurate surgical procedures, which provide reassurance of its efficiency. Keywords: Mandibular reconstruction; Patient-specific implant; 3D-printing; Oral surgery; Head and neck cancer.
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24. Park E-K, Lim J-Y, Yun I-S, Kim J-S, Woo S-H, Kim D-S, et al. Cranioplasty enhanced by three-dimensional printing: custom-made three-dimensional-printed titanium implants for skull defects. Journal of Craniofacial Surgery. 2016;27(4):943-9.
25. Le Clerc N, Baudouin R, Carlevan M, Khoueir N, Verillaud B, Herman P. 3D titanium implant for orbital reconstruction after maxillectomy. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020;73(4):732-9.
26. Bachelet J-T, Cordier G, Porcheray M, Bourlet J, Gleizal A, Foletti J-M. Orbital reconstruction by patient-specific implant printed in porous titanium: a retrospective case series of 12 patients. Journal of Oral and Maxillofacial Surgery. 2018;76(10):2161-7.
27. Kim YC, Jeong WS, Park T-k, Choi JW, Koh KS, Oh TS. The accuracy of patient specific implant prebented with 3D-printed rapid prototype model for orbital wall reconstruction. Journal of Cranio-Maxillofacial Surgery. 2017;45(6):928-36.
28. Gueutier A, Kün-Darbois J-D, Laccourreye L, Breheret R. Anatomical and functional rehabilitation after total bilateral maxillectomy using a custom-made bone-anchored titanium prosthesis. International Journal of Oral and Maxillofacial Surgery. 2020;49(3):392-6.
29. Fernandes N, Van den Heever J, Hoogendijk C, Botha S, Booysen G, Els J. Reconstruction of an extensive midfacial defect using additive manufacturing techniques. Journal of Prosthodontics. 2016;25(7):589-94.
30. Ma J, Ma L, Wang Z, Zhu X, Wang W. The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures: a case report. Medicine. 2017;96(27):e7250.
31. Lim H-K, Choi Y-J, Choi W-C, Song I-S, Lee U-L. Reconstruction of maxillofacial bone defects using patient-specific long-lasting titanium implants. Scientific Reports. 2022;12(1):7538.
32. Sadr-Eshkevari P, Rashad A, Vahdati SA, Garajei A, Bohluli B, Maurer PJP, et al. Alloplastic mandibular reconstruction: a systematic review and meta-analysis of the current century case series. 2013;132(3):413e-27e.
33. Touré G, Gouet EJJoO, Surgery M. Use of a 3-Dimensional Custom-Made Porous Titanium Prosthesis for Mandibular Body Reconstruction With Prosthetic Dental Rehabilitation and Lipofilling. 2019;77(6):1305-13.
34. Qassemyar Q, Assouly N, Temam S, Kolb FJIjoo, surgery m. Use of a three-dimensional custom-made porous titanium prosthesis for mandibular body reconstruction. 2017;46(10):1248-51.
2. Bianchi B, Copelli C, Ferrari S, Ferri A, Sesenna EJJoC-MS. Free flaps: outcomes and complications in head and neck reconstructions. 2009;37(8):438-42.
3. Eisele D, Smith RV. Complications in head and neck surgery. Complications in Head and Neck Surgery with CD Image Bank: Elsevier Inc.; 2009.
4. Öhman D, Schaefer C, Nannmark U, Kjeller G, Malmström JJIJoO, Implants M. Mandible reconstruction with patient-specific implants: Case report of five consecutive patients. 2019;34(1).
5. Toso SM, Menzel K, Motzkus Y, Adolphs N, Hoffmeister B, Raguse J-D. Patient-specific implant in prosthetic craniofacial reconstruction: first report of a novel technique with far-reaching perspective. Journal of Craniofacial Surgery. 2015;26(7):2133-5.
6. Brånemark P-I, Albrektsson T. Titanium implants permanently penetrating human skin. Scandinavian journal of plastic and reconstructive surgery. 1982;16(1):17-21.
7. Tjellström A, Granström G. Long-term follow-up with the bone-anchored hearing aid: a review of the first 100 patients between 1977 and 1985. Ear, Nose & Throat Journal. 1994;73(2):112-4.
8. Federspil PA. Implant-retained craniofacial prostheses for facial defects. GMS current topics in otorhinolaryngology, head and neck surgery. 2011;8:Doc03.
9. Sandner A, Bloching M. Retrospective analysis of titanium plate-retained prostheses placed after total rhinectomy. International Journal of Oral & Maxillofacial Implants. 2009;24(1).
10. Farmand M. A new implant system for the fixation of facial prostheses. Deutsche Zeitschrift fur Mund-, Kiefer-und Gesichts-chirurgie. 1991;15(6):421-7.
11. Kurtulmus H, Cotert HS, Guneri P. Computed tomography-based planning and three-dimensional modeling for craniofacial implant placement: a technical note. International Journal of Oral & Maxillofacial Implants. 2009;24(5).
12. Palousek D, Rosicky J, Koutny D. Use of digital technologies for nasal prosthesis manufacturing. Prosthetics and orthotics international. 2014;38(2):171-5.
13. Vera C, Barrero C, Shockley W, Rothenberger S, Minsley G, Drago C. Prosthetic reconstruction of a patient with an acquired nasal defect using extraoral implants and a CAD/CAM copy‐milled bar. Journal of Prosthodontics on Dental Implants. 2015:197-204.
14. Peel S, Bhatia S, Eggbeer D, Morris DS, Hayhurst C. Evolution of design considerations in complex craniofacial reconstruction using patient-specific implants. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2017;231(6):509-24.
15. O'Reilly EB, Barnett S, Madden C, Welch B, Mickey B, Rozen S. Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2015;68(3):329-38.
16. Shah AM, Jung H, Skirboll S. Materials used in cranioplasty: a history and analysis. Neurosurgical focus. 2014;36(4):E19.
17. Acero J, Calderon J, Salmeron JI, Verdaguer JJ, Concejo C, Somacarrera ML. The behaviour of titanium as a biomaterial: microscopy study of plates and surrounding tissues in facial osteosynthesis. Journal of cranio-maxillofacial surgery. 1999;27(2):117-23.
18. Blake G, MacFarlane M, Hinton J. Titanium in reconstructive surgery of the skull and face. British journal of plastic surgery. 1990;43(5):528-35.
19. Lethaus B, Bloebaum M, Koper D, Poort-ter Laak M, Kessler P. Interval cranioplasty with patient-specific implants and autogenous bone grafts–success and cost analysis. Journal of Cranio-Maxillofacial Surgery. 2014;42(8):1948-51.
20. Alasseri N, Alasraj A. Patient-specific implants for maxillofacial defects: challenges and solutions. Maxillofacial Plastic and Reconstructive Surgery. 2020;42:1-8.
21. Kreutzer K, Steffen C, Koerdt S, Doll C, Ebker T, Nahles S, et al. Patient-specific 3D-printed miniplates for free flap fixation at the mandible: A feasibility study. Frontiers in Surgery. 2022;9:778371.
22. Joshi S, Salema HJ, Pawar S, Nair VS, Koranne V, Sane VD. Patient-Specific Implants in Maxillofacial Reconstruction-A Case Report. Annals of Maxillofacial Surgery. 2023;13(2):258-61.
23. Huang M-T, Juan P-K, Chen S-Y, Wu C-J, Wen S-C, Cho Y-C, et al. The potential of the three-dimensional printed titanium mesh implant for cranioplasty surgery applications: Biomechanical behaviors and surface properties. Materials Science and Engineering: C. 2019;97:412-9.
24. Park E-K, Lim J-Y, Yun I-S, Kim J-S, Woo S-H, Kim D-S, et al. Cranioplasty enhanced by three-dimensional printing: custom-made three-dimensional-printed titanium implants for skull defects. Journal of Craniofacial Surgery. 2016;27(4):943-9.
25. Le Clerc N, Baudouin R, Carlevan M, Khoueir N, Verillaud B, Herman P. 3D titanium implant for orbital reconstruction after maxillectomy. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020;73(4):732-9.
26. Bachelet J-T, Cordier G, Porcheray M, Bourlet J, Gleizal A, Foletti J-M. Orbital reconstruction by patient-specific implant printed in porous titanium: a retrospective case series of 12 patients. Journal of Oral and Maxillofacial Surgery. 2018;76(10):2161-7.
27. Kim YC, Jeong WS, Park T-k, Choi JW, Koh KS, Oh TS. The accuracy of patient specific implant prebented with 3D-printed rapid prototype model for orbital wall reconstruction. Journal of Cranio-Maxillofacial Surgery. 2017;45(6):928-36.
28. Gueutier A, Kün-Darbois J-D, Laccourreye L, Breheret R. Anatomical and functional rehabilitation after total bilateral maxillectomy using a custom-made bone-anchored titanium prosthesis. International Journal of Oral and Maxillofacial Surgery. 2020;49(3):392-6.
29. Fernandes N, Van den Heever J, Hoogendijk C, Botha S, Booysen G, Els J. Reconstruction of an extensive midfacial defect using additive manufacturing techniques. Journal of Prosthodontics. 2016;25(7):589-94.
30. Ma J, Ma L, Wang Z, Zhu X, Wang W. The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures: a case report. Medicine. 2017;96(27):e7250.
31. Lim H-K, Choi Y-J, Choi W-C, Song I-S, Lee U-L. Reconstruction of maxillofacial bone defects using patient-specific long-lasting titanium implants. Scientific Reports. 2022;12(1):7538.
32. Sadr-Eshkevari P, Rashad A, Vahdati SA, Garajei A, Bohluli B, Maurer PJP, et al. Alloplastic mandibular reconstruction: a systematic review and meta-analysis of the current century case series. 2013;132(3):413e-27e.
33. Touré G, Gouet EJJoO, Surgery M. Use of a 3-Dimensional Custom-Made Porous Titanium Prosthesis for Mandibular Body Reconstruction With Prosthetic Dental Rehabilitation and Lipofilling. 2019;77(6):1305-13.
34. Qassemyar Q, Assouly N, Temam S, Kolb FJIjoo, surgery m. Use of a three-dimensional custom-made porous titanium prosthesis for mandibular body reconstruction. 2017;46(10):1248-51.
| Files | ||
| Issue | Vol 12, No 1 (Winter 2025) | |
| Section | Case Report(s) | |
| Keywords | ||
| Mandibular reconstruction; Patient-specific implant; 3D-printing; Oral surgery; Head and neck cancer. | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Parhiz A, Karimpour M, Farahmand F, Damercheli S, Amirzade Iranaq MH. Rehabilitation of Mandibulectomy with Patient-Specific Instrument: A Case Report. J Craniomaxillofac Res. 2025;12(1):50-56.
