Computer Assisted Oral and Maxillofacial Reconstruction

Ablative tumor surgery, orbital and mid face reconstruction as much as skull base surgery requires detailed planning using CT or MRI. Reconstruction is depending on reliable information to choose correct type of grafts and to predict the outcome. This study evaluates the benefit and the indications of computer assisted surgery in the treatment of cranio-maxillofacial surgery.Based on a CT or MRI data set an optical navigation system was used for preoperative planning, intraoperative navigation and postoperative control. Surgery was preoperatively planned and intraoperatively navigated. Preoperatively required soft and hard tissue was measured using the mirrored data set of the unaffected side; size and location of the graft were chosen virtually. Intraoperatively contours of transplanted tissues were navigated to the preoperatively simulated reconstructive result.Computer assisted treatment was successfully completed in all cases (n=107). Preoperatively outlined safety margins could be exactly controlled during tumor resection. Reconstruction was designed and performed precisely as virtually planned. Image guided treatment improves preoperative planning by visualization of the individual anatomy, intended reconstructive outcome and by objectivation the effect of adjuvant therapy. Intraoperative navigation makes tumor and reconstructive surgery more reliable by showing the safety margins, saving vital structures and leading reconstruction to preplanned objectives

Endoscope-Assisted Transoral Reduction and Internal Fixation Versus Closed Treatment of Mandibular Condylar Process Fractures-A Prospective Double-Center Study

Purpose: The aim of this international AO-study was to compare the functional outcome after open versus closed treatment of mandibular condylar neck fractures. Patients and Methods: A prospective comparative study with two follow-ups (FU) at 8-12 weeks and 1 year was undertaken in two clinics, which exclusively privileged either surgical or conservative treatment due to different therapeutic agendas. Patients from clinic 1 (ENDO group) received endoscope-assisted transoral open reduction and internal fixation, whereas patients from clinic 2 (CONS group) were treated conservatively without surgery. Patients with unilateral condylar neck fractures showing one or more of the following conditions were included: displacement of the condyle with an inclination >30 degrees and/or severe functional impairment such as malocclusion or open bite, with or without dislocation of the condylar fragment; severe pain upon palpation or movement, and/or vertical shortening of the ascending ramus. High or intracapsular condylar neck fractures were excluded. Results: 75 patients (44 CONS and 31 ENDO patients) with condylar neck fractures were included in this study. The Asymmetric Helkimo Dysfunction Score (A-HDS) was slightly lower in the CONS group than in the ENDO group at the 8-12-week FU, corresponding to better function on the short-term. At the 1-year FU, however, there were slightly better values in the ENDO group. For the Clinical Dysfunction Index (Di) and the Anamnestic Dysfunction Index (Ai), CONS patients had a better outcome than ENDO patients at the 8-12 week FU, ie, a higher proportion of ENDO patients had severe symptoms due to the operative trauma. Yet these symptoms improved by one year, finishing with a significant higher proportion of symptom-free patients in the ENDO group. In addition, these patients had better values for the Index for Occlusion and Articulation Disturbance (Oi) at both FU examinations, ie, the proportion of patients without any occlusal disturbances was significantly higher in the ENDO group. On average, the duration of postoperative maxillo-mandibular fixation (MMF) was 3 times longer for the CONS group than for the ENDO group (33 vs. 11 days). Conclusion: Both treatment options may yield acceptable results for displaced condylar neck fractures. Especially in patients with severe malocclusion directly after trauma, however, endoscope-assisted transoral open reduction and fixation seems to be the appropriate treatment for prevention of occlusal disturbances during FU