Segmental Mandibulectomy and Mandibular Reconstruction with Fibula-Free Flap Using a 3D Template
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | No of Patients (%) | |
---|---|---|
Age (median—range) | 65.1 years—48–78 years | |
Gender | Male Female Ratio (M/F) | 5 (71.4%) 2 (28.6%) 2.5 |
Primary site of disease | Alveolar ridge/Retromolar trigone Floor of mouth | 3 (42.9%) 4 (57.1%) |
Tobacco use | Yes No | 6 (90%) 1 (10%) |
Alcohol excess | Yes No | 5 (71.4%) 2 (28.6%) |
Tobacco and alcohol use | --- | 5 (71.4%) |
cTNM | cT4aN0M0 cT3N2bM0 | 6 (85.7%) 1 (14.3%) |
Type of mandibular defect according with Brown | Class II Class III | 3 (42.9%) 4 (57.1%) |
Type of procedure | Anterior segmental pelvi-glosso-mandibulectomy (mandibular defect class III according to Brown + type IVa glossectomy according to Ansarin) Segmental hemi-pelvi-mandibulectomy (mandibular defect class II according to Brown) | 4 (57.1%) 3 (42.9%) |
Synchronous neck dissection | Unilateral Bilateral | 3 (42.9%) 4 (57.1%) |
Postoperative complications | Clavien-Dindo IIIA Clavien-Dindo IIIB | 1 (14.3%) 1 (14.3%) |
pTNM | pT4aN0 pT4aN1 pT4aN2b pT4aN3b (ENE+) | 3 (42.9%) 1 (14.3%) 1 (14.3%) 2 (28.5%) |
Outline Symmetry, Including Mental Projection (Both Bony and Soft Tissue) | Scarring in the Face (Including Flap Exposure) | Others | Results (Number of Patients and %) | |
---|---|---|---|---|
4 (excellent) | Completely symmetric | No scarring | No lip deformity or facial paralysis | 3 (42.9%) |
3 (good) | Slightly asymmetric | No scarring | Lip deformity/facial paralysis | 4 (57.1%) |
2 (fair) | Slightly asymmetric | Scarring including exposed skin graft with good color match | Lip deformity/facial paralysis | 0 |
1 (poor) | Asymmetric or Poor mental projection | Exploded skin island, bad color match | Lip deformity/facial paralysis | 0 |
Domain | Pre-Operative 3D-Group | Postoperative 3D-Group | Pre- and Postoperative Absolute Difference 3D-Group |
Intercondilar distance (mm) | |||
M | 107.74 | 108.9 | 3.02 |
SD | 9.46 | 10.2 | 1.56 |
Intergonial distance (mm) | |||
M | 89.22 | 90.7 | 1.84 |
SD | 7.46 | 6.21 | 2.11 |
Antero-posterior distance (mm) | |||
M | 117.8 | 118.35 | 2.41 |
SD | 10.9 | 9.73 | 1.9 |
Gonial angle (°) | |||
M | 113 | 111 | 3 |
SD | 3.63 | 5.3 | 1.8 |
Domain | Pre-Operative No 3D-Group | Post-Operative No 3D-Group | Pre- and Postoperative Absolute Difference No 3D-Group |
Intercondilar distance (mm) | |||
M | 100 | 100.1 | 4.1 |
SD | 4.4 | 4 | 3.04 |
Intergonial distance (mm) | |||
M | 84.8 | 88 | 5.28 |
SD | 4.4 | 5.3 | 4.5 |
Antero-posterior distance (mm) | |||
M | 122.1 | 122.1 | 2.8 |
SD | 7.1 | 6.3 | 1.5 |
Gonial angle (°) | |||
M | 110.5 | 109.5 | 5 |
SD | 8.8 | 6.9 | 3.7 |
Statistical analysis (3D vs. No 3D) | |||
p = 0.46 | p = 0.13 | p = 0.74 | p = 0.27 |
1 − a = 0.95 | 1 − a = 0.95 | 1 − a = 0.95 | 1 − a = 0.95 |
CI −9.735–7.57 | CI −21.79–14.91 | CI −4.64–3.96 | CI −14.72–10.72 |
Site of Primary | Type of Mandibular Defect According with Brown | Type of Procedure | Resection of Tongue | Resection of Skin | Adjuvant Treatment | Functional Results | Aesthetic Results |
---|---|---|---|---|---|---|---|
Floor of the mouth n = 4 | Class III | Anterior segmental Pelvi-glosso-mandibulectomy (n = 4) | Type Iva glossectomy according to Ansarin et al. [19] (n = 4) | No (n = 0) | YES n = 2 NO n = 2 | No PEG n = 2 Temporary PEG n = 1 Definitive PEG n = 1 | Katsuragi classification 4 n = 1 Katsuragi classification 3 n = 3 |
Alveolar ridge/retromolar trigone n = 3 | Class II | Segmental Hemi-pelvi-mandibulectomy (n = 3) | No (n = 0) | No (n = 0) | YES n = 3 NO n = 0 | No PEG n = 3 Temporary PEG n = 0 Definitive PEG n = 0 | Katsuragi classification 4 n = 2 Katsuragi classification 3 n = 1 |
Domain | Pre-Operative | Post-Operative |
---|---|---|
Function subscales | ||
Physical function | ||
M | 77.8 | 78.9 |
SD | 34.4 | 22.5 |
Role function | ||
M | 66.7 | 55.6 |
SD | 51.6 | 46.7 |
Emotional function | ||
M | 41.7 | 80.5 |
SD | 32.9 | 6.8 |
Cognitive function | ||
M | 83.3 | 94.4 |
SD | 25.8 | 8.6 |
Social function | ||
M | 80.5 | 83.3 |
SD | 24.5 | 18.3 |
Global health/Quality of Life | ||
M | 52.8 | 61.1 |
SD | 41 | 22.1 |
Symptom subscales/items | ||
Fatigue | 44.4 | 44.5 |
M | 50.2 | 32.2 |
SD | ||
Nausea/vomiting | ||
M | 0 | 8.3 |
SD | 0 | 20.4 |
Pain | ||
M | 47.2 | 33.3 |
SD | 42.7 | 42.2 |
Dyspnea | ||
M | 38.9 | 11.1 |
SD | 49.1 | 17.2 |
Insomnia | ||
M | 22.2 | 11.1 |
SD | 34.4 | 27.1 |
Appetite loss | ||
M | 33.3 | 33.3 |
SD | 36.5 | 42.2 |
Constipation | ||
M | 38.9 | 33.3 |
SD | 49.1 | 36.5 |
Diarrhea | ||
M | 5.5 | 0 |
SD | 13.6 | 0 |
Financial difficulties | ||
M | 0 | 27.8 |
SD | 0 | 44.3 |
Domain | M | SD | Range |
---|---|---|---|
Pain | 83.33 | 20.41 | 50 to 100 |
Appearance | 95.83 | 10.21 | 75 to 100 |
Activity | 83.33 | 25.82 | 50 to 100 |
Recreation | 79.17 | 33.23 | 25 to 100 |
Swallowing | 68.33 | 22.29 | 30 to 100 |
Chewing | 41.67 | 20.41 | 0 to 50 |
Speech | 68.33 | 36.56 | 0 to 100 |
Shoulder | 90 | 15.49 | 70 to 100 |
Taste | 61.67 | 39.71 | 0 to 100 |
Saliva | 90 | 15.49 | 70 to 100 |
Mood | 70.83 | 24.58 | 25 to 100 |
Anxiety | 78.33 | 27.87 | 30 to 100 |
Health-related QOL compared to month before having cancer | 45.83 | 18.82 | 25 to 75 |
Health-related QOL during the past 7 days | 63.33 | 15.06 | 40 to 80 |
Overall QOL during the past 7 days | 73.33 | 10.33 | 60 to 80 |
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Tatti, M.; Carta, F.; Bontempi, M.; Deriu, S.; Mariani, C.; Marrosu, V.; Foddis, E.; Gerosa, C.; Marongiu, G.; Saba, L.; et al. Segmental Mandibulectomy and Mandibular Reconstruction with Fibula-Free Flap Using a 3D Template. J. Pers. Med. 2024, 14, 512. https://doi.org/10.3390/jpm14050512
Tatti M, Carta F, Bontempi M, Deriu S, Mariani C, Marrosu V, Foddis E, Gerosa C, Marongiu G, Saba L, et al. Segmental Mandibulectomy and Mandibular Reconstruction with Fibula-Free Flap Using a 3D Template. Journal of Personalized Medicine. 2024; 14(5):512. https://doi.org/10.3390/jpm14050512
Chicago/Turabian StyleTatti, Melania, Filippo Carta, Mauro Bontempi, Sara Deriu, Cinzia Mariani, Valeria Marrosu, Emanuele Foddis, Clara Gerosa, Giuseppe Marongiu, Luca Saba, and et al. 2024. "Segmental Mandibulectomy and Mandibular Reconstruction with Fibula-Free Flap Using a 3D Template" Journal of Personalized Medicine 14, no. 5: 512. https://doi.org/10.3390/jpm14050512