Secondary Mandible Reconstruction with Computer-Assisted-Surgical Simulation and Patient-Specific Pre-Bent Plates: The Algorithm of Virtual Planning and Limitations Revisited

Round 1

Reviewer 1 Report

The paper "Secondary Mandible Reconstruction With Computer-Assisted 
and Patient-Specific Pre-Bent Plates: the Algorithm of Virtual Planning and Limitations Revisited " is interesting. 

The abstract is clear and well structured. The introduction is clear and concise.

Materials and methods are well written and with many interesting figures. Results are clearly presented. The discussion is well conducted. References: I think that the authors should cite other recent references about the CAD CAM technology and its uses.

Author Response

Point 1: I think that the authors should cite other recent references about the CAD CAM technology and its uses.

Response: Thanks for reviewer's comment. We have added some recent references. (References 1,10,11,26)

Reviewer 2 Report

Dear authors!

Thank you for this novel and scientifically well performed research. Maxillofacial traumatology and reconstruction methods are of interest to practical healthcare, so modern approaches with scientific justification are relevant.

The study describes the preparatory stage well, but I have a question about the osteoplastic materials that you prefer to use to achieve the clinical effect of the operation. Does it matter and if so, what would be the recommendations.
I also ask you to clarify and, if possible, expand the description of soft tissue surgery, in particular muscle fixation.

Author Response

Point 1: The study describes the preparatory stage well, but I have a question about the osteoplastic materials that you prefer to use to achieve the clinical effect of the operation. Does it matter and if so, what would be the recommendations?

Response: We would like apologize for not getting the question correctly. Since all the secondary defects were reconstructed with vascularized tissue transfers (which is always regarded gold standard), there were no scope of osteoplastic materials in our cases. If osteoplastic materials refer to particulate bone grafts or bone cements, we believe that those materials won’t be suitable for secondary mandibular reconstructions, especially larger ones.

Point 2: I also ask you to clarify and, if possible, expand the description of soft tissue surgery, in particular muscle fixation?

Response: We have explained the detailed steps of access surgery (section 2.3) including use of old scar as incision, contracture release, coronoidectomy, excision of fibrotic tissues etc. Attempt was made in all cases to cover the reconstructed bone with available masticator muscles in the area of vicinity.

 

Reviewer 3 Report

Thank you for the opportunity to review article titled "Secondary Mandible Reconstruction With Computer-Assisted  and Patient-Specific Pre-Bent Plates: the Algorithm of Virtual  Planning and Limitations Revisited”

Abstract is too long, the authors should follow the journal guidelines of 200 words and rewrite it.

Lines 44-47 should focus on mandibular defects as in the title not on craniofacial defects as this can be confusing. This sentence should be removed or rewritten.

Lines 57-59 need references

In the introduction section more information about the cause and prevalence of secondary mandibular reconstruction should be added.

The aim or the hypothesis of the study is not presented  at all.

The inclusion and exclusion criteria are not clear and not in accordance with the subject/ title of the paper.

The advantages of the proposed algorithm should be presented and discussed, the reason behind Table 1 is hard to understand as it is not needed, a graph presenting the differences in accuracy should be added. More information about how the differences in position would impact the treatment outcome. There is almost no statistics presenting the research outcome.

Bending or cutting  of the plates can destroy the anticorrosive layer of the plate thus such procedures are not recommended. The authors should describe in more detail the limitations of the technique and present the advantages of the proposed technique in regard to corrosion and bacteria contamination of the plates. For example they should refer to the following paper: https://doi.org/10.1016/j.injury.2021.12.020

In the discussion please discuss and refer to the paper: https://doi.org/10.1016/j.bspc.2020.102342. 

In general the discussion is a little bit too long and the references should be more up to date, mostly not older than 5 years.

Author Response

Point 1: Abstract is too long, the authors should follow the journal guidelines of 200 words and rewrite it.

Response: Done as suggested

Point 2: Lines 44-47 should focus on mandibular defects as in the title not on craniofacial defects as this can be confusing. This sentence should be removed or rewritten.

Response: The sentence has been removed as suggested.

Point 3: Lines 57-59 need references

Response: Reference added as suggested.

Point 4: In the introduction section more information about the cause and prevalence of secondary mandibular reconstruction should be added.

Response: Done as suggested.

Point 5: The aim or the hypothesis of the study is not presented  at all.

Response: Aim incorporated in the last paragraph of Introduction segment.

Point 6: The inclusion and exclusion criteria are not clear and not in accordance with the subject/ title of the paper.

Response: Necessary modifications done as suggested.

Point 7: The advantages of the proposed algorithm should be presented and discussed, the reason behind Table 1 is hard to understand as it is not needed, a graph presenting the differences in accuracy should be added. More information about how the differences in position would impact the treatment outcome. There is almost no statistics presenting the research outcome.

Response: The advantage of the proposed algorithm has now been mentioned in the methodology section. Since the aim of the study was to devise an algorithm in different defect scenarios, we believe that our study has provided a technique where a 3D template can be produced with comparable accuracy except in cases of huge bilateral defects, as shown by relevant statistical tests; as mentioned in results section.

Point 8: Bending or cutting  of the plates can destroy the anticorrosive layer of the plate thus such procedures are not recommended. The authors should describe in more detail the limitations of the technique and present the advantages of the proposed technique in regard to corrosion and bacteria contamination of the plates. For example they should refer to the following paper: https://doi.org/10.1016/j.injury.2021.12.020

Response: The suggested paper has been mentioned and findings elaborated in the discussion section.

Point 9: In the discussion please discuss and refer to the paper: https://doi.org/10.1016/j.bspc.2020.102342. 

Response: Viewing the abstract, the study seems to investigate the stress distribution pattern of rectangular and star shaped plates under varying loading for purpose of fixation of mandibular fractures. The conclusion too mentions that patients with mandibular body fracture can be successfully treated with 3D printed modular plates. We would humbly apologize that we couldn’t quite relate the study results and conclusion with our study in consideration.

Point 10: In general the discussion is a little bit too long and the references should be more up to date, mostly not older than 5 years.

 

Response: Discussion has been shortened to an extent. We have removed some old references and add new references . (Add references 1,10,11,26)

Round 2

Reviewer 3 Report

 Tha manuscript has improved a lot