CAD/CAM techniques improve outcomes in jaw reconstruction after cancer surgery

For patients undergoing jaw reconstruction after surgery for head and neck cancer, computer-aided design and manufacturing (CAD/CAM) techniques can improve some key clinical outcomes, reports a study in the May issue of Plastic and Reconstructive Surgery^®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Our experience suggests that CAD/CAM techniques offer several benefits in patients undergoing free fibula reconstruction of the lower jaw, including a reduced risk of long-term complications requiring hardware removal," comments ASPS Member Surgeon Mario G. Solari, MD, of University of Pittsburgh.

CAD/CAM has 'revolutionized' jaw reconstruction – does it improve patient outcomes?

Over the past decade, "[P]reoperative virtual surgical planning through CAD/CAM has revolutionized the way we approach head and neck reconstruction," according to the authors. Using CAD/CAM technology, surgeons can design and create "three-dimensionally printed, patient-specific cutting guides" as well as pre-formed hardware for use in reconstruction.

CAD/CAM has been successfully applied to "free fibula flap" reconstruction after surgery for head and neck cancer – using bone and tissue grafts from the lower leg to reconstruct the jaw. "However, given the relatively recent introduction [of CAD/CAM], studies performing head-to-head comparison to the conventional technique are limited," Dr. Solari and coauthors write. Their new study directly compares the short- and long-term outcomes of conventional and CAD/CAM-assisted free fibula flap reconstruction.

The study included 215 patients undergoing free fibula reconstruction of the lower jaw (mandible) between 2012 and 2021, mainly after cancer surgery. Of these, 136 patients had CAD/CAM-assisted reconstruction and 79 underwent conventional reconstruction.

Improved efficiency and accuracy with CAD/CAM lead to clinical benefits

Patients undergoing CAD/CAM-assisted reconstruction spent less time in the operating room (OR) – about an hour less than the conventional group. There was no significant difference in hospital days.

Most short-term complications were similar between groups, including return to the OR, major bleeding, blood clot-related complications, and rates of total and complete loss of the free fibula flap were similar as well. However, the CAD/CAM group was less likely to have dehiscence (reopening) of the incision site: 7.4% versus 16.5%.

Analysis of longer-term outcomes (two to 2.5 years) focused on 195 patients with no major complications in the first 30 days. While most long-term complications were similar between groups, patients undergoing CAD/CAM-assisted reconstruction were less likely to need further surgery to remove the reconstruction hardware. After adjustment for potential risk factors, patients in the CAD/CAM group were 60% less likely to undergo hardware removal.

The reduction in operating room time reflects "the lack of time-consuming hardware manipulations and bony adjustments" with conventional free fibula flap reconstruction, the researchers write. Previous studies have reported increased accuracy and solid bone fusion with CAD/CAM; these improvements may lead to a reduction in long-term complications necessitating hardware removal.

The study adds new evidence that integrating CAD/CAM techniques provides meaningful clinical benefits for patients undergoing jaw reconstruction. Dr. Solari and colleagues conclude: "Given the added cost with the use of CAD/CAM, future studies focusing on cost-effectiveness of this approach with respect to long-term outcomes and hardware maintenance will be important to justify the clinical significance of our results."