DOI: 10.1055/s-0037-1601865
Virtual Surgical Planning for the Management of Severe Atrophic Mandible Fractures
Publication History
22 December 2016
05 February 2017
Publication Date:
19 April 2017 (eFirst)

Abstract
Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the reconstruction of two cases of severe atrophic mandible fracture using VSP. Two elderly edentulous/partially dentate patients who presented with fractures of their mandibles and who underwent reconstruction using VSP were included. Both had Class III atrophy at the region of the fracture. While both fractures were complex, the mechanism of injury differed with one being a tractor accident and the other being a pathologic fracture. Both patients presented with critical medical conditions. CT scans were obtained on both. The displaced segments were aligned virtually using mirror images and the midline of the maxilla. Three-dimensional models were fabricated to allow preoperative contouring of 2.5-mm reconstruction plates. Patients were operated under general anesthesia and fractures reduced and stabilized with 2.5-mm reconstruction plates placed at the lateral border of the mandible. Average treatment time for both patients was a little over 2 hours. There was good reduction with both. VSP is a valuable tool to assess and reduce complex fractures with less surgical time and predictable results.
References
- 1 Neumann P, Siebert D, Schulz A , et al. Using virtual reality techniques in maxillofacial surgery planning. Virtual Real (Walth Cross) 1999; 4: 213-222
- 2 Saad A, Winters R, Wise MW, Dupin CL, St Hilaire H. Virtual surgical planning in complex composite maxillofacial reconstruction. Plast Reconstr Surg 2013; 132 (3) 626-633
- 3 Swennen GR, Mollemans W, Schutyser F. Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging. J Oral Maxillofac Surg 2009; 67 (10) 2080-2092
- 4 Hirsch DL, Garfein ES, Christensen AM, Weimer KA, Saddeh PB, Levine JP. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg 2009; 67 (10) 2115-2122
- 5 Roser SM, Ramachandra S, Blair H , et al. The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results. J Oral Maxillofac Surg 2010; 68 (11) 2824-2832
- 6 Antony AK, Chen WF, Kolokythas A, Weimer KA, Cohen MN. Use of virtual surgery and stereolithography-guided osteotomy for mandibular reconstruction with the free fibula. Plast Reconstr Surg 2011; 128 (5) 1080-1084
- 7 Tepper OM, Sorice S, Hershman GN, Saadeh P, Levine JP, Hirsch D. Use of virtual 3-dimensional surgery in post-traumatic craniomaxillofacial reconstruction. J Oral Maxillofac Surg 2011; 69 (3) 733-741
- 8 Zheng GS, Su YX, Liao GQ , et al. Mandible reconstruction assisted by preoperative virtual surgical simulation. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113 (5) 604-611
- 9 Kupfer P, Saadad N, Hughes PJ. Open reduction and internal fixation of bilateral atrophic mandible fractures utilizing virtual surgical planning, custom cutting guides and reconstruction plate. A case report. J Oral Maxillofac Surg 2016; 74: e89
- 10 Van Sickels JE, Cunningham LL. Management of atrophic mandible fractures: are bone grafts necessary?. J Oral Maxillofac Surg 2010; 68 (6) 1392-1395
- 11 Buchbinder D. Treatment of fractures of the edentulous mandible, 1943 to 1993: a review of the literature. J Oral Maxillofac Surg 1993; 51 (11) 1174-1180
- 12 Tiwana PS, Abraham MS, Kushner GM, Alpert B. Management of atrophic edentulous mandibular fractures: the case for primary reconstruction with immediate bone grafting. J Oral Maxillofac Surg 2009; 67 (4) 882-887
- 13 Carlsson GE. Clinical morbidity and sequelae of treatment with complete dentures. J Prosthet Dent 1998; 79 (1) 17-23
- 14 Madsen MJ, Haug RH, Christensen BS, Aldridge E. Management of atrophic mandible fractures. Oral Maxillofac Surg Clin North Am 2009; 21 (2) 175-183 , v
- 15 Ellis III E, Price C. Treatment protocol for fractures of the atrophic mandible. J Oral Maxillofac Surg 2008; 66 (3) 421-435
- 16 Benech A, Nicolotti M, Brucoli M, Arcuri F. Intraoral extra-mucosal fixation of fractures in the atrophic edentulous mandible. Int J Oral Maxillofac Surg 2013; 42 (4) 460-463
- 17 Landa JS. Classification of mandibular resorption. Dent Radiogr Photogr 1967; 40 (3) 62-65
- 18 Atwood DA. Reduction of residual ridges: a major oral disease entity. J Prosthet Dent 1971; 26 (3) 266-279
- 19 Mercier P, Lafontant R. Residual alveolar ridge atrophy: classification and influence of facial morphology. J Prosthet Dent 1979; 41 (1) 90-100
- 20 Seibert JS. Reconstruction of deformed, partially edentulous ridges, using full thickness onlay grafts. Part I. Technique and wound healing. Compend Contin Educ Dent 1983; 4 (5) 437-453
- 21 Lekholm U, Zarb GA. Patient selection and preparation. Branemark PI, Zarb GA, Albrektsson T. Tissue Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago, IL: Quintessence Publishing Company; 1985: 199-209
- 22 Misch CE, Judy KW. Classification of partially edentulous arches for implant dentistry. Int J Oral Implantol 1987; 4 (2) 7-13
- 23 Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg 1988; 17 (4) 232-236
- 24 Luhr HG, Reidick T, Merten HA. Results of treatment of fractures of the atrophic edentulous mandible by compression plating: a retrospective evaluation of 84 consecutive cases. J Oral Maxillofac Surg 1996; 54 (3) 250-254 , discussion 254–255
- 25 Scott RF. Oral and maxillofacial trauma in the geriatric patient. Fonseca RJ, Walker RV. Oral and Maxillofacial Trauma. 2nd ed.. 2. Philadelphia, PA: Saunders; 1997: 1045-1072
- 26 Bruce RA, Ellis III E. The second Chalmers J. Lyons Academy study of fractures of the edentulous mandible. J Oral Maxillofac Surg 1993; 51 (8) 904-911
- 27 Gassner R, Tuli T, Hächl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg 2003; 31 (1) 51-61
- 28 Wittwer G, Adeyemo WL, Turhani D, Ploder O. Treatment of atrophic mandibular fractures based on the degree of atrophy--experience with different plating systems: a retrospective study. J Oral Maxillofac Surg 2006; 64 (2) 230-234
- 29 Pombo M, Luaces-Rey R, Pértega S , et al. Review of 793 facial fractures treated from 2001 to 2008 in a Coruña University Hospital: types and etiology. Craniomaxillofac Trauma Reconstr 2010; 3 (1) 49-54
- 30 Marciani RD. Invasive management of the fractured atrophic edentulous mandible. J Oral Maxillofac Surg 2001; 59 (7) 792-795
- 31 Nasser M, Fedorowicz Z, Ebadifar A. Management of the fractured edentulous atrophic mandible. Cochrane Database Syst Rev 2007; 24 (1) CD006087
- 32 Hanasono MM, Jacob RF, Bidaut L, Robb GL, Skoracki RJ. Midfacial reconstruction using virtual planning, rapid prototype modeling, and stereotactic navigation. Plast Reconstr Surg 2010; 126 (6) 2002-2006
- 33 Broyles JM, Wallner C, Borsuk DE, Dorafshar AH. The role of computer-assisted design and modeling in an edentulous mandibular malunion reconstruction. J Craniofac Surg 2013; 24 (5) 1835-1838