Reconstruction

Question 1

planning phase

Answer 1

first phase in CASS - computer aided surgical simulation

manipulation of CT/CBCT Dicom data

Question 2

phase after surgery

Answer 2

evaluation phase

1. planning
2. modeling
3. surgical
4. evaluation

Question 3

cons of microvascular free fibula flap

Answer 3

BONE STOCK

Question 4

approaches to reconstruction

Answer 4

1. integrity
2. function
3. form
   - aesthetics more last

Question 5

major tissues utalized for free tissue grafting

Answer 5

1. radial forearms
2. scapula
3. iliac crest
4. fibula *
5. lateral thigh

Question 6

basics of free flaps

Answer 6

aka free tissue transfer
flaps are autogenously “transplanted” tissue
- skin, muscle, fascia, bone

Question 7

blood supply for free flaps

Answer 7

intrinsic – anatomy native to donor site

requirement for flap viability
- blood comes in and blood comes out

Question 8

CASS stands for

Answer 8

computer aided surgical simulation

CASS / virtual surgery

Question 9

typical applications of CASS

top three noted

Answer 9

1. three dimensional models for treatment planning
2. custom design prosthesis
3. replication of segmental anatomic objects for fabrication of surgical reconstructive guides

Question 10

opportunities for error

Answer 10

1. disconnect b/w ablative and reconstructive teams
2. fibular osteotomies are ofen eyeballed
3. bone to bone contact
4. adequate ORTHOGNATHIC relationships
5. condylar alignment
6. proper placement of fibula in a anterior/ posterior and inferior superior dimensino

Question 11

the phases of CASS

Answer 11

1. planning
2. modeling
3. surgical
4. evaluation

Question 12

what goes into the planning phase

Answer 12

high resolution CT/CBCT/CTA scan

3D virtual reconstrutios

scanned occlusal records / dental casts if applicable

web meeting

Question 13

phase 2 is

Answer 13

modeling
- life sized stereolithographic model of native craniofacial skeletn and / or pathology

• cutting guides, reconstruction plating templates, occlusal splints
• working stereolithographic models

Question 14

evaluation phase

Answer 14

4th

• postoperative CT scans
• overlays, comparisons

Question 15

“top down” planning?

Answer 15

True – with maxillofacial reconstruction

- planning from occlusal / prosthodontic perspective of top-down

Question 16

microvascular free fibula flap discovered when

Answer 16

1989– hidalgo first to report on a series of vascularized fibula grafs for mandibular reconstruction

Question 17

main disadvantage of microvascular free fibula flap is

Answer 17

LACK OF BONE STOCK
- insufficient bone for the reconstruction of both the skeletal base (inferior border of the mandible) and the alveolar ridge

resulting in vertical discrepency between reconstructed and unaffected sides
-lack of vertical height –

Question 18

pros of microvascular free fibula flap

Answer 18

1. long vascular pedicle
2. solid/ sizeable bone stock
3. reliable blood supply
4. distant donor site/ low donor morbidity
5. ability to accuratley plan using 3-d sofware

Question 19

cons of microvascular free fibula flap

Answer 19

1. bone stock
2. lengthy operation
3. complex with many opportunities for error

the main disadvantage of the fibula flap is the insufficient bone for the reconstruction of both the skeletal base (inferior border of mandible) and the alveolar ridge.

Question 20

microvascular free fibula is ability to carry —-

Answer 20

carry bone, skin, muscle, nd fascia

With an outstanding
length available for harvest, a solid and sizeable bone stock, a reliable blood supply, an allowance for manipulation of the components of the flap while maintaining adequate blood supply, and the ability to carry bone, skin, muscle and fascia, the fibula flap has become one of the most commonly used vascularized osseous and osteocutaneous flaps for reconstruction of defects around the body, especially the mandible

Question 21

Virtual surgery improves predictability and accuracy?

details

Answer 21

YES because the traditional microvascular free fibula

• free hnd approach
• operator / experience dependent
• prone to inaccuracies, intra-op adjustments, rarely restored

Question 22

the future in terms of plates

Answer 22

technology enabling pre-milled plates

Question 23

potential drawbacks of CASS

Answer 23

cost
adaptability
increased preoperative planning time

Question 24

CASS offers

- list

Answer 24

• optimal preoperative planning
• decreased intra-operative time
• teaching aide
• improves expectations of both patient/ surgeon
• promotes close coordination between ablative/ reconstruction teams
• less invasive procedures??

Question 25

integrity

Answer 25

alimentary tract face neck intracranial first aspect / approach to reconstruction

Question 26

function

Answer 26

second approach to reconstruction mastication swallowing speech facial expressions

Question 27

form

Answer 27

3rd approach to reconstruction | - asthetics