A recent computed tomography (CT) scan in DICOM format with thin slices should be obtained. Firstly, accurate digital design is needed. There are a number of essential steps required to achieve success in 3D planning.
Other considerations include the final aesthetic result, the potential impact on quality of life for the patient and the ability of the reconstruction to withstand radiotherapy, if this is likely to be required. Any reconstruction must also attempt to restore the complex functional requirements of this region, namely speech, swallow and mastication. The amount of osseous and soft tissue required and the potential for dental rehabilitation must be considered carefully. The surgeon must attempt to reconstruct the complex geometry of the face so as to maintain the continuity of the jaws and also replicate the curvature of the arches where possible. The primary aims are to restore form and function.
Reconstruction of the facial skeleton is a complex task with a number of aims that the surgeon must consider. Recent years have seen the exponential growth in the use of these systems with improvements in intra-operative time, ease of use and cost. It then allows for the manufacture of adjuncts to surgery such as cutting guides and patient specific plates, which aim to reduce operative time and increase accuracy of reconstruction. Three-dimensional (3D) planning, also referred to as virtual surgical planning (VSP) or computer aided design/computer aided manufacture (CAD/CAM), has evolved to allow surgeons to digitally plan resection and reconstruction to a high degree of precision. This period has seen the development and rapid evolution of digital systems to aid in surgical planning and treatment. Head and neck reconstruction has undergone significant evolution over the last 20–30 years.
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