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Clinical Oral Investigations

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Open Access 01-05-2024 | Computed Tomography | Research

Three-dimensional assessment of upper airway changes associated with mandibular positional deviations following fibula free flap reconstruction

Authors: Katja Leonie Schulz, Ragai Matta, Christopher-Philipp Nobis, Tobias Möst, Marco Kesting, Rainer Lutz

Published in: Clinical Oral Investigations | Issue 5/2024

Abstract

Objectives

Fibula free flaps (FFF) are the standard approach to mandibular reconstruction after partial resection, with the goal of restoring aesthetics and masticatory function. The graft position affects both and must be carefully selected. Correlations between sagittal positioning and upper airway anatomy are known from orthognathic surgery. This study aims to evaluate changes in mandibular position and upper airway anatomy after reconstructive surgery with FFF and corresponding correlations.

Materials and methods

Mandibular position after reconstruction was evaluated using three-dimensional datasets of pre- and postoperative computed tomography scans of patients treated between 2020 and 2022. Three-dimensional measurements were performed on both condyles and the symphyseal region. Changes in upper airway volume and minimum cross-sectional area (minCSA) were analysed. Intra-rater reliability was assessed. Correlations between changes in upper airway anatomy and sagittal mandibular position were tested.

Results

The analysis included 35 patients. Intra-rater reliability was good to excellent. Condylar deviations and rotations were mostly rated as small. Changes in symphyseal position were considerably greater. Median airway volume decreased in the oropharynx and hypopharynx. Posterior deviation of the symphysis was associated with a decreasing minCSA in the hypopharynx and vice versa.

Conclusions

The overall accuracy of mandibular reconstructions with FFF is high, but there is room for optimization. The focus of research should be extended from masticatory to respiratory rehabilitation.

Clinical relevance

Effects on respiratory function should be considered prior to graft positioning. The clinical relevance of upper airway changes within the complex rehabilitation of reconstructive surgery patients needs to be further investigated.

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Title: Three-dimensional assessment of upper airway changes associated with mandibular positional deviations following fibula free flap reconstruction
Authors: Katja Leonie Schulz
Ragai Matta
Christopher-Philipp Nobis
Tobias Möst
Marco Kesting
Rainer Lutz
Publication date: 01-05-2024
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Published in: Clinical Oral Investigations / Issue 5/2024
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-024-05646-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Three-dimensional assessment of upper airway changes associated with mandibular positional deviations following fibula free flap reconstruction

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

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