This discussion will focus on digitally driven occlusion-based jaw reconstruction in major head and neck reconstructions. The conventional approach to use of bone containing free flaps (BCFF) required the use of intraoperative intuitive decision making with regard to design of the osseous reconstruction. If osseointegrated implants were to be installed, the implant positioning may have also been undertaken with intraoperative intuitive decision. The consequence of intraoperative intuitive reconstruction design decisions may result in inconsistent or at times suboptimal anatomical and functional outcomes. To overcome the limitations of intraoperative intuitive decision making, the use of digital surgical design and simulation (SDS) has emerged as a viable technology in major jaw reconstruction with the promise of improved function. The process of developing a digital workflow will be considered together with the structuring of a team to undertake digitally driven occlusion-based BCFF reconstruction that incorporates osseointegrated implants. The importance of objective measurement of function will be considered. The required digitally designed and additive manufactured surgical tools will be discussed. With the digital workflow developed, the use of the ART procedure has emerged for jaw reconstruction in oncology patients. This procedure has become the workhorse for reconstruction of jaws by the Northern Alberta Head and Neck Cancer Team. The ART procedure will be considered as will be the required digitally designed surgical tools and instruments that are additive manufactured. The additional complexities of managing reconstruction and rehabilitation with osseointegrated implants in patients treated with radiation therapy will be considered. The intent of the discussion is to provide participants with insight into the value of a digitally driven occlusion-based approach to reconstruction of the jaws in cancer patients where improved accuracy, cosmetic, and functional outcomes have opportunity of being realized as well as considerably reducing treatment times.
Upon completion of this presentation, participants should be able to: 1) organize the digital workflow and team design required to undertake a digitally driven occlusion-based BCFF reconstruction of the jaws; 2) recognize the clinical and digitally driven workflow of undertaking an ART procedure to reconstruct jaws of head and neck cancer patients; 3) explain the importance of planning for and objectively measuring functional outcomes of patients undergoing BCFF reconstruction of the jaws; and 4) identify the complexities of using the discussed ART approach in managing patients treated with radiation therapy.