METHOD OF MANUAL SEGMENTATION IN VOLUMETRIC ASSESSMENT OF COMPLEX TREATMENT’S RESULTS OF PATIENTS WITH SEVERE MANDIBULAR ATROPHY WITH USE OF REVASCULARIZED AUTOGENOUS FIBULAR TRANSPLANT
Purpose. To assess the results of complex treatment of patients with severe mandibular atrophy using the method of multispiral computed tomography (MCT) manual segmentation for volume calculation of native mandible and revascularized fibula autogenous transplant at all treatment stages and after. Material and methods. During the 2017 and 2018 years, at the department of «Maxillofacial Surgery» of «CRID», 5 female patients with severe mandibular atrophy, aged within 47 to 64 years (mean - 53 years), underwent surgical treatment using revascularized fibula autogenous transplant. The volumetric measurement of mandible and revascularized fibula autogenous transplant was done by means of manual segmentation of head MCT obtained previous to reconstruction, before dental intraosseus implants insertion, and 3 months after rehabilitation with implantsupported prosthetic constructions. Segmentation of structures of interest was done within +135 to +1860 Hounsfield Units. As a start point for native mandible segmentation the entering into mandibular canal was used. Results. In two presented clinical cases was noted the absence of mandibular atrophy progression after the reconstructive surgery, as well as volume increase of revascularized fibula autogenous transplant 3 months after starting of functional loading of intraosseus implants by 1,282 cm³ (11,92%) and 1,368 cm³ (11,65%). Conclusions. The manual segmentation of MCT represents a reliable method for assessment of results of complex treatment in patients with severe mandibular atrophy using revascularized fibula autogenous transplant. Increase of revascularized autogenous transplant volume occurs as a result of functional adaptation in response to biomechanical load, transmitted by mastication.