Max Johannes Dullaart1, Maarten Jan Antony van Alphen1, Annelieke Boudina Schoen2, Margje Bertine Buitenhuis3, Loes Margaretha Marie Braun4, Menno Krap1,5, Michiel Wilhelmus Maria van den Brekel1,6, Luc Hendricus Elizabeth Karssemakers1,7, Richard Dirven1
1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
2 University Medical Center Utrecht, Utrecht, The Netherlands
3 Mobius 3D Technologies, Nieuw-Vennep, The Netherlands
4 Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
5 Foundation of Special Dental Care, Amsterdam, The Netherlands
6 Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
7 Academic Center for Dentistry Amsterdam, Amsterdam, The Netherlands
Introductie en doelstelling
To increase the number of patients who can speak hands-free after total laryngectomy, we aim to assess the viability of the manubrium sterni bone (MSB) for bone implantation.
Materiaal en methode
This retrospective cross-sectional study was conducted at the Department of Head and Neck Surgery, of the Netherlands Cancer Institute in Amsterdam, the Netherlands, and approved by its Institutional Review Board. We included CT-scans of 25 males and 24 females aged 53 to 88 years, and measured MSB morphometry and density, soft tissue thickness (STT) and bone surface slope, and classified the MSB. Heat maps were created to identify potential implant locations.
Resultaten
Median MSB height was 50.7 (95% CI [49.4-53.4]) mm, and mean thickness ranged from 8.7 [8.3-9.2] to 13.1 [12.7-13.6] mm. Mean width ranged from 53.2 [51.1-55.4] to 57.1 [55.3-59.1] mm. Significantly greater values of thickness and width were found in males. Body height had a significant positive effect on thickness and width measured at the thickest level. Median STT was 14.4 [12.7-17.4] mm, on which BMI had a significant positive effect. Trapezoid was the most common shape. Mean densities were 325 and 60 HU for cortical and cancellous bone, respectively, and cancellous density was significantly higher in males. As such, the MSB is most similar to the posterior maxilla with regard to implantation.
Conclusie
In theory, the MSB is able to support a combination of three to four 6-mm implants, or of one 6-mm to 8-mm and two 10-mm implants, placed in a linear, triangular or diamond-shape arrangement.
Referenties
1. Vatzia K, Fanariotis M, Makridis KG et al (2021) Frequency of sternal variations and anomalies in living individuals evaluated by MDCT. Eur J Radiol 142:109828.
2. Norton MR, Gamble C (2001) Bone classification: an objective scale of bone density using the computerized tomography scan. Clin Oral Implants Res 12:79–84
3. Free J, Eggermont F, Derikx L et al (2018) The effect of different CT scanners, scan parameters and scanning setup on Hounsfield units and calibrated bone density: a phantom study. Biomed Phys Eng Express 4:055013.
Funding
This collaboration project was co-funded by PPP Allowance awarded by Health~Holland, Top Sector Life Sciences & Health (funding no. LSHM22016_H013), to stimulate public-private partnerships.
