A Revised Approach for Mandibular Reconstruction With the Vascularized Iliac Crest Flap Using Virtual Surgical Planning and Surgical Navigation

Abstract

The purpose of this study was to describe a revised approach for mandibular reconstruction with vascularized iliac crest flap using virtual surgical planning and surgical navigation. Preoperative maxillofacial and iliac non-contrast-enhanced computed tomography (CT) scans were acquired, and CT data were imported into ProPlan CMF software (Materialise, Leuven, Belgium). We performed virtual mandibulectomy and superimposed the 3-dimensional iliac image on the mandibular defect. The surgeon shaped the iliac flap according to virtual parameters and the stereomodel. Surgical navigation was used to check and correct the shaped segments. The position of the osteotomy lines and relevant parameters regarding the shape of the iliac flap also were provided to the surgeon. After computer simulation, a reconstructed mandibular stereomodel was manufactured. A reconstruction plate was prebent and fixed on this model using titanium screws. The model was scanned, data were imported into ProPlan CMF, the mandible was segmented, and data were imported into the intraoperative navigation system. Then, the model was registered with the original CT data, and the reconstruction plate was eliminated. Navigation data were exported into a universal serial bus drive, which was connected to the terminal working station during surgery. Intraoperative navigation was used to implement the virtual plan for patients. The sagittal, coronal, axial, and 3-dimensional reconstruction images displayed by the navigation system were used to accurately determine the osteotomy sites and osteotomy trajectory during surgery. Surgical probe guidance was used to mark the osteotomy line and transfer the virtual procedure to real-time surgery. Using our method, we precisely recovered the original configuration of the mandible. The shift in the reconstructed mandible and plate was less than 5mm. We provided a new method for mandibular reconstruction with vascularized iliac crest flap and an individual reconstruction plate using computer-assisted techniques involving surgical navigation, which have the potential to improve the clinical outcomes of this procedure.