Abstract
Several different methods exist for reconstructing the mandibular body and ramus defect with the use of a free vascularized fibula flap, but none have adequately addressed the long-term mechanical stability and osseointegration. The aim of this study is to compare the biomechanics of different surgical methods and to investigate the best approach for reconstructing the mandibular body and ramus defect. Five finite element models based on different reconstructive methods were simulated. Stress, strain, and displacement of connective bone sections were calculated for five models and compared. The models were printed using a 3D printer, and stiffness was measured using an electromechanical universal testing machine. The postoperative follow-up cone beam computed tomography (CBCT) was taken at different time points to analyze bone mineral density of connective bone sections. The results showed that the “double up” (DU) model was the most efficient for reconstructing a mandibular body and ramus defect by comparing the mechanical distribution of three sections under vertical and inclined loading conditions of 100 N. The stiffness detection showed that stiffness in the DU and “double down” (DD) models was higher compared with the “single up” (SU), “single down” (SD), and “distraction osteogenesis” (DO) models. We used the DU model for the surgery, and postoperative follow-up CBCT showed that bone mineral density of each fibular connective section increased gradually with time, plateauing at 12 weeks. We conclude that a free vascularized fibula flap of the DU type was the best approach for the reconstruction of the mandibular body and ramus defect. Preoperative finite element analysis and stiffness testing were shown to be very useful for maxillofacial reconstruction.
Highlights
Mandibular defects can often be caused by a number of phenomena, including but not limited to tumors, trauma, and inflammation
We describe the use of a preoperative biomechanical force distribution analysis of three fibular connecting sections (S1, S2, and S3) under vertical and inclined loading conditions of 100 N and show that the double up” (DU) model was the best approach for reconstructing the mandibular body and ramus defect in this particular case
After the models were printed, stiffness detection showed that the DU and double down” (DD) models were stiffer compared to the single up” (SU), single down” (SD), and distraction osteogenesis” (DO) models
Summary
Mandibular defects can often be caused by a number of phenomena, including but not limited to tumors, trauma, and inflammation. The reconstruction of a mandibular defect with a vascularized free fibula flap is a well-established method [1]. Many studies have reported on the use of 3D finite element analysis (FEA) in mandibular reconstruction [12,13,14,15,16]. Most of these studies deal with a postoperative analysis. We BioMed Research International aimed to compare the biomechanics of different surgical methods preoperatively and to investigate the best approach for reconstructing the mandibular body and ramus defect. Postoperative bone mineral density test further verifies the results of preoperative stress, strain, displacement analysis, and stiffness detection. We expanded these earlier observations and analyzed the stress, strain, and displacement of connective bone sections using five different bone reconstruction models
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