Abstract
BackgroundComputer-assisted and template-guided mandibular reconstruction provides higher accuracy and less variation than conventional freehand surgeries. The combined osteotomy and reconstruction pre-shaped plate position (CORPPP) technique is a reliable choice for mandibular reconstruction. This study aimed to evaluate the accuracy of CORPPP-guided fibular flap mandibular reconstruction and analyze the possible causes of the deviations.Patients and MethodsFrom June 2015 to December 2016, 28 patients underwent fibular flap mandibular reconstruction. Virtual planning and personalized CORPPP-guided templates were applied in 15 patients while 13 patients received conventional freehand surgeries. Deviations during mandibulectomy and fibular osteotomy, and overall and triaxial deviation of the corresponding mandibular anatomical landmarks were measured by superimposing the pre- and postoperative virtual models.ResultsThe deviation of the resection line and resection angle was 1.23 ± 0.98 mm and 4.11° ± 2.60°. The actual length of fibula segments was longer than the designed length in 7 cases (mean: 0.35 ± 0.32 mm) and shorter in 22 cases (mean: 1.53 ± 1.19 mm). In patients without ramus reconstruction, deviations of the ipsilateral condylar head point (Co.), gonion point (Go.), and coracoid process point (Cor.) were 6.71 ± 3.42 mm, 5.38 ± 1.71 mm, and 11.05 ± 3.24 mm in the freehand group and 1.73 ± 1.13 mm, 1.86 ± 0.96 mm, and 2.54 ± 0.50 mm in the CORPPP group, respectively, with significant statistical differences (p < 0.05). In patients with ramus reconstruction, deviations of ipsilateral Co. and Go. were 9.79 ± 4.74 mm vs. 3.57 ± 1.62 mm (p < 0.05), and 15.17 ± 6.53 mm vs. 4.36 ± 1.68 mm (p < 0.05) in the freehand group and CORPPP group, respectively.ConclusionMandibular reconstructions employing virtual planning and personalized CORPPP-guided templates show significantly higher predictability, convenience, and accuracy of mandibular reconstruction compared with conventional freehand surgeries. However, more clinical cases were required for further dimensional deviation analysis. The application and exploration of clinical practice would also continuously improve the design of templates.
Highlights
Mandibular defects can be caused by radical surgery of oral and maxillofacial tumors, osteomyelitis, or trauma of the jaw, and can lead to severe functional and aesthetic deficits, negatively affecting quality of life
In the combined osteotomy and reconstruction pre-shaped plate position (CORPPP) group, the lesions were resected in accordance with the preoperative designs, the pre-shaped titanium plates and titanium screws were placed smoothly, and the occlusal relation was well recovered
The titanium plates were pre-shaped according to the 3D-printed mandible model preoperatively
Summary
Mandibular defects can be caused by radical surgery of oral and maxillofacial tumors, osteomyelitis, or trauma of the jaw, and can lead to severe functional and aesthetic deficits, negatively affecting quality of life. Vascularized autologous bone grafting, especially the fibular free flap, serves as the workhorse for segmental mandibular defect reconstruction [1,2,3,4]. Templateguided mandibular reconstruction provides higher accuracy, acceptability, and less variation than the conventional free-hand surgeries [8,9,10,11,12]. Computer-assisted and template-guided mandibular reconstruction provides higher accuracy and less variation than conventional freehand surgeries. This study aimed to evaluate the accuracy of CORPPP-guided fibular flap mandibular reconstruction and analyze the possible causes of the deviations
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