Abstract
In the present study, the reproducibility and postoperative stability of a 3D printed surgical guide were evaluated in mandibular reconstruction with an osteocutaneous free flap (OCFF), including a fibular free flap (FFF) and deep circumflex iliac artery free flap (DCIA). Fifteen patients were enrolled, and a 3D surgical guide was fabricated by simulation surgery using preoperative (T0) Computed tomography (CT) images. Mandibular reconstruction was performed with OCFF using the 3D surgical guide. Postoperative CTs were taken immediately, 1 week (T1), and 6 months (T2) after surgery, to evaluate the reproducibility of the 3D surgical guide and condyle stability. Error of the 3D surgical guide ranged from 0.85 to 2.56 mm. There were no differences in reproducibility according to flap type. Condylar error and error at mandible midpoint were significantly different in FFF. However, there was no difference in DCIA error between the condyle and mandible midpoint. Regarding condyle stability 6 months after surgery, condyles moved more than 2 mm (up to 2.85 mm) in FFF, whereas there were no significant movement in DCIA. Careful intraoperative flap fixation and closed postoperative observation should be considered for stable clinical outcome, especially in the case of FFF.
Highlights
The mandible is an important structure in the maxillofacial area that functions in mastication, pronunciation, and organization of the lower facial contour [1,2]
Regarding condyle stability 6 months after surgery, condyles moved more than 2 mm in fibula free flap (FFF), whereas there were no significant movement in deep circumflex iliac artery free flap (DCIA)
There were no significant differences in gender and mean age between DCIA or FFF groups (p = 0.71 and 0.25, respectively)
Summary
The mandible is an important structure in the maxillofacial area that functions in mastication, pronunciation, and organization of the lower facial contour [1,2]. Reconstruction of the mandible with vascularized osteocutaneous free flap (OCFF) has become the gold standard method for patients undergoing mandibular resection because it allows composite tissue reconstruction of wide mandibular defect. This technique maintains viability under postoperative radiation therapy and provides enough bone for future dental implant rehabilitation. FFF involves a long cortical bone shaft, which is suitable for wide resection of mandible It can be harvested with a wide skin paddle that can be used for oral mucosa or facial skin defect [8,9,10]. It has a smaller height than the Materials 2020, 13, 2333; doi:10.3390/ma13102333 www.mdpi.com/journal/materials
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