Mandibular Reconstruction With a Deep Circumflex Iliac Artery Flap Using Computer-Assisted and Intraoral Anastomosis Techniques

Abstract

This study aimed to evaluate intraoral anastomosis of a deep circumflex iliac artery (DCIA) flap in combination with computer-assisted techniques for mandibular reconstruction. Between December 2015 and March 2018, 4 patients with mandibular discontinuity defects caused by ablative tumor surgery were included in the study. Mandibular reconstruction was performed with a DCIA flap using computer-assisted and intraoral anastomosis techniques. A computer-aided design-computer-aided manufacturing cutting guide, a reconstruction stereomodel, and a prebent reconstruction plate were used for mandibular reconstruction in each patient.Anastomosis was performed on the facial artery and vein using the deep circumflex iliac vessels through an intraoral approach. The resulting error-grade color map was used to evaluate repeatability between the preoperative design and postoperative results. Mandibular reconstruction with a DCIA flap using computer-assisted and intraoral anastomosis techniques was successful in all 4 patients. All flaps survived with no severe complications. Satisfactory cosmetic outcomes and occlusion with sufficient bone height for implants were achieved postoperatively. Repeatability between the virtual plan and postoperative result was 81.1%±8.2% within 1mm, 85.8%±8.1% within 2mm, and 89.6%±6.7% within 3mm. The use of intraoral anastomosis and computer-assisted techniques with DCIA flaps for mandibular reconstruction without additional facial scarring is feasible and advantageous. However, the findings should be interpreted cautiously owing to the relatively short follow-up time and limited number of patients involved in this study.