Abstract
BackgroundThis study was conducted to evaluate the feasibility, clinical outcomes, and accuracy of patient-specific 3D-printed miniplates for mandible reconstruction with fibula free flaps.MethodsA feasibility study was conducted with 8 patients. Following virtual planning, patient-specific 1.0 mm titanium non-locking miniplates were produced via laser selective melting. 3D-printed cutting and drilling guides were used for segmental mandible resection and flap harvesting. Flap fixation was performed with two 4-hole miniplates and 2.0 mm non-locking screws (screw length 7 mm) for each intersegmental gap. Clinical follow-up was at least 6 months. Preoperative and postoperative CT/cone beam CT data were used for 3D accuracy analysis and evaluation of bone healing. Plate-related complications were monitored clinically.ResultsPatient-specific miniplate fixation of all flaps was successfully conducted (4 mono-segmental, 4 dual-segmental) with high accuracy (3.64 ± 1.18 mm) between the virtual plan and postoperative result. No technical complications were encountered intraoperatively. Osseous union occurred in all intersegmental gaps (1 partial, 18 complete) after 10 ± 2 months. No material fracture, dislocation, or plate exposure was observed.ConclusionsBased on this pilot observational study including a limited number of patients, free flap fixation for mandibular reconstruction with patient-specific 3D-printed miniplates is feasible and associated with high accuracy, bone healing, and remote soft tissue complications.
Highlights
Fibula free flap (FFF) reconstruction is the treatment of choice for segmental mandibular defects
Either load-bearing reconstruction plates with bi-cortical screws or load-sharing miniplates with mono-cortical non-locking screws are used for flap fixation
In patient 7, all miniplates were removed as early as 7 months after surgery, as complete osseous union was detected in a postoperative cone beam CT (CBCT), and the patient had advocated for short-term dental rehabilitation
Summary
Fibula free flap (FFF) reconstruction is the treatment of choice for segmental mandibular defects. Either load-bearing (locking) reconstruction plates with bi-cortical screws or load-sharing miniplates with mono-cortical non-locking screws are used for flap fixation. 1990s [1], virtual planning was first described for mandible reconstruction in 2005 [2]. The combination of the computeraided design/computer aided manufacturing (CAD/CAM) workflow with milled and, later, selective laser-melted patient-specific reconstruction plates revolutionized mandible reconstruction with free flaps [3]. The main advantages of patient-specific 3D-printed plates are high surgical precision, efficiency, and decreased surgery time [4, 5]. A backward-planned, fully guided CAD/CAM procedure is the state of the art, with a good aesthetic and functional outcome (Figure 1). This study was conducted to evaluate the feasibility, clinical outcomes, and accuracy of patient-specific 3D-printed miniplates for mandible reconstruction with fibula free flaps
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