Abstract

BackgroundThis study aimed to establish surgical guiding techniques for completing mandible lesion resection and reconstruction of the mandible defect area with fibula sections in one surgery by applying additive manufacturing technology, which can reduce the surgical duration and enhance the surgical accuracy and success rate.MethodsA computer assisted mandible reconstruction planning (CAMRP) program was used to calculate the optimal cutting length and number of fibula pieces and design the fixtures for mandible cutting, registration, and arrangement of the fibula segments. The mandible cutting and registering fixtures were then generated using an additive manufacturing system. The CAMRP calculated the optimal fibula cutting length and number of segments based on the location and length of the defective portion of the mandible. The mandible cutting jig was generated according to the boundary surface of the lesion resection on the mandible STL model. The fibular cutting fixture was based on the length of each segment, and the registered fixture was used to quickly arrange the fibula pieces into the shape of the defect area. In this study, the mandibular lesion was reconstructed using registered fibular sections in one step, and the method is very easy to perform.Results and conclusionThe application of additive manufacturing technology provided customized models and the cutting fixtures and registered fixtures, which can improve the efficiency of clinical application. This study showed that the cutting fixture helped to rapidly complete lesion resection and fibula cutting, and the registered fixture enabled arrangement of the fibula pieces and allowed completion of the mandible reconstruction in a timely manner. Our method can overcome the disadvantages of traditional surgery, which requires a long and different course of treatment and is liable to cause error. With the help of optimal cutting planning by the CAMRP and the 3D printed mandible resection jig and fibula cutting fixture, this all-in-one process of mandible reconstruction furnishes many benefits in this field by enhancing the accuracy of surgery, shortening the operation duration, reducing the surgical risk, and resulting in a better mandible appearance of the patients after surgery.

Highlights

  • This study aimed to establish surgical guiding techniques for completing mandible lesion resection and reconstruction of the mandible defect area with fibula sections in one surgery by applying additive manufacturing technology, which can reduce the surgical duration and enhance the surgical accuracy and success rate

  • The fibula was placed on the fibula cutting fixture to cut it into suitable pieces, and the cut fibula pieces were arranged on the registered fixture in sequence

  • After the position orientation was completed based on registered fixture, the fibula assembly was fixed and available to be quickly set up onto the mandible defect area for completion of the mandible reconstruction entity model

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Summary

Introduction

This study aimed to establish surgical guiding techniques for completing mandible lesion resection and reconstruction of the mandible defect area with fibula sections in one surgery by applying additive manufacturing technology, which can reduce the surgical duration and enhance the surgical accuracy and success rate. During reconstruction by free fibula flap, skin and a portion of fibula in the adjoining soft tissue are harvested when the fibula is removed, and the fibula and soft tissues are used to restore the defect by microscopic anastomosis surgery to allow integration with the arteries and veins of the neck [1]. At present, this method is the most prevalent for mandible reconstruction surgery, because the length of the fibula is adequate for the reconstruction of various mandible defects, and in addition the survival rate is up to 90% [2,3,4]. This causes a cosmetic problem, and leads to a greater challenge in terms of the design of dental implants and dentures in the future

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