The application of 3-D biomodeling technology in complex mandibular reconstruction—experience of 47 clinical cases

Abstract

3-D biomodeling technology associated with stereolithography has become a fundamental tool in reconstructive surgery in recent years as it enables a highly accurate definition of the defect to be reconstructed. In complex mandibular reconstruction using free flaps, the exact 3-D characteristics of the flap are decisive to restore symmetry and structural integrity, which enables a good functional and aesthetic result. This paper reports the application of an innovative 3-D biomodeling approach for the calculation of the exact contours, angles, length, and general morphology of iliac crest and fibula free flaps for mandibular reconstruction. Between 2003 and 2009, we managed 47 complex mandibular reconstruction cases using this technology. The free flaps used were fibula (n = 29) and iliac crest (n = 18) transferred as osseous or osteocutaneous flaps. From computer tomography scans, virtual 3-D images of the patient's anatomy were converted into 3-D physical models using first Freeform Modeling® software and then selective laser stereolithography technology. Intra-operative bone osteotomies and modeling were guided by these biomodels. Functional and aesthetic end results were at least considered satisfactory in 95.7% of the patients. The majority (80.8%) were in the good and very good end-result categories. This personalized designing of free flaps enabled optimization of pre-operative planning, reduced operative time, and significantly improved the aesthetic and bio-functional outcome. We found it to be particularly useful in major secondary defects (oncological, osteoradionecrosis, trauma) with important distortion of craniofacial structure, congenital malformations, and primary tumor surgery when the dimensions of the tumor have altered normal anatomy considerably.