The NYU Experience With Free Fibula Reconstruction of the Mandible Utilizing Virtual Surgical Planning

Abstract

Statement of the Problem: The use of free osseous flaps has become the gold standard for reconstruction of complex mandibular defects. Popularized by Hidalgo in 1989, the free fibula transfer has become the operation of choice for these indications. While this operation has become routine; contouring of the flap using wedge osteotomies, as well as its inset remain operator dependent and imprecise. At our institution we have attempted to make this process more uniform and reproducible through the use of virtual planning and pre-fabricated cutting jigs. We have previously reported our experience on computer-aided design and manufacturing; however the purpose of this study was to review our series of free fibula mandibular reconstructions using these adjunctive technologies. Methods: Prior to surgery all patients underwent CT scanning of the face and bilateral lower extremities. These images were then transmitted to an outside vendor. In consultation with both the ablative and reconstructive teams, a surgical plan was devised and performed virtually, cutting jigs for both creation of themandibular defect and for fibular osteotomies were fabricated, and a stereolithicmodel that allows for precise pre-surgical bendingof a reconstructionplatewas created. The rest of the surgical procedure was performed in standard fashion. Following IRB approval, all cases between 2009 and 2012were identified and retrospectively reviewed. In addition to patient demographics, the charts were reviewed for surgical indications, microvascular anastomoses, use of a skin paddle, use of a ‘‘double barrel’’, timing of dental implant placement (immediate versus delayed), and timing of dental prosthetic rehabilitation (immediate versus delayed). Methods of Data Analysis: This was a retrospective chart review from 2009 to the present. Fifty-four reconstructionswere identified ashavingundergonepresurgical virtual planning and subsequent surgery formandibular reconstruction with microvascular free fibula transfer. Patient demographics and case variables were analyzed. Results: Fifty-four reconstructions were performed in 52 patients. Patients were evenly divided between a private, university affiliated medical center and a large county hospital. The most common indications were ma-