Postoperative Facial Appearance Research Articles

Nursing care of a patient after a craniofacial area microsurgical transplant in a teenage boy

Abstract Aim. The aim of the study was to make selected nursing diagnoses for a patient after a microsurgical transplant in the facial area, with the aim of providing the patient with comprehensive care in the perioperative period. Material and methods. The study describes the case of a child after microsurgical transplantation of a flap taken from the left iliac plate to the right submandibular region. The individual case method was used. Clinical interview, observation, measurement and medical documentation data were analyzed. Results. Four selected nursing diagnoses were presented along with planned interventions: risk of complications at the site of microsurgical flap transplantation, risk of donor site infection, discomfort caused by intense oozing of secretions from the postoperative wound in the oral cavity and the boy’s depressed mood caused by low self-esteem resulting from the changed postoperative facial appearance and the failure of the first surgical procedure. Conclusions. Nursing interventions should be adapted to the patient’s dynamically changing recovery process. They should be based on systematic inspection of the recipient and donor sites for the occurrence of complications. Education of the patient and the caregiver is an important element of the therapeutic process. It was not possible to significantly improve the child’s mood.

Postoperative facial appearance of patients with extensive oral squamous cell carcinoma can be adequately preserved with in‑house virtually planned mandibular reconstruction

Postoperative facial appearance of patients with extensive oral squamous cell carcinoma can be adequately preserved with in‑house virtually planned mandibular reconstruction

Clinical analysis of 226 cases of deviated nose with deviated nasal septum treated by endoscopic assisted functional rhinoplasty

Objective: To explore the method and effect of endoscopic assisted functional rhinoplasty for patients with deviated nose and deviated nasal septum, which achieve correction of nasal morphology and ventilation dysfunction. Methods: The clinical data of 226 patients with deviated nose and deviated nasal septum from June 2009 to February 2022 who were treated by endoscopic assisted functional rhinoplasty in the Affiliated Hospital of Qingdao University were analyzed retrospectively. There were 174 males and 52 females, with the age ranging from 7 to 67 years old. The effect was evaluated by subjective and objective evaluation methods. SPSS 27.0 software was used for statistical analysis. Results: All patients were followed up for 6 to 24 months, 174 cases were cured (174/226, 76.99%), 52 cases were effective (52/226, 23.01%), and the total effective rate was 100% (226/226). The difference between preoperative and postoperative facial appearance deviation was statistically significant ((6.84±2.25)mm vs (1.82±1.05)mm, t=38.94, P<0.001), and the nasal ventilation function of all patients was improved. Conclusions: Endoscopic assisted functional rhinoplasty for the patients with deviated nose combined with deviated nasal septum has the advantages of clear surgical field, fewer complications, and good result. It can achieve the purpose of simultaneous correction of nasal and ventilation dysfunction, which is recommended for popularizing in clinical application.

The perforator flap of ipsilateral nasolabial sulcus used to repair the defect after the eradication of nasal vestibular squamous cell carcinoma

Objective: To investigate the feasibility of only surgical resection for nasal vestibular squamous cell carcinoma and the efficacy of perforator flap of ipsilateral nasolabial sulcus in repairing postoperative defects. Methods: The clinical data of 8 cases with squamous cell carcinoma of the nasal vestibule who admitted to Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University were analyzed, including 6 males and 2 females, aged from 38 to 75 years. The tumor of the nasal vestibule was eradicated in time after making definite diagnosis of lesions, then the perforators flap of the ipsilateral nasolabial sulcus was used for repairment, without performing further chemotherapy or radiotherapy after surgery. The tumor recurrence, facial appearance, nostril form, donor area scar, nasal ventilation function, and cutaneous sensation were evaluated after surgery. Descriptive analysis was used in this research. Results: There were 2 cases of stage T1 and 6 cases of stage T2 in 8 cases. After 32 to 45 months of following-up, no recurrence accurred and all the flaps survived well. However, there was about 2 mm necrosis of the transplanted flap in the lateral foot of the alar in one case, which was healed well by carrying out wound care after 10 d. And the dark color flap was occurred in another case, showing the flap's backflow trouble, yet it was improved with addressing timely during 5 d postoperation. Pincusion-like deformity of the transplanted flap occurred in 4 cases (50%), which subsided gradually after 6 months. The morphology of the anterior nostril was altered in 4 cases (50%), but there was no ventilation trouble and no need for addressment in any case. The postoperative facial appearance was rated as excellentor good with hidden scar in the donor site, and the sensation of the transplanted flaps was indistinct from the surrounding tissue after 3 months. Conclusions: Surgical resection of nasal vestibular squamous cell carcinoma with tumor stage T1-2 is a feasible treatment. And it is the one of the best reconstructive methods of the perforator flap of the ipsilateral nasolabial sulcus to repair the deformities after the surgery.

Buccal Fat Pad Flap in Orthognathic Surgery: Facial Soft Tissue Volume's Redistribution Strategy to Improve the Esthetic Outcomes.

Traditional osteotomic procedures can fail to restore the natural appearance of the face and can sometimes highlight the intrinsic decrease in the volume of soft tissues; in these cases, soft-tissue-improving procedures should be considered. The authors describe a new strategy that can help redistribute facial soft tissues and enhance facial esthetics in orthognathic surgery using a pedicled buccal fat flap to increase the volume of the malar soft tissue envelope. Between January 2017 and January 2021, 47 patients with dentoskeletal deformity who needed to increase the projection of the cheekbone contour underwent orthognathic surgery with simultaneous pedicled buccal fat pad flap for malar augmentation. Preoperative and postoperative facial appearance was evaluated by clinical examination and analysis of photographs to assess the occlusal and esthetic outcomes. A patient questionnaire was used to assess self-evaluation satisfaction scores. A good projection of the cheekbone contour was obtained, and noticeable postoperative facial esthetic improvement was observed in all patients. The overall esthetic improvement was considered "excellent" by 89.36% of patients, and facial esthetic improvement was assessed as "very much improved" or "much improved" by the clinicians in 95.7% of cases. The buccal fat pad flap is a promising and easy technique in orthognathic surgery that helps harmonize the malar region; improve esthetic outcomes with predictable and lasting long-term stability; and ensure very low morbidity and great esthetic satisfaction.

Nasal skin reconstruction: Time to rethink the reconstructive ladder?

BackgroundNasal scarring can compromise aesthetics and function given its complex three-dimensional structure and central location. This study aimed to measure patients’ satisfaction after reconstruction for nasal defects following Mohs micrographic surgery. MethodsPatients presenting with nasal nonmelanoma skin cancer at Memorial Sloan Kettering Cancer Center New York, USA and Catharina Hospital Eindhoven, Netherlands from April 2017 to November 2019 were asked to participate. Reconstruction type, complications, and patients satisfaction were assessed. Patients completed the FACE-Q Skin Cancer – Satisfaction with Facial Appearance scale (preoperative and 1-year postoperative) and the Appraisal of Scars scale (1-year postoperative). ResultsA total of 128 patients completed the preand postoperative scales. There were 35 (27%) surgical defects repaired with primary closures, 71 (55.5%) with flaps, and 22 (17.2%) with full-thickness skin grafts (FTSG). Patients that underwent a flap or FTSG reconstruction had higher scar satisfaction scores than primary closures (p = 0.03). A trend was seen with patients following flap reconstructions scoring 7.8 points higher than primary closures and patients with upper nose defects scoring 6.4 points higher than lower nose defects. Males were significantly more satisfied than females. No significant difference was observed in the preoperative and postoperative facial appearance scores between the three groups (p = 0.39). ConclusionPatients are more satisfied in the long term with their scars after flap reconstructions compared to primary closures. Therefore, nasal skin reconstruction may not follow the traditional reconstructive ladder and more complex approaches may lead to higher long-term scar satisfaction.

Outcome of full digital workflow for orthognathic surgery planning in the treatment of asymmetric skeletal class III deformity

Studies have reported the advantages of digital imaging-assisted orthognathic surgery planning, but there is scarce information about a full digital planning modality. This study evaluated the 3D cephalometric-based and patient-reported outcomes of a full digital workflow for orthognathic surgery planning in the treatment of asymmetric maxillomandibular disharmony. A postoperative 3D image dataset of 30 Taiwanese Chinese patients with asymmetric skeletal Class III deformities who underwent full digital planning for two-jaw surgery were retrieved from the authors' database. The 3D cephalometric data (dental, skeletal, and soft tissue evaluations) were compared to the ethnicity-matched 3D cephalometric normative values. Patient-reported outcome measure tools regarding postoperative overall appearance and satisfaction with facial areas (ranging from 0 to 100 and 0 to 10, respectively) were administered. The number of needed or requested revisionary surgery was collected. No difference (all p>0.05) was observed between the orthognathic-surgery-treated patients and the normative value for most of the tested 3D cephalometric parameters, with the exception (p<0.05) of three mandible and occlusal-plane-related parameters. Both patient-reported outcome measure tools showed that patients' satisfaction with their postoperative appearance was high for overall face (89.7±4.5) and specific facial regions (nose, 7.1±1.3; lip, 8.3±1.6; upper gum, 8.5±1.2; cheek, 8.8±1.1; chin, 9.2±1.2; and teeth, 9.3±0.8), with no need for revisionary surgery. The patients treated with a full 3D digital planning-assisted two-jaw surgery had a similar 3D dental relation, facial convexity, and symmetry compared to healthy ethnicity-matched individuals, and they reported higher satisfaction levels with their postoperative facial appearance results.

Deep Simulation of Facial Appearance Changes Following Craniomaxillofacial Bony Movements in Orthognathic Surgical Planning.

Facial appearance changes with the movements of bony segments in orthognathic surgery of patients with craniomaxillofacial (CMF) deformities. Conventional bio-mechanical methods, such as finite element modeling (FEM), for simulating such changes, are labor intensive and computationally expensive, preventing them from being used in clinical settings. To overcome these limitations, we propose a deep learning framework to predict post-operative facial changes. Specifically, FC-Net, a facial appearance change simulation network, is developed to predict the point displacement vectors associated with a facial point cloud. FC-Net learns the point displacements of a pre-operative facial point cloud from the bony movement vectors between pre-operative and simulated post-operative bony models. FC-Net is a weakly-supervised point displacement network trained using paired data with strict point-to-point correspondence. To preserve the topology of the facial model during point transform, we employ a local-point-transform loss to constrain the local movements of points. Experimental results on real patient data reveal that the proposed framework can predict post-operative facial appearance changes remarkably faster than a state-of-the-art FEM method with comparable prediction accuracy.

Patient-reported Aesthetic Satisfaction following Facial Skin Cancer Surgery Using the FACE-Q Skin Cancer Module.

Background:Over 5 million basal and squamous cell skin cancers are diagnosed each year. Seventy to 80% of these cancers occur in the head and neck region, for which surgical excision is the standard treatment. As patient satisfaction and quality of life are among the most important outcomes in plastic and reconstructive surgery, understanding patient perception of aesthetic postoperative outcome is critical. The objective of this study was to assess aesthetic satisfaction following facial skin cancer surgery using the FACE-Q Skin Cancer Module in the context of sociodemographic and clinical factors.Methods:This is a single-center, cross-sectional study in a tertiary care cancer setting of patients who underwent facial skin cancer surgery from March 1, 2016, to March 31, 2018. Patients completed the FACE-Q Skin Cancer Satisfaction with Facial Appearance and Appraisal of Scar scales postoperatively, between May 21, 2018, and October 1, 2018.Results:Patients completed the Satisfaction with Facial Appearance (n = 405) and Appraisal of Scar scales (n = 408) postoperatively (response rate 39%). Lower postoperative facial appearance and scar satisfaction scores were associated with female gender, younger age (<65 years), surgery location on the lip or nose, repair by flap or graft, and greater defect size. Linear regression models established that younger age, female gender, nose location, and flap repair were independently predictive of lower aesthetic satisfaction.Conclusions:Sociodemographic factors, central facial location, and repair type strongly contribute to aesthetic satisfaction following facial skin cancer surgery. This patient-reported data may guide counseling regarding postoperative aesthetic outcome and inform patient expectations.

Clinical efficacy of fractional CO2 laser combined with platelet rich plasma on facial acne scars

Objective To evaluate the efficacy of autologous platelet rich plasma(PRP)combined with fractional CO2 laser for facial acne scar. Methods A total of 57 patient with acne scar were selected. Test group was treated with fractional CO2 laser combined with PRP, that is, fractional CO2 laser treatment first, followed by PRP evenly in the surgical area; control group was only treated by fractional CO2 laser. Efficacy evaluation was carried out using visual assessment, including PhotoshopCS5 gray value evaluation, patient's satisfactory evaluation and rate of side effects. Results All patients were followed up for 4-6 months, and the photos were compared before and after treatment. Compared with the control group erythema and decrustation time were decreased, scar skin wound healing accelerated, postoperative facial appearance was obviously improved in the test group. The gray value discrepancy rates were (0.150 + 0.061)% and(0.120 + 0.030)% in the two group, respectively, with a significant difference (P<0.05). Conclusions Platelet rich plasma combined with fractional CO2 laser is an effective, safe and convenient method in the treatment of facial ance scar. Key words: Autologous; Platelet rich plasma; Fractional CO2 laser; Acne scar

A surgical simulation system for predicting facial soft tissue deformation

In the field of cranio-maxillofacial (CMF) surgery, surgical simulation is becoming a very powerful tool to plan surgery and simulate surgical results before actually performing a CMF surgical procedure. Reliable prediction of facial soft tissue changes is in particular essential for better preparation and to shorten the time taken for the operation. This paper presents a surgical simulation system to predict facial soft tissue changes caused by the movement of bone segments during CMF surgery. Two experiments were designed to test the feasibility of this simulation system. The test results demonstrate the feasibility of fast and good prediction of post-operative facial appearance, with texture. Our surgical simulation system is applicable to computer-assisted CMF surgery.

Virtual Surgical Planning in Precise Maxillary Reconstruction With Vascularized Fibular Graft After Tumor Ablation

Reconstruction of maxillary and midfacial defects due to tumor ablation is challenging to conventional operation. The purposes of this study are to evaluate the precise 3-dimensional position of the fibular flap in reconstruction of maxillary defects assisted by virtual surgical planning and to assess the postoperative outcomes compared with conventional surgery. We retrospectively reviewed 18 consecutive patients who underwent maxillary reconstruction with a vascularized fibular flap assisted by virtual surgical planning after maxillary or midfacial tumor ablation. Conventional surgery was performed in another 15 patients. Proplan CMF surgical planning (Materialise, Leuven, Belgium) was performed preoperatively in the virtual planning group. Fibular flaps were harvested and underwent osteotomy assisted by prefabricated cutting guides, and the maxilla and midface were resected and reconstructed assisted by the prefabricated cutting guides and templates in the virtual planning group. The operative time and fibular flap positions were evaluated in the 2groups. Postoperative fibular positions of the maxillary reconstruction were compared with virtual plans in the virtual planning group. The postoperative facial appearance and occlusal function were assessed. The operations were performed successfully without complications. The ischemia time and total operative time were shorter in the virtual planning group than those in the conventional surgery group (P < .05). High precision of the cutting guides and templates was found on both the fibula and maxilla in the virtual planning group. The positions of the fibular flaps, including the vertical and horizontal positions, were more accurate in the virtual planning group than those in the conventional surgery group (P < .05). Bone-to-bone contact between the maxilla and fibular segments was more precise in the virtual planning group (P < .05). Postoperative computed tomography scans showed excellent contour of the fibular flap segments in accordance with the virtual plans in the virtual planning group. All patients were alive with no evidence of disease. Functional mandibular range of motion, good occlusion, and an ideal facial appearance were observed in the virtual planning group. Virtual surgical planning appears to achieve precise maxillary reconstruction with a vascularized fibular flap after tumor ablation, as well as an ideal facial appearance and function after dental rehabilitation. The use of prefabricated cutting guides and plates eases fibular flap molding and placement, minimizes operating time, and improves clinical outcomes.

Multi-Factorial Functional Analysis of the Patients with Reconstruction for Oral Carcinoma

This paper is to evaluate postoperative function which has undergone reconstruction with vascularized or pedicled flaps for the treatment of oral carcinomas. The subjects consisted of 22 cases of 17 male and 5 female patients, and their mean age was 55 years. The sites of reconstruction were the tongue in 12 cases, mandible in 10 cases. The reconstruction was performed using deltopectoral (DP) flaps in 6 cases, pectoralis major musculo cutaneous (PMMC) flaps in 3 cases, DP flap + PMMC flap in one case, forearm (FA) flaps in 8 cases and peroneal (P) flaps with fibula in 4 cases. Postoperative masticatory, speech, swallowing functions and facial appearance were evaluated by Multi-factorial analysis. All functional results seem to be related to the type of resection. By multi-factorial analysis, the type of mandibular resection, flap area, and anterior resection were related to the masticatory or speech function in tongue resection. In mandibular resection, masticatory function was subjected to age; speech function was subjected to type of mandibular resection and plate reconstruction. The facial appearance was subjected to flap area. These results suggested that postoperative function was not related to only one factor, but using the classification of each defect site as one of the factor of multi-factorial analysis was useful.

Subjective assessment of facial aesthetics after maxillofacial orthognathic surgery for obstructive sleep apnoea

We aimed to evaluate the subjective perception of facial appearance by patients after maxillofacial surgery for obstructive sleep apnoea (OSA), and explored the possible correlation between satisfaction and surgical outcome. A total of 26 patients, 24 men and 2 women (mean (SD) age 45 (7) years), subjectively assessed their facial appearance before and after operation using a visual analogue scale (VAS). To investigate a possible association between postoperative facial appearance and surgical outcome, we analysed postoperative scores for the apnoea/hypopnoea index (AHI) and Epworth sleepiness scale (ESS). Postoperatively, 14 (54%) indicated that their facial appearance had improved, 4 (15%) recorded a neutral score, and 8 (31%) a lower score. The rating of facial appearance did not correlate with changes in the AHI or ESS following surgery. This study supports the view that most patients are satisfied with their appearance after maxillofacial orthognathic surgery for OSA. The subjective perception of facial aesthetics was independent of the surgical outcome.

Accuracy of three-dimensional soft tissue predictions in orthognathic surgery after Le Fort I advancement osteotomies

Prediction of postoperative facial appearance after orthognathic surgery can be used for communication, managing patients’ expectations, avoiding postoperative dissatisfaction and exploring different treatment options. We have assessed the accuracy of 3dMD Vultus in predicting the final 3-dimensional soft tissue facial morphology after Le Fort I advancement osteotomy. We retrospectively studied 13 patients who were treated with a Le Fort I advancement osteotomy alone. We used routine cone-beam computed tomographic (CT) images taken immediately before and a minimum of 6 months after operation, and 3dMD Vultus to virtually reposition the preoperative maxilla and mandible in their postoperative positions to generate a prediction of what the soft tissue would look like. Segmented anatomical areas of the predicted mesh were then compared with the actual soft tissue. The means of the absolute distance between the 90th percentile of the mesh points for each region were calculated, and a one-sample Student's t test was used to calculate if the difference differed significantly from 3mm.The differences in the mean absolute distances between the actual soft tissue and the prediction were significantly below 3mm for all segmented anatomical areas (p<0.001), and ranged from 0.65mm (chin) to 1.17mm (upper lip). 3dMD Vultus produces clinically satisfactory 3-dimensional facial soft tissue predictions after Le Fort I advancement osteotomy. The mass-spring model for prediction seems to be able to predict the position of the lip and chin, but its ability to predict nasal and paranasal areas could be improved.

Modified maxillomandibular advancement for obstructive sleep apnoea: towards a better outcome for Asians

Excluding tracheostomy, maxillomandibular advancement (MMA) is the most effective surgical treatment for obstructive sleep apnoea (OSA). However, the anticipated facial changes may prevent acceptance of this procedure by patients with bimaxillary protrusion, a common feature of Asian faces. We therefore developed a modified MMA technique for such cases, consisting of anterior segmental osteotomies together with standard Le Fort I and bilateral sagittal split osteotomies. A prospective study of 20 consecutive Taiwanese adults with moderate-to-severe OSA who underwent modified MMA and postsurgical orthodontics was undertaken to evaluate the efficacy with regard to OSA and the postoperative facial appearance and dental occlusion. After modified MMA, the mean apnoea–hypopnoea index decreased from 41.6±19.2 n/h to 5.3±4.0 n/h (P<0.001). All patients had a successful outcome. No patient was dissatisfied with their postoperative facial appearance. The mean Peer Assessment Rating score decreased from 21.9±14.3 to 1.7±1.6 (P=0.001). The data suggest that the modified MMA is effective in treating patients with moderate-to-severe OSA without negatively affecting facial appearance or dental occlusion. To achieve a better outcome, surgical–orthodontic integration is warranted. The surgery-first approach can achieve early improvement.

Assessment of quality of life in giant ameloblastoma adolescent patients who have had mandible defects reconstructed with a free fibula flap.

BackgroundThe reconstruction of mandibular defects after giant ameloblastoma resection is one of the most challenging problems facing reconstructive surgeons. Mandibular resection has been associated with a poor quality of life (QOL), particularly in adolescent patients reconstructed with a free fibula flap. This study aims to evaluate QOL outcomes in adolescent patients who have had mandibular resections of giant ameloblastoma and reconstruction with a free fibula flap and to collect information about their socio-cultural situation.MethodsThe present study assessed 45 adolescent patients who had undergone immediate mandible reconstruction with a free fibula flap for faint ameloblastoma using University of Washington Quality of Life (UW-QOL) and 14-item Oral Health Impact Profile (OHIP-14) questionnaires.ResultsThirty-five of the 54 questionnaires were returned (64.81%). In the UW-QOL, of the twelve disease-specific domains, the best three scores from the patients related to pain, shoulder and appearance and the worst three scores related to chewing, anxiety and saliva. In the OHIP-14, the lowest-scoring domain was handicap, followed by physical pain and social disability.ConclusionsMandibular reconstruction with a free fibular flap significantly influenced the adolescent patients’ QOL. Adolescent patients pay more attention to postoperative facial appearance; this should be considered in surgical planning.

Systematic Analysis of Clinical Outcomes of Anterior Maxillary and Mandibular Subapical Osteotomy With Preoperative Modeling in the Treatment of Bimaxillary Protrusion

The purpose of this study was to determine the changes in teeth and hard tissues after preoperative modeling and bimaxillary anterior subapical osteotomy for the treatment of bimaxillary protrusion. Cephalometric analysis was used to evaluate the aesthetic effects and occlusal relationships obtained. The subjects included 19 women and 1 man (aged 19-41 years; average, 29 years) with bimaxillary protrusion who underwent anterior subapical osteotomy of both the maxilla and mandible, with simultaneous genioplasty, if required. Based on a preoperative computer-aided manufacturing/design-assisted and model surgical design and an occlusal guide plate, new occlusal relationships were established for the patients. In addition, the preoperative and postoperative cephalometric radiographs were systematically analyzed. In all patients, the surgical incisions underwent primary healing, with no infection or osteonecrosis. Significant differences were observed in the preoperative and postoperative values of all hard tissue and teeth parameters, except for SGn-FH degrees and Co-MP. The most obvious significant differences were seen in L1-OP°, Id-Pog-Go°, IIA°, U1E-Apog, L1E-Apog, U1E-NA, and L1-NA° (P < 0.001). Postoperative follow-up lasted for 12 to 36 months. All patients eventually achieved normal jaw relationships, tooth arch forms, and Spee curves. No evident irregularities of teeth arrangement or abnormal occlusal relationships were observed. All patients were satisfied with their postoperative facial appearance, except for 1 patient, who underwent repeat surgery because of relapse. With the use of a precise preoperative model surgical design, orthognathic surgery, a simple and time-saving technique, can be used to correct bimaxillary protrusion with satisfactory postoperative occlusal relationship and facial aesthetic appearance and minimal postoperative complications.

Measures of health-related quality of life and socio-cultural aspects in young patients who after mandible primary reconstruction with free fibula flap

BackgroundThe reconstruction of mandibular defects after trauma or tumor resection is one of the most challenging problems facing reconstructive surgeons. Although the primary intended outcome of surgery to treat head-and-neck malignancies is still the disease-free survival of the patient, health-related quality of life (HRQOL) is now seen as an essential secondary outcome. This study aims to evaluate HRQOL outcomes in young patients undergoing primary mandible reconstruction with free fibula flap and to collect information about their socio-cultural situation.MethodsThe HRQOL outcomes of 25 young patients after primary mandible reconstruction with free fibula flap for mandible malignancies were assessed using the Medical Outcomes Study-Short Form-36 (MOS SF-36) and University of Washington Quality of Life (UW-QOL) questionnaires 12 months postoperatively.ResultsUsing the UW-QOL questionnaire, the best-scoring domain was ‘pain’, whereas ‘chewing’ and ‘anxiety’ were given the lowest scores. Using the MOS SF-36 questionnaire, the best-scoring domain was ‘physical functioning’, while ‘bodily pain’ and ‘general health’ also scored well.ConclusionsMandible reconstruction with fibula flap will significantly influence a young patient’s HRQOL. Young patients pay more attention to postoperative facial appearance; this should be considered in surgical planning. The socio-cultural data show a fairly low level of education for the majority of patients.

PP152: Triple template method of CAD/CAM assisted mandibular reconstruction

To design a new CAD/CAM technique to accurately transfer the simulation planning of mandiubular reconstruction to real surgery. First, we designed triple-template-method of computer assisted mandiubular reconstruction by defining mandibulectomy, fibula cutting and positioning. Then, we tested the accuracy of this method by cadaveric surgery. Finally, we applied this method in four patients who required mandibular resection and immediate reconstruction. Cadaveric surgery showed that the triple template method can accurately transfer the simulation planning to the real surgery. In the patient oriented study, the reconstructed mandibles presented high similarity to the surgical planning. Postoperative facial appearance and occlusal relationship were satisfying (Figs. 1–4). The method of defining the tumor resection, fibula cutting and positioning by surgical templates was accurate enough for mandible reconstruction surgery.