Reconstruction Of Mandible Research Articles

Pre-Surgical Planning Using Virtual And 3D Printing Model as Guidance for SECONDARY Mandible Reconstruction with Bone Graft: A Case Report

Reconstruction of mandibular defects due to trauma or tumor resection is a significant challenge for surgeons, given the unique and variable shape of the mandible in terms of curvature, length, and height. Numerous techniques have been developed to achieve both aesthetic and functional outcomes. This case report presents a 28-year-old patient with mandibular irregularity following ameloblastoma dissection, which was reconstructed with non-vascularized bone grafts (NBGs) from the left iliac crest approximately 10 years ago. Prior to our procedure, virtual planning and 3D modeling were employed to accurately assess the bone defect. After debridement, a 5 cm defect was identified, and NBGs were harvested from the right iliac crest for reconstruction. NBGs are commonly used for small mandibular defects (<6 cm), non-continuity defects, and benign pathologies, and they can be performed in centers without microsurgical expertise. The use of virtual planning and 3D printing enables the surgical team to thoroughly study the case, anticipate potential issues, and improve precision, resulting in better outcomes and reduced operative time. NBGs, guided by virtual planning and 3D modeling, prove to be an effective technique in reducing surgical time and minimizing the risk of failure during the postoperative recovery period.

Intraoperative Real-Time Image-Guided Fibular Harvest and Mandibular Reconstruction: A Feasibility Study on Cadaveric Specimens.

This study assesses the feasibility of real-time surgical navigation to plan and guide sequential steps during mandible reconstruction on a series of cadaveric specimens. An image-guided surgical (IGS) system was designed including customized mandible and fibula fixation devices with navigation reference frames and an accompanied image-guided software. The mandibular and fibular segmental osteotomies were performed using the IGS in all five cadaveric patients. Procedural time and cephalometric measurements were recorded. Five real-time IGS mandibulectomy and fibular reconstruction were successfully performed. The mean Dice score and Hausdorff-95 distance between the planned and actual mandible reconstructions was 0.8 ± 0.08 and 7.29 ± 4.81 mm, respectively. Intercoronoid width, interangle width, and mandible projection differences were 1.15 ± 1.17 mm, 0.9 ± 0.56 mm, and 1.47 ± 1.62 mm, respectively. This study presents the first demonstration of a comprehensive image-guided workflow for mandibulectomy and fibular flap reconstruction on cadaveric specimens and resulted in adequate cephalometric accuracy.

Zinc and chitosan-enhanced β-tricalcium phosphate from calcined fetal bovine bone for mandible reconstruction.

Mandibular defects pose significant challenges in reconstructive surgery, and scaffold materials are increasingly recognized for their potential to address these challenges. Among various scaffold materials, Beta-tricalcium phosphate (β-TCP) is noted for its exceptional osteogenic properties. However, improvements in its biodegradation rate and mechanical strength are essential for optimal performance. In this study, we developed a novel β-TCP-based scaffold, CFBB, by calcining fetal bovine cancellous bone. To enhance its properties, we modified CFBB with Chitosan (CS) and Zinc (Zn), creating three additional scaffold materials: CFBB/CS, CFBB/Zn2+, and CFBB/Zn2+/CS. We conducted comprehensive assessments of their physicochemical and morphological properties, degradation rates, biocompatibility, osteogenic ability, new bone formation, and neovascularization both in vitro and in vivo. Our findings revealed that all four materials were biocompatible and safe for use. The modifications with CS and Zn2+ significantly improved the mechanical strength, osteogenic, and angiogenic properties of CFBB, while concurrently decelerating its resorption rate. Among the tested materials, CFBB/Zn2+/CS demonstrated superior performance in promoting bone regeneration and vascularization, making it a particularly promising candidate for mandibular reconstruction. The CFBB/Zn2+/CS scaffold material, with its enhanced mechanical, osteogenic, and angiogenic properties, and a controlled resorption rate, emerges as a highly effective alternative for the repair of oral mandible defects. This study underscores the potential of combining multiple bioactive agents in scaffold materials to improve their functionality for specific clinical applications in bone tissue engineering.

Axial split step osteotomy of free iliac crest flaps for mandible reconstruction: Preliminary results.

Vascularized bone grafting (VBG) is preferred for mandibular reconstruction post-tumor ablation. Although various bone-free flaps are used, their application is compromised by limitations including insufficient bone volume and poor shape. Here, we report mandibular reconstruction using axial split-step osteotomy with an iliac crest-free flap. Over December 2018-November 2020, 12 patients underwent mandibular reconstruction via axial split osteotomy using a free iliac-crest flap. The preoperative iliac-crest length was 5.7-9.5 mm (median, 7.5 cm); the mean post-axial split-osteotomy iliac-crest length increased to 9.59 mm (range, 6.34-15.15 mm). All patients presented with initial healing 2 weeks postoperation; good bone healing was achieved in all grafted flaps by the third month of follow-up. We propose a new axial split-step osteotomy technique using free iliac-crest flaps for mandibular reconstruction. We demonstrated this novel technique's reliability for safe and effective bone lengthening and establishing a reliable occlusal relationship.

Porous Gelatin Methacrylate Gel Engineered by Freeze-Ultraviolet Promotes Osteogenesis and Angiogenesis.

Alveolar bone defect reconstruction is a common challenge in stomatology. To address this, a thermosensitive/photosensitive gelatin methacrylate (GelMA) gel was developed based on various air solubilities and light-curing technologies. The gel was synthesized by using a freeze-ultraviolet (FUV) method to form a porous and quickly (within 15 min) solidifying modified network structure. Unlike other gel scaffolds limited by complex preparation procedures and residual products, this FUV-GelMA gel shows favorable manufacturing ability, promising biocompatibility, and adjustable macroporous structures. The results from a rat model suggested that this gel scaffold creates a conducive microenvironment for mandible reconstruction and vascularization. In vitro experiments further confirmed that the FUV-GelMA gel promotes osteogenic differentiation of human bone marrow mesenchymal stem cells and angiogenesis of human umbilical vein endothelial cells. Investigation of the underlying mechanism focused on the p38 mitogen-activated protein kinase (MAPK) pathway. We found that SB203580, a specific inhibitor of p38 MAPK, abolished the therapeutic effects of the FUV-GelMA gel on osteogenesis and angiogenesis, both in vitro and in vivo. These findings introduced a novel approach for scaffold-based tissue regeneration in future clinical applications.

Cranio-Maxillo-Facial Reconstruction with Polyetheretherketone Patient-Specific Implants: Aesthetic and Functional Outcomes.

Reconstructing cranio-maxillo-facial defects presents significant challenges. This study evaluates the results of polyetheretherketone patient-specific implants (PEEK PSIs) in primary and secondary cranio-maxillo-facial reconstructions, with a focus on aesthetic and functional outcomes and long-term complications. From October 2009 to February 2023, 45 patients underwent cranio-maxillo-facial reconstructions with PSIs. Patients aged 18 years or older, with a minimum follow-up period of 12 months, were included. The morpho-functional outcome was evaluated through a modified Katsuragy Scale, the Visual Analogue Scale (VAS) for pain, and four FACE-Q|Aesthetics© scales. In total, 44 PSIs were placed in 37 patients (51.3% males; mean age 45.1 years). The main cause of the defect was the resection of a tumor (55.4%). Mean follow-up was 78.6 months. Clinical evaluations showed an improvement in the postoperative period both in patient's and surgeon's scores (p: 0.01 and p: 0.002, respectively). Subgroup analysis confirmed a significant improvement in patients undergoing cranioplasty (p = 0.02) and mandible reconstruction (p = 0.03). No cases of prosthesis dislocation, rupture, or long-term infection were recorded. PEEK PSIs offer significant advantages in craniofacial reconstructions. Despite challenges in predicting soft tissue adaptation, overall patient satisfaction was high with no long-term complications. Future improvements should focus on predicting and enhancing soft tissue adaptations.

An innovative method for three-dimensional bone reconstruction of the anterior mandible with preserved dentition using an allogeneic bone block: A 6-month follow-up.

Bone defects around the teeth affect a large portion of the population. Bone regeneration in the area of existing teeth is completely different from that in an edentulous area. To date, no method has been developed for three-dimensional (3D) bone reconstruction in regions with preserved teeth. This study aimed to radiologically evaluate the results of the new method of 3D mandibular bone reconstruction in preserved dentition using a custom-made allogeneic bone block with a 6-month follow-up. Alveolar ridge dimensions were radiographically assessed before and 6 months after reconstruction using cone beam computed tomography (CBCT) scans in 32 patients (192 teeth). Reconstruction used a bone block that had been previously planned and prepared using CAD/CAM technology. The observed changes in alveolar bone dimensions were highly significant in most cases (p < 0.001). The closer to the tooth root apex, the lower the bone growth in the sagittal dimension (average of the mean values for each tooth examined in the measured heights): CEJ2: 2.9 mm, ½ CEJ2: 2.7 mm, ¼ CEJ2: 1.9 mm, and API: 1.4 mm. The maximum bone growth in the vertical dimension was observed on tooth 43 (9.9 mm), followed by 32 (9.8 mm), 33 (8.5 mm), 31 (8.4 mm), 42 (8 mm), and 41 (7 mm). The degree of decrease in vestibular dehiscence of the bone was greater the closer the tooth was to the midline (average of -3.8 mm and -3.4 mm for the central incisors; average of -2.8 mm and -2.6 mm for the lateral incisors; average of -2.6 mm and -2.5 mm for the canines). The results prove that it is possible to prevent bone dehiscence in patients undergoing orthodontic treatment, increasing the ability and effectiveness of covering recessions and improving the morphology of the lower part of the face.

Progress of Ossification after Mandibular Reconstruction by Free Fibula Flap Depending on Different Timing of Radiotherapy: A Retrospective 3D Analysis by CT Scans.

Background: The aim of this study was to evaluate the difference between pre- and post-operative radiotherapy on the progress of ossification after free fibula flap reconstruction of the mandible using three-dimensional (3D) analysis. Methods: A total of 38 free fibula reconstructions of the mandible were evaluated retrospectively for ossification between bone segments by measuring Hounsfield Units (HU) in at least two postoperative computer tomography scans (average of 2.4 scans per patient; around the 5th, 12th, 16th, and 19th month postoperative). Three subgroups were created according to the time of irradiation: preoperative radiotherapy (preORT) (n = 11), postoperative radiotherapy (postORT) (n = 16), and patients without any radiation therapy (n = 11) as the control group (noRT). HU in eight regions of interest (ROI) and overlapping surfaces between segments per contact point, as well as influencing factors, were analyzed. Results: The fastest progress in gain of HU ossification with a difference of 0.30 HU/day was observed in noRT compared to preORT (p = 0.002). postORT was -0.24 HU/day slower than preORT (p = 0.005). Original and grafted bone showed a significantly slower HU uptake than between two graft segments with -84.18 HU/day (p < 0.001). Moreover, a larger initial overlapping surface between the segments in cm2 resulted in a higher rise of HU/day (p < 0.001). Conclusions: 3D analysis of post-reconstructive CT scans shows prolonged ossification of mandible reconstructions by free fibula after head and neck radiation. The effect is distinct in cases with post-operative adjuvant radiotherapy. The effects of radiotherapy on ossification may be minimized by a larger initial contact surface and improved operational techniques. Moreover, HU longitudinal measurements and 3D analysis offer new perspectives for clinical evaluation of successful bony healing.

Free fibula mandible reconstruction for osteoradionecrosis is more challenging than for primary cancer.

Osteoradionecrosis (ORN) of the mandible is an unfortunate potential sequela of radiotherapy for head and neck cancer. In advanced cases of ORN, mandibulectomy, and free fibula flap reconstruction are required. We hypothesized that patients undergoing fibula free flap reconstruction and mandibulectomy for ORN pose unique challenges and experience more complications than patients undergoing fibula free flaps after oncologic mandibulectomy. After IRB approval, we created a database of all free fibula flaps for mandible reconstruction from April 2005 through February 2019. Medical records were retrospectively reviewed for patient and surgical characteristics and postoperative outcomes. Four-hundred seventy-nine patients met the inclusion criteria (168 ORN vs. 311 non-ORN patients). Propensity-matching was performed based on age, BMI, smoking status, preoperative chemotherapy, and virtual surgery planning use, which yielded 159 patients in each group. ORN patients received more double-skin-island fibula flaps than non-OR patients (20.8% vs. 5.7%, p < 0.001). Recipient artery other than the facial artery was utilized more commonly in ORN patients (42.1% vs. 17.0%, p < 0.001). In the unmatched cohort, ORN patients had higher rates of delayed wound healing (26.2% vs. 16.8%, p = 0.01) and surgical site infections (21.4% vs. 13.2%, p = 0.02). Rates of flap loss, return to the operating room, hematoma, operative time, and length of stay were similar between the groups. On logistic regression analysis, osteoradionecrosis was an independent risk factor for delayed wound healing. Based on these data, mandibular reconstruction with fibula flaps for osteoradionecrosis appears more complicated than mandible reconstruction following de novo cancer resection. Surgeons should anticipate employing two skin islands for intraoral and extraoral resurfacing, utilizing unconventional recipient vessels, and managing the delayed wound healing that ensues more commonly than non-ORN patients.

Squamous Cell Carcinoma Lesion at Fibula Free Flap Donor Site Following Mandible Reconstruction in a Known Case of Carcinoma Mandibular Alveolus: Case Report and Review of Literature

Squamous Cell Carcinoma Lesion at Fibula Free Flap Donor Site Following Mandible Reconstruction in a Known Case of Carcinoma Mandibular Alveolus: Case Report and Review of Literature

Computer-Assisted Surgery in Mandible Reconstruction.

Computer-assisted surgery is the most significant recent advancement in osseous head and neck reconstruction. Computer-aided design (CAD) software allows computerized planning of resection and reconstruction. Computer-aided manufacturing (CAM) can be used to create models, cutting guides, and patient-specific plates. Several studies have shown that these techniques are more accurate and result in decreased flap ischemia times compared with conventional techniques. CAD also facilitates the immediate placement of dental implants. The most useful application of computer-assisted surgery is delayed reconstruction, in which soft tissue contraction and the absence of a specimen as a reference make accurate estimation of the defect challenging. The drawbacks of CAD/CAM are lack of intraoperative flexibility and cost. Some centers have created in-house CAD/CAM processes using open-source software and commercially available three-dimensional printers.

Poor condyle position after mandibular reconstruction and a classification system for patients with "VSCU" based on computed tomography: a cross-sectional study with retrospective data collection.

Although the application of vascularized free bone muscle flap to reconstruct the mandible has become a standardized approach for mandible reconstruction, the results of its reconstruction are not always satisfactory. The purpose of this study was to identify the types of mandibular and condylar defects by analyzing the unsatisfactory cases of mandibular reconstruction in clinical practice, and to provide some clinical experience of reconstruction. Our study retrospectively analyzed 364 patients who underwent mandibular resection and vascularized free bone flap reconstruction of the mandible and temporomandibular joint (TMJ). We innovatively proposed a "VSCU" classification system (V: vertical position, S: sagittal position, C: coronal position, U: condylar resection is not required) by analyzing computed tomography (CT) scans of mandibular branches and TMJs. In all, 221 cases of free iliac muscle flap and 143 cases of fibula muscle flap were included in this study, of which 23 cases had unsatisfactory results after TMJ reconstruction. We classified 23 patients with unsatisfactory mandibular reconstruction according to the "VSCU" classification system. The most common type was U + V + SfC (n=8), followed by V - SfC + U + (n=4), V - s + C + U + (n=3), V - sbcou - (n=3), V - SBC + U + (n=2), V - s + C + U - (n=1). The most common classification was insufficient mandibular rami length, followed by condylar sagittal anteriorization. There was no significant change in the position of condyle on the healthy side during mandibular reconstruction involving condyle. P1 on the affected side was 52.28±4.17 mm before operation and 58.94±5.65 mm after operation, P<0.01; P2 was 12.83±3.49 mm before operation and 24.90±7.15 mm after operation. S2 was 4.54±2.84 mm before operation and 19.10±8.54 mm after operation. A2 was 11.46±3.35 mm before operation and 24.15±8.29 mm after operation. The P values were all less than 0.01, and the differences were statistically significant. We propose to use the "VSCU" classification system for accurate 3-dimensional (3D) analysis and positioning, and then obtain accurate models through computer-aided design and manufacturing (CAD/CAM), which can reduce the occurrence of poor reconstruction effect and unreasonable joint position, and is worthy of clinical promotion.

A new concept for mandible reconstruction after oncological resection: Multisegment virtual surgical planning

PurposeVirtual surgical planning (VSP) is good for three dimensional reconstructions in maxillofacial surgery, but it is not problem-free completely especially when the resection margins cannot be affirmed in preoperative period. We aimed to obtain an ideal reconstruction with elaborating VSP to be prepared for adverse conditions during surgery and to proceed the oncological resections step- by- step with A, B, and C resection planes. Patients and methodsFour patients undergoing multisegment VSP for the primary mandible malignancies were included in the study. The first resection margin was detected as plan A in VSP, and plans of B and C were also prepared considering the tumor- positive result of intraoperative frozen section procedure. ResultsFollowing the tumor resection, margins were extended to the plan B in two patients, and plan C in one patient in accordance with the results of the frozen section procedure.Histogram comparison of the localizations of osteotomies in mandible and fibula, and positions of the implants were calculated at a confidence level of 95 % (p > 0.95) and mean difference was found -0.55 mm, while standard deviation was 1.76 mm. ConclusionMultisegment virtual surgical planning seems to achieve the optimal reconstruction with the staged resection preventing redundant removal of tumor- free structures like bone and teeth.

Dynamic optimisation for graded tissue scaffolds using machine learning techniques

Tissue scaffolds have emerged as a promising solution for treatment of critical size bone defects, offering significant advantages over conventional strategies. One of the key functionalities of bone scaffolds is their ability to promote long-term bone ingrowth effectively. To enhance this functionality, we develop a novel dynamic optimisation framework to customise bone scaffolds for achieving maximum bone ingrowth outcomes over a certain period in this study. To improve the design efficiency, we extensively leverage machine learning (ML) techniques within our proposed dynamic optimisation framework. Specifically, two neural networks are integrated into a dynamic bone growth model, and another neural network is coupled with a genetic algorithm for dynamic optimisation process. To demonstrate the effectiveness and efficiency of the approach, we employ a sheep mandible reconstruction for treating a critical size bone defect as an illustraive example. To validate the finite element (FE) model established, we first conduct a mechanical test on the sheep mandible assembled with a tailored 3D printed scaffold made of Polyetherketone (PEK) material. Then, we compare three different optimisation schemes, namely uniform design, lateral gradient design, and vertical gradient design, with an empirical design under the same biomechanical conditions. A 18.5 % enhancement is found in the long-term bone ingrowth when the optimised scaffold is adopted in comparison with the empirical design, which is attributed to the fine-tuning of strut sizes within lattice scaffold structures for facilitating bone regeneration in the gradient regions. This study proposes a novel design framework by combining ML and time-dependent topology optimisation, which provides a new methodology for developing innovative tissue scaffolds with better clinical outcomes.

Reconstruction of Composite Mandible Defects Using a Cellular Bone Allograft and Soft Tissue Free Flap Coverage

Study Design Retrospective case series. Objective Cellular bone allografts (CBAs) contain the components of a successful bone graft with no autologous component and have been used extensively outside the head and neck. Descriptions of their utilization for mandible reconstruction are limited. We review our experience utilizing a CBA, with no autologous component, for the reconstruction of mandible defects. Methods Patients undergoing reconstruction of a composite mandible defect with a CBA, no added autologous component, within a patient-specific graft cage and soft tissue free flap coverage were retrospectively identified. Graft survival and defect management are assessed and results of post-operative imaging reported. Results Five subjects, aged 23–56 years, underwent reconstruction of mandible defects with the described technique. Defects resulted from gunshot wounds in 4 patients and the composite resection of a low-grade malignancy in one. The defect was definitively managed in 4 subjects, 3 of which had post-operative imaging demonstrating bone formation. The fifth experienced graft failure after developing an orocutaneous fistula and was successful salvaged with an osteocutaneous fibula free flap. Conclusions Our early experience is promising that a CBA, with no autologous component, and soft tissue free flap coverage can be used for the reconstruction of composite mandible defects in select patients.

The comparison between various methods of mandibular reconstruction based on finite element analysis.

The Mandible can be damaged by pathological factors, tumors, trauma, infection, and needs a surgical operation for reconstruction and restoring function. There are different methods for the reconstruction of mandible. Based on the surgical approach, primary reconstruction of mandible by reconstruction plate after resection is necessary for maintaining mandibular symmetric and esthetic of the lower third of the face. A finite element model of mandible and masticatory muscles was produced from a normal person (male with 35-year-old). The normal model was resected from the left sixth tooth to the second tooth. The pathological model was reconstructed in different conditions by macro plate. Different conditions were analyzed and compared based on bite force on right fifth tooth, stress developed on screws and macro plate. The finite element analysis results showed that maximum bite force and lower stress on screws were seen in the pathological model (condition 5) when one macro plate and six screws were inserted in the mid-body. The findings showed that the use of two macro plates causes lower stress on it than when we use one. Use of one macro plate and six screws is the best choice in mandibular immobilization which decrease the stress applied on bone and increase the bite force. Because of less stress developed on macro plates and screws, use of two macro plates or one macro plate in mid-body area are also preferred.

Fibular free flap with proximal perforator skin paddle due to aberrant anatomy — a case report

BackgroundThe fibular free flap is considered one of the most valuable options for mandible reconstruction. A perforator flap has gained widespread acceptance in oral and maxillofacial reconstruction. Typically, the fibula flap is obtained primarily with the distal perforator due to its reliable blood supply, with less attention given to the proximal perforators during the harvesting process. Normally, the distal perforator of the fibula exhibits stability and shows limited anatomical variations. However, there have been reported cases in which the distal perforator is absent. At times, these vascular abnormalities remain undetectable through Doppler examination or preoperative angiography evaluation. Therefore, this case details the experience of encountering the rare event of vascular abnormality in oral cancer surgery.Case presentationThis article reports the case of a patient who presented with a congenital absence of the distal perforator in the peroneal artery, attributed to a vascular abnormality. Additionally, we provide a review of the concept of utilizing the proximal perforator as an alternative approach in the flap harvesting process.ConclusionsWhile the distal perforator of the peroneal artery is typically utilized for fibula free flap procedures, surgeons must remain cognizant of the potential for its absence due to aberrant anatomy. Recognizing an alternative approach in such cases can be pivotal for precise surgical planning and favorable outcomes in oral and maxillofacial reconstruction

Mandible Reconstruction with 3D Printed Models

Background: When surgeons operate under general anesthesia, length of surgery, not only its outcome, matters. In maxillofacial surgery we can reduce the time in reconstructive surgery by using presurgical bended plates in presurgically designed 3D models. Method: The study measured the mean time to bend the plates preoperatively on a printed three-dimensional model and the capability of the plates to adapt well on the mandible intraoperatively in cases of mandibular reconstruction after partial resection of the mandible due to pathology, such as benign aggressive tumors. Results and conclusions: The mean time to bend the plates preoperatively was 17 minutes, with rapid adaptation during surgery. This is important in minimizing the time that the wound is exposed to the environment and minimizes the trauma to the surrounding soft tissues. Multiple checks of the plate if bended at time of surgery can increase trauma to the surrounding soft tissues. The study supports the recommendation of the use of the preoperatively corrected and printed 3D models to prebend the plates pre-operatively. This step should be included as a routine workflow in elective cases, since it is not be possible in cases of emergency or urgency.

Personalized lattice-structured prosthesis as a graftless solution for mandible reconstruction and prosthetic restoration: A finite element analysis

Oral cavity tumors are a prevalent cause of mandible reconstruction surgeries. The mandible is vital for functions like oralization, respiration, mastication, and deglutition. Current mandible reconstruction methods have low success rates due to complications like plate fracture or exposure, infections, and screw loosening. Autogenous bone grafts are commonly used but carry the risk of donor region morbidity. Despite technological advances, an ideal solution for mandible reconstruction remains elusive. Additive manufacturing in medicine offers personalized prosthetics from patient-specific medical images, allowing for the creation of porous structures with tailored mechanical properties that mimic bone properties. This study compared a commercial reconstruction plate with a lattice-structured personalized prosthesis under different biting and osseointegration conditions using Finite Element Analysis. Patient-specific images were obtained from an individual who underwent mandible reconstruction with a commercial plate and suffered from plate fracture by fatigue after 26 months. Compared to the commercial plate, the maximum von Mises equivalent stress was significantly lowered for the personalized prosthesis, hindering a possible fatigue fracture. The equivalent von Mises strains found in bone were within bone maintenance and remodeling intervals. This work introduces a design that doesn't require grafts for large bone defects and allows for dental prosthesis addition without the need for implants.

A Novel Method for Secondary Mandible Reconstruction to Re-Achieve a Native Condyle Position Comprising a New Design for Cutting Guides and New Positioning Devices.

Secondary mandibular reconstruction using fibular free flaps (FFF) is a technical challenge for surgeons. Appropriate operation planning is crucial for postoperative quality control and is notably necessary for the (re-) achievement of a physiological condylar position, and the sensible expansion and shaping of the transplant. Computer-assisted planning may help to reconstruct mandibular defects in a patient-specific and precise manner. Herein, we present a newly-developed workflow for secondary mandibular reconstruction using FFF; it comprises digital planning and in-house manufacturing to perform precise secondary mandible reconstruction. This method utilizes a newly designed positioning device to ensure the precise positioning of the fibula segments in relation to each other and the mandibular stumps. The presented in-house-printed positioning device made it possible to achieve digital planning with high precision during surgery.