A CAD/CAM-prototyped anatomical condylar prosthesis connected to a custom-made bone plate to support a fibula free flap

Abstract

This paper describes a new protocol for mandibular reconstruction. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to manufacture custom-made cutting guides for tumor ablation and reconstructive plates to support fibula free flaps. CT scan data from a patient with an odontogenic keratocyst on the left mandibular ramus were elaborated to produce a virtual surgical plan of mandibular osteotomy in safe tissue for complete ramus resection. The CAD/CAM procedure was used to construct a customized surgical device composed of a cutting guide and a titanium reconstructive bone plate. The cutting guide allowed the surgeon to precisely transfer the virtual planned osteotomy into the surgical environment. The bone plate, including a custom-made anatomical condylar prosthesis, was designed using the outer surface of the healthy side of the mandible to obtain an ideal contour and avoid the bone deformities present on the side affected by the tumor. Operation time was reduced in the demolition and reconstruction phases. Functional and aesthetic outcomes allowed patients to immediately recover their usual appearance and functionality. This new protocol for mandibular reconstruction using CAD/CAM to construct custom-made guides and plates may represent a viable way to reproduce the patient's anatomical contour, give the surgeon better procedural control, and reduce operation time.

Computer-Assisted Surgery for Segmental Mandibular Reconstruction with the Osteoseptocutaneous Fibula Flap

“…Achieving negative margins has been reported in only as few as 12 cases, which may warrant further investigation. 8,38,39 Even if it is true that the extent of the lesion can be visualized on the three-dimensional model to determine resection sites, it might only be possible for cancer and not osteoradionecrosis, in which bone quality assessed clinically usually determines resection margins. 40 Coverage and soft-tissue reconstruction are not well-reported in the virtual surgical planning and computer-aided design and modeling literature.…”

Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence

“…The genioplasty template system that was first developed by our Surgical Planning Laboratory and other bone templates (e.g., graft or ostectomy) and cutting and drilling guides can also be fabricated as needed 1,3,10,15 . Surgical plates can either be pre-bent on a physical model 3,10,22 , or custom-fabricated 23 . If necessary, a roadmap can also be created for the navigational surgery to guide the surgeon performing osteotomies and drilling screw holes 3,22,24 .…”

The accuracy of computer-assisted primary mandibular reconstruction with vascularized bone flaps: iliac crest bone flap versus osteomyocutaneous fibula flap

“…This can be an important drawback in primary reconstruction after tumor ablation, and leads to difficulties in adapting the virtual plan to the intraoperatively changed situation 29. However, the patients of the present study received primary mandibular reconstruction due to osteomyelitis.…”