A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction

Abstract

ObjectivesAlthough computer-assisted surgery using fibula flap has been widely applied for oncologic jaw reconstruction in recent years, the inaccurate positioning of the fibula harvest guide brings sliding and rotational errors, which leads to compromised accuracy in simultaneous implant placement and dental rehabilitation. This study aimed to develop a novel three-dimensional (3D)-printed patient-specific fibula malleolus cap to increase oncologic reconstruction accuracy.MethodsIn this prospective comparative study with a recent historical control cohort, patients in need of oncologic jaw reconstruction with fibula free flaps were recruited. In the study group, the fibula was harvested with the guide of the malleolus cap, whereas in the control group, without the malleolus cap. Deviations of location and angulation of distal fibula osteotomies, jaw reconstruction segments, and simultaneous dental implants were compared.ResultsTwenty patients were recruited, with 10 in each arm. The application of the malleolus cap significantly reduced the deviations in locations and angles of distal fibula osteotomies, from 9.5 to 4.1 mm and 25.3° to 8.7°. For the simultaneous dental implants placed in the fibula flaps, there was a significant increase in the accuracy of implant platform locations (the average deviation from 3.2 to 1.3 mm), apex locations (from 3.8 to 1.5 mm), and angles (from 11.3° to 4.6°). No significant difference was detected in the accuracy of fibula reconstruction segments.ConclusionsWe developed a novel fibula malleolus cap to overcome the sliding and rotational errors during fibula flap harvesting for oncologic jaw reconstruction, with increased accuracy in simultaneous dental implants. This is a step forward to achieve a satisfactory functional outcome of jaw reconstruction with dental rehabilitation.

Predictability and Effectiveness of Jaws Reconstructive Prosthesis after Tumor Removal: A Systematic Review and Meta-Analysis

“…The distal remaining fibula's osteotomy end was chosen as the best place to fit; that plane is the actual osteotomy plane. The postoperatively reconstructed jaw was superimposed on the preoperative plan with the best match of the unoperated portion of the natural mandible [14] (Table 2).…”

Current Trends in the Reconstruction and Rehabilitation of Jaw following Ablative Surgery

“…To overcome the sliding and rotating errors caused by the placement of fibula cutting guides, Pu et al developed a novel malleolus cap for fibula flap harvesting. With the use of a malleolus cap, the simultaneous dental implants in the fibula approached a similar level of accuracy compared to the guided implant placement in the native maxilla and mandible, which further proved the reliability of the jaw-in-a-day technique with simultaneous dental rehabilitation [ 35 ].…”

A quantitative comparison of bone resection margin distances in virtual surgical planning versus histopathology: a prospective study

“…Computer-assisted surgery has transformed jaw resection and reconstruction surgeries in the past decades 8 . 3D-printed patient-specific resection guides could precisely locate the osteotomy plane according to virtual surgical planning (VSP) based on imaging 7 , 9 , 10 , thus making the comparison between the ʻplanned resection marginʼ and ʻfinal pathological marginʼ possible. This prospective study was designed to quantitatively evaluate the reliability of margin distances measured in the preoperative surgical plan in predicting margin status in the final histopathology and associated factors, and to provide guidance on the design of osteotomy planes during VSP based on preoperative imaging.…”