Computer-Aided Design and Computer-Aided Manufacturing Versus Conventional Free Fibula Flap Reconstruction in Benign Mandibular Lesions: An Italian Cost Analysis

Factors influencing CAD/CAM accuracy in fibula free flap mandibular reconstruction

“…Mandibular reconstruction represents a genuine challenge, as it should re-establish the aesthetics of the face, restore the patient's ability to eat in public, maintain the intelligibility of speech and achieve an accessible airway 11 . Reconstructive surgeons are in consensus that CAS yields outcomes superior to those of conventional surgery, with a comparable cost burden 6,12 . Despite the popularity and accuracy of CAD/CAM-aided mandibular reconstruction, few objective analyses have been performed to examine the reproducibility of virtual planning with large samples 5 .…”

“…Use of the FFF has several advantages, including harvest from the longest (up to 25 cm) dense bicortical bone, the ability to employ a simultaneous two-team approach, adequate length and diameter of peroneal vessels, least donor-site morbidity and dual blood supplies from the contemporary intraosseous and segmental periosteal arterial systems, which permits the performance of multiple osteotomies (separated by as little as 2 cm) 2 and thereby optimal bone shaping without concern for bone viability 3 . Since Hirsch's description of the pioneering technique in 2009 4 , computer-assisted surgery (CAS) or computer-aided design/ computer-aided manufacturing (CAD/CAM) for mandibular reconstruction has gained popularity due to its reproducibility, its role in improving surgeons' performance and patient satisfaction (aesthetic and functional), and its cost burden, which is comparable to those of traditional freehand reconstructive techniques 5,6 . CAD/CAM technology has been applied successfully even for secondary mandibular reconstruction, which is considered to be a reconstructive challenge 7 .…”

“…van Baar et al performed a systematic review which revealed that three methods are used for CAD/CAM evaluation: comparison of 1) preoperative and postoperative DICOM images, 2) preoperative (unrevised to the virtual plan, without segmentation or neomandible) and postoperative STL models and 3) preoperative (revised to the virtual plan, including the neomandible) and postoperative STL models 9 . Despite the widespread utilisation and proven accuracy of this technology, studies comparing it with traditional reconstructive techniques, with the analysis of variables affecting computer-aided reconstruction, are lacking 5,6 . In this study, we aimed to objectively assess the accuracy and reproducibility of CAD/CAM technology in mandibular reconstruction with vascularised FFFs, using superimposition software to assess average linear deviations and to evaluate the potential effects of various factors on the outcomes of these procedures.…”

Computer-aided Design and Syringe-aided Manufacturing for Mandibular Reconstruction Using a Vascularized Fibula Flap

“…A previous study in which the cost of CAD-CAM of mandibular reconstruction using a free fibula flap is analyzed reported that the cost of operative medical devices of CAD-CAM group is €3,876.4 higher than that of conventional method group. 15 The cost of the 3D physical model of the mandible, which is used in our article, is about ¥40,000 = €333. Therefore, our method is about €3,500 cheaper than that of VSP with cutting guides.…”

A multicenter survey on computer‐aided design and computer‐aided manufacturing mandibular reconstruction from Italian community

“…In particular, the accuracy of planning transfer from virtual planning into the operating room, precision of reconstructive plates, and reliability of cutting guides have been largely documented in the international literature (Tarsitano, Ciocca, Scotti, & Marchetti, ; Wilde et al, ). Cost is the greatest factor limiting the adoption of such technologies, but recent studies have suggested that sparing of surgical time and increasingly accurate results minimize this problem, and several reports indicate that the costs are comparable to those of freehand procedures (Bolzoni et al, ).…”