Computer-assisted versus traditional freehand technique in fibular free flap mandibular reconstruction: a morphological comparative study

Abstract

The purpose of the study was to compare the accuracy of computer-assisted surgery (CAS) and the traditional freehand technique for fibular free flap mandibular reconstruction as well as to evaluate the accuracy of the CAS planning. The medical records of 18 patients who underwent mandibular reconstruction with fibular free flap were reviewed. The CAS group (n = 7) benefited from virtual surgical planning and custom patient-specific plates and surgical cutting guides. The Control group (n = 11) was treated by conventional surgery. Morphometric comparison was done by calculating the differences in specific linear and angular parameters on pre- and postoperative CT-scans for both groups by using ProPlan CMF software. Symmetry was also assessed by calculating the ratio of the affected versus the nonaffected side. In the CAS group, planned and postoperative CT-scans were compared to evaluate accuracy. The morphometric comparison showed no statistically significant differences between the groups except for the axial angle on the nonaffected side (mean difference 1.0° in the CAS group versus 2.9° in the Control group; p = 0.03). Ratios of the affected side over the nonaffected side showed no differences between the two groups. In the CAS group, the accuracy assessment showed a mean distance deviation of 2.3 mm for mandibular osteotomies and 1.9 mm for fibular osteotomies. Our results indicated that CAS and the conventional freehand techniques were comparable in their ability to provide a satisfactory morphological fibular free flap mandibular reconstruction. Moreover, the accuracy of the CAS technique was within the range reported in the literature.

Clinical evaluation of an automated virtual surgical planning platform for mandibular reconstruction

“…[3][4][5][6][7][8][9][10][11][12] Although the specifics of VSP vary, they all follow the general workflow of segmenting radiological data to create a 3D model, planning on the model, and using surgical guides to carry out the reconstruction plan. Generally, VSP can be divided into three modes: external planning through a commercial planning service in which the surgeon has a virtual meeting with the third party, 7,9,11 in-house planning using commercial dedicated planning software, 4,5,10 and, less commonly, in-house planning using a custom software workflow. 3,8,12 VSP has been shown to reduce operating and ischemia time, [4][5][6]13 and in some cases shown to improve the accuracy of reconstructions compared to the standard freehand approach.…”

“…The quality of the reconstruction directly impacts mastication, deglutition, and facial aesthetics. A wave of virtual surgical planning (VSP) has recently emerged as an improvement on the traditional freehand approach 3‐12 . Although the specifics of VSP vary, they all follow the general workflow of segmenting radiological data to create a 3D model, planning on the model, and using surgical guides to carry out the reconstruction plan.…”

Modalities and State of Art in Oral Cancer Reconstruction

“…It can also be implemented in mandibular or midface reconstruction using fibula free flap or iliac crest flap. It requires a preoperative CT scan planning design and preparation of the customized mandibular reconstruction plate and cutting guides providing a most precise reconstruction [16,17]. Current communication between the resective surgeon, reconstructive surgeon, and team that supports the technology is necessary to assess all the information previous to surgery.…”

Condyle dislocation following mandibular reconstruction using a fibula free flap: complication cases

“…By using VSP and VSP-based CAD/CAM surgical guides, the original jaw bone shape can be reconstructed more accurately than when using pre-surgical computed tomography (CT) data of the jawbone and fibula [7, 10]. The guides reduce the size of bone segments in fibular bone grafting and enable more sophisticated reconstruction [3].…”