Development of a template tool for facilitating fibula osteotomy in reconstruction of mandibular defects by digital analysis of the human mandible

Abstract

Objectives Mandibular reconstruction after segmental mandibulectomy can be challenging without virtual surgical planning and osteotomy guides. The purpose of this study was to analyze anatomic parameters to facilitate the evaluation of ideal fibula wedge osteotomies to reconstruct the neomandibula in a simple and cost-effective manner without the need for preoperative virtual planning. Materials and methods Computed tomography scans were acquired from randomly selected patients, and all images were obtained from routine clinical diagnostics, e.g., tumor staging, or preoperatively before reconstruction. Data was used to calculate stereolithographic models of the mandible for length and angle measurements. Statistical analysis was performed (p < 0.05). Results CT scans of 100 patients were analyzed: 39 were female and 61 were male patients, mean age was 59.08a. The mandibular arch angle proved to be constant with 241.07 ± 2.39°. The outside B-segment length was 80.05 ± 5.16 mm; the anterior S-segment length was 27.69 ± 3.16 mm. The angle of the mandibular arch showed differences in means (p = 0.004) between age groups, but effect was proved low. No relevant statistical significances were detected. Conclusions The development of a mandible reconstruction template tool would benefit the majority of head and neck patients, which is due to a constant mandibular arch angle and symphysis segment length throughout the general patient population, allowing the mimicking of a harmonic mandibular arch with up to three fibula segments. Clinical relevance The developed mandible reconstruction template tool can facilitate the fibula wedge osteotomies necessary for reconstruction of an ideal neomandibula providing a novel approach which is simple and cost-effective.

Chimeric LSMAP Double-barrel Fibula Free Flap: Goal-oriented Surgical Technique and Tips for One-stage Mandibular Reconstruction

“…The SB was removed subperiosteally and discarded to help a proper mandibular angle shape. The SC was placed along the lower border of the mandible and together with the first forms the mandibular angle of 240 degrees 10 (center-right). The SD was removed subperiosteally and discarded to prevent stretching or compressing the vascular bundle, leaving the periosteum intact between the SC and E, allowing a safe rotation of the latter (lower-left).…”

Doppler Ultrasound and Computed Tomography Angiography Application in Planning of Lower Extremities Perforator Flaps for the Reconstruction of Acquired Maxillofacial Defects (Case Report)

“…Устранение челюстно-лицевых дефектов путем аутотрансплантации кожного лоскута с перфорантным сосудом, а также малоберцовой кости пациента получило широкое применение в медицине [3,4]. Данные операции позволяют, во-первых, восстановить естественную работу поврежденных тканей лица, а во-вторых, вернуть эстетический внешний вид, что немаловажно в повседневной жизни человека в социуме.…”

Investigating the accuracy of mandibulectomy and reconstructive surgery using 3D customized implants and surgical guides in a rabbit model

“…Restoration poses further challenges when the entire mandible is defective. In such cases, along with the restoration of the lower facial area primarily via mandibular reconstruction, the opening, closing, and mastication functions of the mouth should be restored, which renders the procedure to be an extremely complex reconstructive surgery [4]. Therefore, for improving the quality of life of patients, it is important to aesthetically and functionally reconstruct various defective areas of the mandible, which is challenging for clinicians.…”

“…Favorable results have been reported for spinal surgery in the field of orthopedics and sternal reconstruction in the field of thoracic surgery [14,15]. This method has been used in cases of defective mandible reconstruction wherein the continuity of the mandible was lost and the mandible, including the mandibular joint and entire mandible [2][3][4], was affected. In addition, it has been used in plastic surgery for facial contouring [16].…”