Mandibular reconstructions with free fibula flap using standardized partially adjustable cutting guides or CAD/CAM technique: a three- and two-dimensional comparison

Abstract

BackgroundMandibular reconstruction with the fibula free flap (FFF) is performed freehand, CAD/CAM-assisted, or by using partially adjustable resection/reconstruction aids. The two latter options represent the contemporary reconstructive solutions of the recent decade. The purpose of this study was to compare both auxiliary techniques with regard to feasibility, accuracy, and operative parameters.Methods and materialsThe first twenty consecutively operated patients requiring a mandibular reconstruction (within angle-to-angle) with the FFF using the partially adjustable resection aids between January 2017 and December 2019 at our department were included. Additionally, matching CAD/CAM FFF cases were used as control group in this cross-sectional study. Medical records and general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time) were analyzed. In addition, the pre- and postoperative Digital Imaging and Communications in Medicine data of the mandibles were converted to standard tessellation language (.stl) files. Conventional measurements – six horizontal distances (A–F) and temporo-mandibular joint (TMJ) spaces – and the root mean square error (RMSE) for three-dimensional analysis were measured and calculated.ResultsIn total, 40 patients were enrolled (20:20). Overall operation time, ischemia time, and the interval between ischemia time start until end of operation showed no significant differences. No significant difference between the two groups were revealed in conventional measurements of distances (A–D) and TMJ spaces. The Δ differences for the distance F (between the mandibular foramina) and the right medial joint space were significantly lower in the ReconGuide group. The RMSE analysis of the two groups showed no significant difference (p=0.925), with an overall median RMSE of 3.1 mm (2.2–3.7) in the CAD/CAM and 2.9 mm (2.2–3.8) in the ReconGuide groups.ConclusionsThe reconstructive surgeon can achieve comparable postoperative results regardless of technique, which may favor the ReconGuide use in mandibular angle-to-angle reconstruction over the CAD/CAM technique because of less preoperative planning time and lower costs per case.

Effect of segmental versus marginal mandibular resection on local and lymph node recurrences in oral squamous cell carcinoma: is tumorous bone infiltration or location and resulting soft tissue recurrences a long-term problem?

“…Here, group I was reconstructed with different microvascular grafts and group II either with alloplastic titanium plate plus microvascular flap or with a microvascular bone flap. Bony mandibular reconstruction with a microvascular bone graft (fibula or iliac crest) was performed freehand, partially adjusted with a resection guide (KLS ReconGuide), or CAD/CAM planed (Weitz et al 2023 ).…”

A Novel Method for Secondary Mandible Reconstruction to Re-Achieve a Native Condyle Position Comprising a New Design for Cutting Guides and New Positioning Devices

“…The FFF has been successfully used in mandibular reconstruction for decades [1]. Therefore, current developments mainly consider methods which will ensure that osteotomies will be performed more precisely, and that the graft will be inserted into the recipient area more precisely [3,4,[9][10][11].…”

“…Initially, the configuration of the graft that was harvested, and thus, the angulation and positioning of the FFF in the recipient site, were performed intraoperatively, and they were based on the surgeon's operative experience. More recently, CAD-based methods for surgical planning and the determination of the graft design in particular have been widely described [3,4,[6][7][8]11]. Both industrial surgical planning (concerning the production of the cutting guides to be applied intraoperatively) and so-called "in-house" planning, are common procedures.…”

“…Both industrial surgical planning (concerning the production of the cutting guides to be applied intraoperatively) and so-called "in-house" planning, are common procedures. However, due to the wide availability of reliable planning software and 3D printers, in-house planning is becoming increasingly popular [3,4,[6][7][8]11], partly due to the significant advantage of shorter communication paths [12].…”

Three-dimensional assessment of upper airway changes associated with mandibular positional deviations following fibula free flap reconstruction

“…Much research is underway to optimize the surgical results in terms of accuracy and efficacy. Computer-aided design/computer-aided manufacturing (CAD/CAM) techniques, which allow digital planning of the surgery, and semi-standardized resection and cutting guides (ReconGuide), some of which can be adapted to the clinical situation during the surgery, can help to meet these demands [ 4 , 5 ]. Including these, most modern surgical aids focus on the bony reconstruction.…”