Microsurgical mandibular reconstruction using a resin surgical guide combined with a metal reconstructive plate

Abstract

Introduction In mandibular reconstruction, repositioning the mandibular position is still challenging and time consuming. We invented a new re‐positioning technique using a resin plate combined with a reconstructive plate in reconstructing the mandible with an osteocutaneous free flap. The purpose of this report is to introduce this technique and evaluate the accuracy of mandibular reconstruction using free flaps. We hypothesized that this technique is precise and can reduce intraoperative plate bending at a low cost and short preparation period. Methods Mandibular reconstruction was successfully performed in a total of 10 cases without any complications. In this technique, a pre‐bent reconstructive plate was prepared in accordance with a three‐dimensional model, and then coated with resin. Intraoperatively, the mandibles were secured by fitting these plates snugly and fixing them using a reconstructive plate. Then the resin was removed and free osteocutaneous free flaps were transfer to the defect. Ten patients with a mean age of 68.2 who underwent mandibular resection for aggressive benign (n = 1) or malignant disease (n = 9) were reconstructed using this technique. Seven cases were reconstructed using fibular osteocutaneous free flaps, while scapular osteocutaneous free flaps were used in the remaining cases. The resections entailed: unilateral symphysis and lateral body in four cases, angle to ipsilateral angle in two, ramus to symphysis in two, and lateral body plus angle to symphysis in one case. The deviation of the mandible was evaluated by measuring the preoperative versus postoperative differences in the distances between six bilateral landmarks. Results There were no complications and flap failure in any of the 10 cases. No further intraoperative plate bending was required. One case underwent additional mucosal resection due to recurrence of cancer. Three cases were referred to postoperative chemoradiotherapy. Two patients expired during follow‐up due to recurrence of cancer. Six cases were put back on a normal diet. The other cases who lacked opposing teeth had to remain on a soft diet. The mean follow‐up period was 46.2 months. The average of the absolute deviation values was 1.45 mm. This value was 0.94 mm in six cases with mandibular body defects and 2.26 mm in four cases with mandibular defects involving the ramus. Conclusions The present novel technique is simple, quick to prepare, and accurate. This technique can be a viable option for microsurgical mandibular reconstruction.

Comparison of surgical outcomes between primary plate and fibular flap transfer for reconstruction of segmental mandibular defects

“…Virtual planning combined improved 3D printing technology has proved to be time saving and increase the accuracy (Geusens et al, 2019). However, the cost of virtual planning and 3D printing is high, even not approved by the authorities yet in some countries, resin cutting guide may be an alternative way to improve the outline of the reconstructed mandible (Nuri et al, 2019). Moreover, CAD/CAM with virtual planning may decrease the flexibility during operation if procedure is not going as previously planned (Largo & Garvey, 2018), which traditional way is still needed in some circumstances.…”

Bio-3D printing of scaffold-free osteogenic and chondrogenic constructs using rat adipose-derived stromal cells

“…However, this method is clinically challenging owing to the limitations of bone fixation methods and its success is dependent on the size of the bone graft [5]. Therefore, in recent years, artificial materials (AMs) such as artificial bones and scaffolds have been applied to the treatment of EBDs [6][7][8][9][10]. Nevertheless, AMs are sometimes inferior to AB in terms of strength and integration with the surrounding bone tissue [11].…”