Precision of fibula positioning guide in mandibular reconstruction with a fibula graft

Abstract

BackgroundThis study examined the usefulness of the fibula positioning guide for boosting the accuracy of mandible reconstructions.MethodsThirty mandibular rapid prototype (RP) models were allocated to experimental (N = 15) and control (N = 15) groups. For reference, we prepared a reconstructed mandibular RP model with a three-dimensional printer, based on surgical simulation. In the experimental group, a fibula positioning guide template and fibula cutting guide, based on simulation, were used to reconstruct the mandible with a fibula graft. In the control group, only the fibula cutting guide, with reference to the reconstructed RP mandible model, was used to reconstruct the mandible with a fibula graft. The two mandibular reconstructions were compared to the surgical simulation by registering images with the non-surgical right side of the mandible. On the reconstructed side, 3D measurements were compared between the surgical simulation and actual surgery, and the sum of differences was taken as the total error.ResultsThe combined use of the fibula cutting and positioning guides produced a smaller total error (mean ± SD: 10.0 ± 7.9 mm) than the fibula cutting guide alone (12.8 ± 8.8 mm; p = 0.015). The greatest point error was the vertical error at the mesial point of the anterior fibula segment. The anteroposterior and lateral errors were not significantly different between groups. These results showed that these two methods were not significantly different, except in the total and vertical errors.ConclusionsConsidering the CAD/CAM processes required for creating positioning devices, the benefit provided with a positioning guide justified its use over the fibula cutting guide alone.

Stereolithographic model‑assisted reconstruction of the mandibular condyle with a vascularized fibular flap following hemimandibulectomy: Evaluation of morphological and functional outcomes

“…Lim et al reported that the maximum error was observed in the condylar region when only a fibula-cutting guide was used ( 27 ). This error was thought to be related with the movement of the condylar head in the TMJ ( 27 ).…”

“…Lim et al reported that the maximum error was observed in the condylar region when only a fibula-cutting guide was used ( 27 ). This error was thought to be related with the movement of the condylar head in the TMJ ( 27 ). They suggested that it may be more helpful to adjust the anterior-posterior position of the fibular bone by referring to the 3D model rather than using a cutting guide ( 27 ).…”

Prospects of Robot-Assisted Mandibular Reconstruction with Fibula Flap: Comparison with a Computer-Assisted Navigation System and Freehand Technique

“…17 Current advances in 3D imaging, navigation system, CAD/CAM techniques, STL models, and RP techniques allow reconstructive surgery to be performed rapidly and accurately. 3,[17][18][19] In soft tissue surgery, navigation-guidance may not provide optimal results because of the problem of tissue drifting, but this is not an issue in hard tissue surgery. 17 Nevertheless, whereas robotic surgery has been used for the soft tissue free flap reconstructions, 20,21 its application in craniomaxillofacial bone defect reconstructions is still a novelty.…”

New Virtual Tool for Accurate Evaluation of Facial Volume

“…The use of 3-dimensional (3D) imaging and a 3D digitized mesh in plastic surgery enables the acquisition of objective data and facilitates pre-and postoperative evaluation of malformations, sequelae of trauma and tumors, and orthognathic surgery. In addition, the 3D mesh facilitates guide production with virtual planning and 3D printing [1]- [6], quantification of results after aesthetic surgery [7]- [9], and simulation of volume changes [10]- [16]. Furthermore, digital files may be transmitted easily, enabling file exchange for remote evaluation and wider potential for the clinical use of the 3D mesh [17].…”