Virtual surgical planning in fibula flap mandibular reconstruction

Abstract

Mandibular reconstruction is one of the workhorse in head and neck reconstructive surgery, with the free fibula flap currently considered the gold standard technique. The last two decades have seen considerable developments and a surge in popularity of virtual surgical planning (VSP) and Computer-aided design and manufacturing (CAD-CAM). Starting with virtual performing of the surgery, the possibilities that this technology offers are enormous. Stereolithographic models, customized bone cut guides and prebent reconstruction plates are very useful intraoperative tools. In spite of the high costs of this technology, it is helpful to surgeons in the following ways: (I) During ablative oncological surgery, cleaner bone margins are easily obtained due to bone cut accuracy enhancement; and (II) the efficiency of reconstructive surgery is improved by simplifying the otherwise time-consuming reconstructive steps associated with the traditional free-hand technique. The aim of this article is to describe our experience and to share the tips and pitfalls than we have found along these years with this technology which is producing a paradigm shift in bone graft reconstruction. In conclusion, our recommendation is to use a case-by-case evaluation to select those patients for whom VSP and CAD-CAM will help to obtain the best aesthetical and functional outcomes.