Virtual surgical planning for mandibular reconstruction: Improving the fibula bone flap

Abstract

Mandibular reconstruction is still a challenge in modern maxillofacial surgery, using frequently a free fibula flap for its reconstruction. Fibula in-setting has traditionally relied on manual skills, making the results extremely dependent on the surgeon’s expertise. To solve this problem, this study proposes the use of virtual surgical planning for mandibular reconstruction from a fibula bone, comprising the following four stages: (i) a scanning phase where both mandible and fibula of patient are scanned by computed axial tomography, (ii) a second phase of study where the osteotomies to be performed both in the mandible and the fibula bone are positioned, and where the guide elements are designed to be used in surgery, (iii) a 3D printing phase where the designed elements will be generated, and (iv) a surgical phase where the surgery is performed. This method permits more accurate and predictable results with an adequate bone-to-bone contact, and reduces costs by shortening the operation, decreasing the ischemia time, and reducing the postoperative complications.