The accuracy of computer-assisted primary mandibular reconstruction with vascularized bone faps: Iliac crest bone fap versus osteomyocutaneous fbula fap

Abstract

Background: The intention of mandibular reconstruction is to restore the complex anatomy with maximum possible functionality and high accuracy. The aim of this study was to evaluate the accuracy of computer-assisted surgery in primary mandibular reconstruction with an iliac crest bone fap compared with an osteomyocutaneous fbula fap. Materials and methods: Preoperative computed tomography data of the mandible and the iliac crest or fbula donor site were imported into a specifc surgical planning software program. Surgical guides were manufactured using a rapid prototyping technique for translating the virtual plan, including information on the transplant dimensions and shape, into real-time surgery. Using postoperative computed tomography scans and an automatic surface-comparison algorithm, the actual postoperative situation was compared with the preoperative virtual simulation. Results: The actual fap position showed a mean difference from the virtual plan of 2.43 mm (standard deviation [SD] ±1.26) and a surface deviation of 39%,2 mm and 15%,1 mm for the iliac crest bone fap, and a mean difference of 2.18 mm (SD ±1.93) and a surface deviation of 60%,2 mm and 37%,1 mm for the osteomyocutaneous fbula fap. The position of the neomandible reconstructed with an osteomyocutaneous fbula fap indicated a mean difference from the virtual plan of 1.25 mm (SD ±1.31) and a surface deviation of 82%,2 mm and 57%,1 mm, in contrast to a mean difference of 1.68 mm (SD ±1.25) and a surface deviation of 63%,2 mm and 38%,1 mm for the neomandible after reconstruction with an iliac crest bone fap. For shape analysis, a similarly high accuracy could be calculated for both faps. Conclusion: Virtual surgical planning is an effective method for mandibular reconstruction with vascularized bone faps, and can help to restore the anatomy of the mandible with high accuracy in position and shape. It seems that primary mandibular reconstruction with the osteomyocutane-ous fbula fap is more accurate compared with the vascularized iliac crest bone fap. © 2014 Modabber et al.