Clinical Comparison of CAD/CAM vs. KLS L1® Mandible ReconGuide in Fibula Free Flap Mandible Reconstruction: A Retrospective Clinical Study

Abstract

Introduction: The fibula free flap (FFF) is regarded as the workhorse for lower jaw reconstruction in maxillofacial surgery. Imitating the preexisting shape of the mandible by an FFF while meeting various clinical and geometric aspects can be challenging, even for an experienced surgeon. To enhance the quality and reproducibility of the reconstruction process, several tools are available, mainly based on CAD/CAM techniques and the KLS L1 Mandible ReconGuide. The objective of this study was to examine the clinical use of the KLS L1® Mandible ReconGuide compared to CAD/CAM templates. Material and Methods: In this study, we compared 25 patients who underwent mandibular reconstruction by a FFF with either the KLS L1® Mandible ReconGuide (G1, n = 17) or personalized CAD/CAM-based cutting guides (G2, n = 8). We performed a pre- and postoperative 3D image reconstruction using standard triangle language (STL) to quantify the anatomical results in terms of volume deviations, intercondylar distance, and gonial angle, as well as clinical criteria such as surgery time, function, and postoperative complications. Results: The analysis of pre- and postoperative clinical outcomes in 25 patients revealed no statistically significant differences between the groups. However, it was observed that longer surgery time was group-independent, associated with a 5.63% increase in the length of hospital stays (p = 0.0002). In terms of geometric criteria, the only significant difference referred to the postoperative length of the symphysis, which measured 34.32 mm in G2 versus 34.78 mm in G1 (p = 0.046). Conclusions: Both the KLS L1® Mandible ReconGuide and CAD/CAM templates seem equivalent, effective devices for standardized mandibular reconstruction, with their suitability depending on the specific indications and the segments involved.