evaluation of the accuracy of 3d virtual surgical planning for reconstruction of mandibular defects using free fibular flap
Mandibular reconstruction is considered one of the most complex reconstructive surgeries and continues to be a challenge in the field of craniomaxillofacial and plastic surgery. Mandibular reconstruction has many variable indications including oncologic resections for benign and malignant tumors, traumatic and gun shot injuries, and osteoradionecrosis or osteochemonecrosis. Reconstruction of the mandibular defect has been performed by various non-vascularized grafts which only can serve in limited specific circumstances, like reconstructions of small bony defects provided that no soft tissue involvement and enough coverage. Complications may vary from graft resorption, infection, non-union, graft fracture and osteoradionecrosis if radiation was planned.
With the introduction of microvascular reconstructive surgery, free vascularized bone grafts become the gold standard for reconstruction of mandiblar defects. Free fibular flap offers several advantages, it can supply a large amount of bone and soft tissue easy to harvest, two team approach with less time consuming, its vascular pedicle based on the peroneal artery which is generally long and anatomically reliable, minor donor site morbidity and no need for patient repositioning during surgery.
For optimum restoration of the patient’s esthetics and function, the free fibular flap should be redesigned and recontoured following the natural premorbid state of the mandible and continue to be merged with the resection ends of the mandible homogenously. Virtual surgical planning using preoperative computed tomographic (CT) data which is rendered 3D model to be processed for digitalized simulation of the bony resection and reconstruction and transferred to the operating room in the form of templates and guides to be applied as the planned, and so it ensure high reproducibility of the virtual planned surgery clinically, reducing the side errors, besides its time saving advantage for both the operator and the patient.