Translating computer-aided design and surgical planning into successful mandibular reconstruction using a vascularized iliac-crest flap

Publication date: Available online 3 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Lei Zheng, Xiaoming Lv, Jie Zhang, Shuming Liu, Jianguo Zhang, Yi Zhang
PurposeThis study is to evaluate the computer-aided approach to the reconstruction of mandibular defects using a vascularized iliac-crest flap.Methods and materialsFrom December 2015 to October 2016, 14 patients (8 males and 6 females) aged between 18 and 64 years (median age, 29 years) were treated at the Peking University School and Stomatology Hospital, China. All of the patients were confirmed by histological examination prior to segmental mandibulectomy. Computer-based surgical techniques, including virtual surgical planning, CAD/CAM, rapid prototyping, and intraoperative navigation, were used to restore the anatomical continuity and configuration of the mandible using a vascularized iliac-crest flap. 2 transverse and 1 anterior-posterior (A-P) dimensions were evaluated based on the virtual plan and postoperative CT. The lines from the condylar head to condylar head and from the gonial angle to gonial angle were defined as the transverse dimensions. Measuring a perpendicular line drawn from the mandibular midline to the center point on the condylar head to condylar head measurement was defined as the A-P dimension. Complications were also evaluated during follow-up.ResultsFlap success rate of the patients was 92.9% (13/14), with one flap failure. Post-operation, there were no other serious complications in 13/14 patients who exhibited a good mandibular configuration with good occlusion. Furthermore, the height of bone graft was sufficient for implants. Healing of both the recipient and donor sites with no serious complication was uneventful. The average surgical error in the A-P dimension and transverse dimensions was 1.8±1.0 mm (Range: 0.2 - 3.7 mm), 2.2±1.1 mm (Range: 0.9 – 5.0 mm) and 2.6±1.6 mm (Range: 0.3 – 7.2 mm), respectively.ConclusionsThe use of these digital techniques was found to be a viable option for reconstruction of mandibular defects, but should be interpreted cautiously due to the small number of patients and the relatively short follow-up.



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