Functional Reconstruction of Mandibular Segment Defects with Individual Preformed Reconstruction Plate and CTA-aided Iliac Crest Flap

Publication date: Available online 18 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Maorui Zhang, Pengcheng Rao, Delin Xia, Libo Sun, Xiaoxiao Cai, Jingang Xiao

Abstract

Purpose

With the development of imaging technology and computer-assisted surgery in oral and maxillofacial surgery, digital technology is widely used in vascularized bone flap grafts for mandible reconstruction. The aim of our study is to use digital technology throughout the treatment process to demonstrate that digital techniques can provide a reliable and accurate match between the mandible and the iliac crest flap to achieve functional reconstruction of mandibular segment defects.

Patients and Methods

Twenty patients underwent three-dimension computed tomography (3D CT), mirroring technology, 3D model prototyping and computed tomography angiography (CTA) for treatment planning. Individual preformed reconstruction plates were fabricated and iliac crest flaps were designed preoperatively. After complete resection of the mandibular lesion, the iliac crest flap was shaped to reconstruct the mandibular defects.

Results

During follow-up (range 12 to 36 months), the facial shape, facial symmetry, mouth opening of all patients were well recovered. 3D-CT reconstruction was also taken to evaluate the height, width, length, and bone healing of the iliac crest flap. Postoperative examination revealed ideal bone union between the iliac crest flap and the mandible at 6 months. Nine patients received implant-supported fixed dentures to restore the dentition. After follow-up, all patients were satisfied with their facial esthetics and function. The neo-mandible provides a suitable three-dimensional position for implant-supported fixed partial dentures.

Conclusion

Use of digital techniques throughout the whole course of treatment improves the predictability and convenience of functional mandibular reconstruction. Individual preformed reconstruction plates and CTA effectively guaranteed the accuracy of iliac flap preparation.

http://bit.ly/2MgbFZc