A Revised Approach for Mandibular Reconstruction with the Vascularized Iliac Crest Flap by Virtual Surgical Planning

Mandibular reconstruction with fibula flap shows a 3D discrepancy between the fibula and the remnant mandible. Eight patients underwent three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), stereolitographic models (STL) and CAD/CAM titanium mesh. Vertical ridge augmentation and horizontal dimensions of the fibula, peri-implant bone resorption of the iliac crest graft, implant success rate and functional and aesthetic results were evaluated. Vertical reconstruction ranged from 13.4 mm to 10.1 mm, with an average of 12.22 mm. Iliac crest graft and titanium mesh were able to preserve the width of the fibula, which ranged from 8.9 mm to 11.7 mm, with an average of 10.1 mm. A total of 38 implants were placed in the new mandible, with an average of 4.75 ± 0.4 implants per patient and an osseointegration success rate of 94.7%. Two implants were lost during the osseointegration period (5.3%). Bone resorption was measured as peri-implant bone resorption at the mesial and distal level of each implant, with a variation between 0.5 mm and 2.4 mm, and with a mean of 1.43 mm. All patients were rehabilitated with a fixed implant prosthesis with good aesthetic and functional results.

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Occlusion Guided Double-Barreled Fibular Osteoseptocutaneous Free Flap for Refined Mandibular Reconstruction Aided by Virtual Surgical Planning

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000003841 ◽

2017 ◽

Vol 28 (6) ◽

pp. 1472-1476 ◽

Cited By ~ 4

Author(s):

Xingzhou Qu ◽

Mingyi Wang ◽

Liqun Xu ◽

Jiannan Liu ◽

Shizhu Bai ◽

...

Keyword(s):

Free Flap ◽

Surgical Planning ◽

Mandibular Reconstruction ◽

Virtual Surgical Planning

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Comparison of Complicated and Simple Guiding Templates in Mandibular Reconstruction Using Vascularized Iliac Crest Flap

BioMed Research International ◽

10.1155/2019/7496538 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Mei Zho ◽

Zhe Shao ◽

Yuxi Zhu ◽

Bing Liu ◽

Tianfu Wu

Keyword(s):

Iliac Crest ◽

Operation Time ◽

Mandibular Reconstruction ◽

Height Loss ◽

Virtual Surgery ◽

Intraoperative Procedures ◽

Iliac Crest Flap ◽

Mandibular Defect ◽

Reconstruction Strategy ◽

Graft Success

Objective. This study aims to compare the degree of accuracy achieved in mandibular reconstruction between complicated guiding templates (CGT) and simple guiding templates (SGT), to evaluate the necessity to spend more time to design complicated templates prior to surgery. Methods. The preoperative virtual surgery plan (VSP) was used to simulate the osteotomy and accurate mandibular reconstruction strategy. Then the guiding templates were designed and printed to transfer the VSP into the real operation. Between July 2013 and November 2014, we used the SGT in 13 L-type mandibular defect reconstructions utilising vascularized iliac crest bone (VICB). From March 2015 to March 2018, we used CGT in 14 L-type mandibular defects, also reconstructing with VICB. The indicators of mandibular symmetry, midline deviation, alveolar height loss, bone conjunction gap, and operation time were analyzed and compared between the two groups. Results. The overall bone graft success rate was 100% (27/27) between all patients. The SGT and CGT groups showed similar symmetry (1.01 ± 0.03 vs. 1.03 ± 0.04, P = 0.11) and mandibular midline displacement (1.0 ± 0.7 mm vs. 1.2 ± 0.8 mm, P=0.29). The CGT group showed less alveolar height deficiency than the SGT group (3.0 ± 2.4 mm vs. 7.8 ± 6.8 mm, P=0.01) and lesser bony conjunction gap between the graft and the mandible (1.6 ± 0.7 mm vs. 2.4 ± 1.2 mm, P = 0.02). The average operation time was significantly lower in the CGT group than in the SGT group (340.5 ± 74 min vs. 391.9 ± 41.7 min, P = 0.02). Conclusion. In the simple mandibular reconstruction, the time-consuming CGT did not significantly improve the symmetry and midline displacement compared to SGT, but it demonstrated less reduction (increased preservation) in alveolar height and decreased the size of the bone conjunction gap. And in addition, CGT also reduced the average operation time and simplified intraoperative procedures compared with SGT.

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