Evaluation of the Accuracy of 3D Virtual Surgical Planning for Reconstruction of Mandibular Defects using Free Fibular Flap

Abstract

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. With the introduction of microvascular reconstructive surgery, free fibula flap become the gold standard for reconstruction of mandiblar defects. 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. 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 ensuring high reproducibility and precision.

Material and Methods: Ten patients were included in the study for delayed mandibular reconstruction using free fibular flap. For all the patients preoperative CT scan for the skull and lower limbs were obtained and integrated into the software for virtual planning and guides fabrications. All the cases were operated for reconstruction of the mandible by free fibula flap and then postoperative CT was obtained and rendered 3D model to be superimposed on the preoperative record for assessment of the virtual planning accuracy by different linear and angular measurments.

Results: No statistically significant difference was found between (Virtual) group and (Post) group where (p=0.067) regarding average of linear measurements of all patients. A statistically significant difference was found between (Virtual) group and (Post) group in measurements from axial plane where (p=0.004). No statistically significant difference was found between (Virtual) group and (Post) group where (p=0.723) regarding angles between fibular segments.