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RESULTS OF MANDIBULAR RECONSTRUCTION BY FIBULA FLAP USING SURGICAL CUTTING GUIDES
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Abstract
Backgrounds: We evaluated the results of computer-assisted mandibular reconstruction using open-source software in Vietnam. Patients and methods: This study was conducted on 28 patients who had primary mandibular reconstruction with a microvascular free fibula flap, July 2021 to October 2022. The age of patients ranged from 14 to 63 years old. Virtual surgical planning was perfomed with three open-source softwares (ITK-SNAP, Meshlab, and Blender). The computed tomography scans of preoperative virtual surgical planning and two-week postoperative mandible were used for assessment of accuracy of this procedure. Measurements were used included intercondylar distance, intergonial angle distance, intercoronoid distance, fibula segment length, and gonial angle. Results: The mean of each measurement was similar in both preoperative and postoperative stages: intercondylar distances, 102.79 ± 7.53 mm vs. 102.61 ± 7.39 (p = 0.913); intergonial angle distances, 92.59 ± 6.06 mm vs. 93.83 ± 6.99 (p = 0.064); intercoronoid distances, 98.29 ± 7.03 mm vs. 97.56 ± 5.77 (p = 0.356); fibula segment lengths, 40.19 ± 10.18 mm vs. 39.87 ± 9.80 (p = 0.274); and gonial angles, 121.83 ± 4.08° vs. 122.94 ± 6.98° (p = 0.380). The mean number of osteotomies was 1.39 ± 0.79, and the mean fibula segment lengths was 39.87 ± 9.80 mm (n = 69). The mean follow-up time was 9.86 ± 5.96 months (range, 3 to 22 months). The postoperative occlusion and aesthetics in all patients were satisfied. There was nearly no complication, except for a case had local inflammation due to a lossen screw. Conclusion: Open-source software for CAD/CAM-assisted mandibular reconstructions is a safe and useful technique, with post-operative results were comparable to other commercial softwares. The planning time and printing cost are also reasonable for both surgeons and patients.
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Keywords
mandibular reconstruction, free fibula flap, open-source software, computer-assisted design, virtual surgical planning
References
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