Experience with the use of prebent plates for the reconstruction of mandibular defects

Abstract

Bending of large titanium plates for mandibular reconstruction is a tedious task. This is usually done by trial and error over an intraoperatively bent template. By means of rapid prototype technology, accurate three-dimensional models can be obtained. Using these models, it is possible to design, obtain, and adapt custom hardware for individual surgical cases. Reductions of operating room time when using this technology have been reported from 17% to 60%, with an average of 20%. This translates to reduction of cost and risks, improving the overall surgical outcome. The purpose of this article is to establish the indications and contraindication for the use three-dimensional models and prebent plates. We present our experience with five cases in which prebent reconstruction plates were used for mandibular reconstruction. No significant complications occurred, and satisfactory results were achieved in all cases. We found that the models required to obtain the hardware are extremely accurate, have multiple reported applications, and represent a valuable surgical tool in the planning and execution of reconstructive surgery.

Keywords: Prebent plates; custom hardware; mandible reconstruction; medical rapid prototyping; stereolithographic models.

Figure 1

Panoramic radiograph showing large expansile multilocular radiolucent lesion. Case 3.

Figure 2

Reconstruction plate in place after resection. Case 3.

Figure 3

Postoperative panoramic radiograph. Reconstruction plate with free microvascular fibula graft in place, secured to the plate. Case 3.

Figure 4

Preoperative panoramic radiograph showing unilocular radiolucent lesion at the left mandible. Significant tooth displacement is noted. Case 4.

Figure 5

Anatomic three-dimensional model of the mandible. Noted lateral expansion and displaced second molar. Case 4.

Figure 6

The altered model and specimen to facilitate adaptation of the plate prior to resection. This step will ensure correct contour and position of the segments after resection. Case 4.

Figure 7

Custom prebent plate in position after resection. Case 4.

Figure 8

Preoperative panoramic radiograph showing multilocular radiolucent lesion at the left mandible. Case 5.

Figure 9

Three-dimensional model showing the lesion at the left mandible and planned posterior resection margin. Case 5.

Figure 10

Placement of the prebent reconstruction plate prior to performing the osteotomies to record the preresection position of the proximal and distal segments. Case 5.

Figure 11

Postoperative panoramic radiograph showing the 14-cm mandibular defect with reconstruction plate in place. Case 5.