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. 2015 Jun;35(3):198-201.

Mandibular reconstruction using fibula free flap harvested using a customised cutting guide: how we do it

A Tarsitano  1 , L Ciocca  2 , R Cipriani  3 , R Scotti  2 , C Marchetti  1
Affiliations

Mandibular reconstruction using fibula free flap harvested using a customised cutting guide: how we do it

A Tarsitano et al. Acta Otorhinolaryngol Ital. 2015 Jun.

Abstract
in English, Italian

Free fibula flap is routinely used for mandibular reconstructions. For contouring the flap, multiple osteotomies should be shaped to reproduce the native mandibular contour. The bone segments should be fixed using a reconstructive plate. This plate is usually manually bent by the surgeon during surgery. This method is efficient, but during reconstruction it is complicated to reproduce the complex 3D conformation of the mandible and recreate a normal morphology with a mandibular profile as similar as possible to the original; any aberration in its structural alignment may lead to aesthetic and function alterations due to malocclusion or temporomandibular disorders. In order to achieve better morphological and functional outcomes, we have performed a customised flap harvest using cutting guides. This study demonstrates how we have performed customised mandibular reconstruction using CAD-CAM fibular cutting guides in 20 patients undergoing oncological segmental resection.

Il lembo libero di fibula è routinariamente utilizzato per le ricostruzioni mandibolari. Al fine di ottenere una modellazione del lembo che consenta di ricostruire l'arco mandibolare, sono necessarie multiple osteotomie della fibula. Queste vengono, di norma, eseguite manualmente dal chirurgo; così come la modellazione della placca ricostruttiva che avrà il ruolo di solidarizzare i vari segmenti ossei di fibula. Questo metodo è consolidato, ma ha il difetto di essere incostante in termini di risultati estetici e molto operatore-dipendente. Si ricordi come alterazioni a livello del profilo mandibolare ricostruito costituiscono non solo un difetto estetico, ma possano inficiare anche la funzione articolare e masticatoria. Per queste ragioni vogliamo presentare il nostro workflow CAD-CAM utilizzato in 20 casi di ricostruzioni mandibolari customizzate, in cui il progetto chirurgico virtuale è stato trasferito in sala operatoria mediante l'utilizzo di guide di taglio ossee per la mandibola e la fibula.

Keywords: CAD-CAM technique; Cutting guide; Fibula free flap; Mandibular reconstruction.

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Figures

Fig. 1.
Fig. 1.
3D virtual models of the mandibular tumour (on the left); virtual simulation of surgical defect and reconstruction planned using three fibular bone segments (on the right).
Fig. 2.
Fig. 2.
Mandibular (left) and fibular (right) cutting guides used to perform osteotomies, exactly as pre-operatively planned.
Fig. 3.
Fig. 3.
Fibular segments insetting after cutting guide removal.
Fig. 4.
Fig. 4.
Bone flap osteotomies performed using piezoelectric saw (Mectron s.p.a.).
Fig. 5.
Fig. 5.
Post-operative morphological appearance in a patient who underwent subtotal mandibulectomy and reconstruction using CAD-CAM technique.
See this image and copyright information in PMC

References

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