Three-Dimensional Accuracy of Virtual Planning and Surgical Navigation for Mandibular Reconstruction With Free Fibula Flap

Abstract

Purpose: Although free fibula flaps are widely used for mandibular reconstruction, their 3-dimensional position is difficult to control during conventional surgery. We aimed to improve this process by using computer-aided design (CAD) and surgical navigation.

Patients and methods: We retrospectively reviewed 29 benign tumor patients who underwent primary unilateral mandibular reconstruction with free fibula flap. They were divided into 3 groups: group A, comprising 10 patients, underwent reconstruction based on the surgeon's experience; group B, comprising 7 patients, underwent reconstruction based on CAD; and group C, comprising 12 patients, underwent reconstruction based on CAD and surgical navigation. Condyle and gonion positions and mandibular angles were measured. Operative times were recorded.

Results: Among the 17 patients who underwent condylar resection, the average condyle shift was greater in group A than in groups B and C (P < .05). The average gonion shift was greater in groups A and B than in group C (P < .05). The difference between the reconstructed and contralateral mandibular angles was greater in group A than in groups B and C (P < .05). The mean operative time did not differ among the 3 groups.

Conclusions: CAD can guide mandibular angle remodeling and condyle placement. CAD and surgical navigation increase reconstruction accuracy without prolonging operative time.