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. 2021 Jun;41(3):230-235.
doi: 10.14639/0392-100X-N0549.

Mandibular reconstruction using a new design for a patient-specific plate to support a fibular free flap and avoid double-barrel technique

Achille Tarsitano  1 , Salvatore Battaglia  1 , Giuseppe Corinaldesi  2 , Claudio Marchetti  1 , Gerardo Pellegrino  2 , Leonardo Ciocca  2
Affiliations

Mandibular reconstruction using a new design for a patient-specific plate to support a fibular free flap and avoid double-barrel technique

Achille Tarsitano et al. Acta Otorhinolaryngol Ital. 2021 Jun.

Abstract

Ricostruzione mandibolare con lembo di fibula supportato da nuova tipologia di placca personalizzata al fine di evitare la tecnica della doppia barra.

La ricostruzione mandibolare è particolarmente rilevante per il chirurgo cervico-cefalico, in quanto influenza significativamente i successi in termini di risultati estetici e funzionali per il paziente. Il gold standard per tale ricostruzione è l’utilizzo di lembi ossei rivascolarizzati, stabilizzati mediante una placca ricostruttiva in titanio. Il lembo di fibula rappresenta la prima scelta ricostruttiva laddove necessitino molteplici segmenti ossei. Tuttavia questo lembo, allestito secondo la tecnica della singola barra, non permette di ripristinare l’altezza mandibolare nativa, adeguata per una corretta riabilitazione masticatoria implanto-supportata. Lo scopo di questo studio è quindi presentare un nuovo design di placca ricostruttiva custom-made, atta a posizionare il segmento osseo di fibula in una posizione più coronale, evitando pertanto la necessità di allestire il lembo secondo la tecnica della doppia barra. La placca custom-made contribuisce inoltre al mantenimento del profilo mandibolare, garantendo il ripristino morfologico della ricostruzione. Questo protocollo è stato eseguito su quattro pazienti sottoposti a resezione mandibolare per tumori benigni. I risultati clinici e di accuratezza della procedura sono presentati. Il protocollo presentato sembra una valida alternativa alla tecnica della doppia barra al fine di ripristinare l’altezza mandibolare nativa.

Keywords: customised plate; double-barrel technique; fibula free flap; head and neck surgery; mandibular reconstruction.

Plain language summary

Mandibular reconstruction is a primary concern for head and neck reconstructive surgeons because of the aesthetic restoration needs after ablative surgery, as well as for functional reasons: the mandible has a central functional role in speaking, swallowing and mastication. It is generally agreed that the gold standard for mandibular reconstruction is a bone free flap supported by a reconstructive titanium plate. The fibular flap represents the first choice for multi-segment mandibular reconstruction. The fibula, harvested as a single barrel graft, does not exhibit sufficient thickness to reach the original height of the native mandible; therefore, the positioning of dental implants is often deeper than that of the native alveolar crest. The aim of this study was to evaluate the positioning of the fibular free flap as it pertains to the restoration of vertical mandible height, by modifying the design of a 3D-printed titanium patient-specific implant (PSI). In this novel reconstructive workflow, the customised plate was projected to support the fibular flap at an alveolar bone position above the typical inferior mandibular border, and carried out on four patients. All patients were treated for benign neoplasms involving mandibular bone. Clinical outcomes and accuracy of the procedure are described. Our reconstructive proposal appears to be a valid alternative to the double-barrel technique in order to restore the vertical height of the reconstructed mandible.

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Conflict of interest statement

Conflict of interest

The Authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Tumour resection planning.
Figure 2.
Figure 2.
Positioning of the fibula as related to occlusion, implants and alveolar bone height from lateral (A, B) and occlusal views (C).
Figure 3.
Figure 3.
Virtual design of the containing deck for sustaining the fibular bone segments (red arrow).
Figure 4.
Figure 4.
Mandibular reconstructive plate design according to the native mandibular anatomy.
Figure 5.
Figure 5.
Accuracy assessed by colour map obtained from superimposition between pre-operative planning and post-operative CT-scan.
See this image and copyright information in PMC

References

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