Fibular vascularized osteocutaneous free flap is the gold standard for mandibular reconstruction. The traditional method is very difficult and challenging work. This technique has so far been performed solely depending on the experience of the surgeons. Recently, several software programs that can make accurate preoperative surgical plans in a three dimensional (3D)-virtual system have been developed and used to solve this problem. The aim of this study is to describe our experience and to share several tips and pitfalls of mandibular reconstruction with virtual surgical planning (VSP).

Using fibula flap for mandible reconstruction becomes a common method. Pre-surgical planning always assumes a known removal portion of mandible to plan the cutting of fibula. Researchers have developed jig or mechanism to assist doctors in measuring and guiding cutting locations of the mandible. However, the true locations of mandible removal are never known. To ease the problem, standard mandible parameters is required to locate the removal area. This paper aims to construct a reference line for parameterizing the mandible. The reference line can be divided into four portions that are coincident with the anatomical features areas of the mandible: Symphysis, Body, Angle, and Ramus. Each portion is then re-sampled into 10-15 sections, and these sections faithfully represent the mandible shape. Thus, all mandibles are redefined by these 101 sections. Using these mandible parameters, the removal area is recorded by numerical addressable locations to compute the fibula cut, and the mandible and fibula can be aligned according to the parameters for planning the reconstruction.