Aesthetic Reconstruction of Onco-surgical Mandibular Defects Using Free Fibular Flap with and without CAD/CAM Customized Osteotomy Guide: A Randomized Controlled Clinical Trial

Abstract

Background Reconstruction of mandibular defects following ablative surgery remains a challenge even for experienced surgeons. Virtual planning and guided surgery, including computer-aided design/computer-aided manufacturing (CAD/CAM), afford optimized ways by which to plan complex surgery. This study aimed to evaluate and compare aesthetic outcome and surgical efficiency of free fibular flap (FFF) with and without CAD/CAM customized osteotomy guide (COG) for reconstruction of onco-surgical mandibular defects. Methods Twenty-two patients indicated for segmental mandibulectomy were randomly assigned to either CAD/CAM with COG group or that without COG- Model based reconstruction (MB group) at a 1:1 ratio. Aesthetic outcomes were evaluated by means of morphometric assessment and comparison for each differential area (DAr) and angle (DAn) in the affected side to the contralateral side of the mandible using computerized digital imaging analysis (CDIA) based on the post-operative 3D CT-scan. Subjective evaluation was performed using the Visual Analogue Scale (VAS) and Patient’s Satisfaction Score (PSS). Surgical efficiency was a secondary outcome and evaluated as total operative time and ischemia time. Results The mean sagittal DAr was significantly lower in the COG group (277.28 ± 127.05 vs. 398.67 ± 139.10 mm2, P = 0.045). Although there was an improvement in the axial DAr (147.61 ± 55.42 vs. 183.68 ± 72.85 mm2), the difference was not statistically significant (P = 0.206). The mean differences (Δ) in both sagittal and coronal DAn were significantly lower in the COG group than in the MB group (6.11 ± 3.46 and 1.77 ± 1.12° vs. 9.53 ± 4.17 and 3.44 ± 2.34°), respectively. There were no statistically significant differences in the axial DAn between the two groups (P = 0.386). The PSS was significantly higher in the COG group, reflecting better aesthetic satisfaction than in the MB group (P = 0.041). The total operation and ischemia time were significantly shorter in favor of the COG group with a mean of (562.91 ± 51.22, 97.55 ± 16.80 min vs. 663.55 ± 53.43, 172.45 ± 21.87 min), respectively. Conclusion The CAD/CAM with COG is more reliable and highly valuable in enhancing aesthetic outcomes and surgical efficiency of mandibular reconstruction by FFF compared to that without COG (MB reconstruction). Trial registration This trial was registered at ClinicalTrials.gov. Registration number: NCT03757273. Registration date: 28/11/2018.

Application of 3D printed titanium mesh and digital guide plate in the repair of mandibular defects using double-layer folded fibula combined with simultaneous implantation

“…Mandibular reconstruction and dental restoration are complex tasks that are influenced by multiple factors and involve technologies from different fields. Currently, there are still some inevitable limitations in digital design and 3D printing technology ( Al-Sabahi et al, 2022 ). The design and 3D printing of preoperative guides consume a lot of time, which may delay the treatment opportunity.…”

“…Digital design is applied before surgery to print digital surgical guides, thus determining the range of osteotomy, surgical boundaries, and developing mandibular reconstruction schemes and methods. The surgical osteotomy guides are printed, which can significantly shorten the operation time, reduce surgical errors ( Al-Sabahi et al, 2022 ), and accurately determine the range of osteotomy and implant implantation.…”

Use of Plant Extracts in Polymeric Scaffolds in the Regeneration of Mandibular Injuries

“…The scaffolds were placed in a chamber in the presence of NaOH(s) for 24 h. The dried scaffolds were weighted, placed in PBS buffer, and reweighted at specific times after being gently dried on filter paper. The percentage of buffer absorbed was calculated using Equation (2).…”

“…Reconstruction of the mandible is still a challenge for reconstructive surgery due to the complexity of the surgical procedure, which can range from simple rigid internal fixation to microvascular transfer of free tissue [ 1 , 2 ]. The surgical approach depends on the factors related to the mandibular lesion, such as trauma, infection, osteoradionecrosis, tumor removal, or ablative surgery of the oral cavity and lower face [ 3 ].…”

Innovative Strategies in Microvascular Head and Neck Reconstruction

“…In combination with soft tissue reconstruction, the reconstruction of bony defects has also witnessed tremendous advances, both in terms of technological advancements as well as the incorporation of different donor sites [ 14 ]. The use of virtual surgical planning (VSP) and medical modeling has rapidly grown in popularity and is becoming the gold standard in mandible and midface reconstruction at many institutions [ 15 , 16 , 17 , 18 ]. In addition, facial paralysis is a challenging problem that continues to require new strategies for improving outcomes, particularly in the oncologic setting.…”