Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap: A Systematic Review and Meta-Analysis

Abstract

Background: Computer-assisted mandibular reconstruction facilitates preoperative surgery simulation and transfers the virtual plan to a real operation. This systematic review and meta-analysis aimed to compare the accuracy, efficiency, postoperative complications, and economic viability between computer-assisted mandibular reconstruction and conventional freehand mandibular reconstruction. Methods: The PubMed, Embase, Cochrane Library, and Google Scholar databases were searched up to November of 2018. The accuracy, efficiency, postoperative complications, and economic viability of computer-assisted mandibular reconstruction compared to conventional freehand mandibular reconstruction were systematically reviewed. Continuous and dichotomous data were pooled in mean difference (or standardized mean difference if necessary) and odds ratio, subsequently, with 95 percent confidence interval. Results: A total of 12 studies were included in the systematic review, and data extracted from 11 of them were combined in meta-analysis. The accuracy of computer-assisted mandibular reconstruction was better than or equal to that of conventional freehand mandibular reconstruction according to qualitative analysis, although the quantitative comparison from meta-analysis was excluded because of the diversity of measurements. As for efficiency, computer-assisted mandibular reconstruction, when compared to conventional freehand mandibular reconstruction, revealed a shorter ischemic time, reconstructive time, total operative time, and length of stay. There was no difference in postoperative complication rate. Conclusions: Computer-assisted mandibular reconstruction showed increased efficiency considering the reduced ischemic time, total operative time, reconstructive time, and length of stay. However, the accuracy, reconstruction outcomes, and perioperative cost should be further elucidated because of diverse measurements and the lack of included studies.

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“…The fossa-condyle is important for the attachment of muscles and ligaments of the temporomandibular joint (TMJ) 3 . An abnormal TMJ can lead to aberrant occlusion, difficulty chewing, asymmetric facial contours, and even pain 6,7 . However, due to limited research in this field, little is known about the spatial deviations of the TMJ after mandibular reconstruction 1,3,5,8 .…”

“Three‐in‐one” patient‐specific surgical guides for simultaneous dental implants in fibula flap jaw reconstruction: A prospective case series

“…It has been possible to plan the inset of a free fibula flap in the maxillomandibular complex using digitally planned and printed cutting guides based on the patient's computed tomography (CT) data. Our meta‐analysis revealed the computer‐aided mandibular reconstruction has a higher accuracy and surgical efficiency comparing to conventional freehand mandibular reconstruction, with no difference in postoperative complication rate 7 . Furthermore, the computer‐aided surgery facilitates the placement of dental implants at the optimal position and the modification of the bony reconstruction according to the implant position.…”