Fibula Graft Cutting Devices: Are 3D-Printed Cutting Guides More Precise than a Universal, Reusable Osteotomy Jig?

Abstract

Individual cutting guides for the reconstruction of lower jaw defects with fibular grafts are often used. However, the application of these osteotomy tools is costly and time intensive. The aim of this study was to compare the precision of osteotomies using a 3D-printed guide with those using a universal, reusable, and more cost-efficient Multi-Use Cutting Jig (MUC-Jig). In this non-blinded experimental study, 10 cranio-maxillofacial surgeons performed four graft removals each in a randomized order using the same osteotomy angle, both proximally (sagittal cut) and distally (coronal cut), of a graft (45°, 30°, 15°, or 0°), first with the MUC-Jig then with the 3D-printed cutting guide. The 40 fibula transplants (Tx) of each method (n = 80) were then analyzed concerning their Tx length and osteotomy angles and compared to the original planning data. Furthermore, the surgeons’ subjective perception and the duration of the two procedures were analyzed. The mean relative length and mean relative angle deviation between the MUC-Jig (−0.08 ± 1.12 mm; −0.69° ± 3.15°) and the template (0.22 ± 0.90 mm; 0.36° ± 2.56°) group differed significantly (p = 0.002; p = < 0.001), but the absolute deviations did not (p = 0.206; p = 0.980). Consequently, clinically comparable osteotomy results can be achieved with both methods, but from an economic point of view the MUC-Jig is a more cost-efficient solution.

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

“…In addition, the dependence on the industry reduces flexibility of planning timing and, depending on the complexity of the case, requires a lead time of at least seven to ten working days, during which one to three web meetings are held to discuss the planning and its implementation. In this context, two developments can be observed in the daily routine and more recent literature: first, the establishment of low-cost solutions for the in-house production of cutting guides using open-source software and in-house printers (11)(12)(13)(14) and, second, the use of partially adjustable resection aids such as the ReconGuide (KLS Martin Group; Gebrüder Martin GmbH & Co. KG; Tuttlingen, Germany) and the MUC-Jig (15,16).…”

Three-Dimensional Plotted Calcium Phosphate Scaffolds for Bone Defect Augmentation—A New Method for Regeneration

“…However, when virtually designing the scaffolds shape, a cutting guide in the shape of the bone lid can be manufactured using the same data set as it was conducted by Mangano et al [ 30 ]. The application of cutting guides in order to determine resection margins, and the size and shape of free fibular flaps are widely established [ 40 , 41 , 42 ]. Additionally, the use of cutting guides for the access bone lid when performing enucleation of large mandible cysts was demonstrated as helpful [ 43 ].…”

Mandibular reconstructions with free fibula flap using standardized partially adjustable cutting guides or CAD/CAM technique: a three- and two-dimensional comparison

“…First, the establishment of in-house virtual planning algorithms using open-source software and the production of cutting guides with in-house printers (4)(5)(6)(7)(8). Second, the development of partially adjustable resection/ reconstruction aids such as the ReconGuide and the MUC-Jig (9,10). ReconGuide is a special device that allows up to mandibular angle-to-angle reconstruction with up to three FFF segments by using a partially adjustable resection aid for the mandible and fibula to facilitate the fibula wedge osteotomies without the need of preoperative virtual planning.…”