Study of mandible reconstruction using a fibula flap with application of additive manufacturing technology

Abstract

BackgroundThis study aimed to establish surgical guiding techniques for completing mandible lesion resection and reconstruction of the mandible defect area with fibula sections in one surgery by applying additive manufacturing technology, which can reduce the surgical duration and enhance the surgical accuracy and success rate.MethodsA computer assisted mandible reconstruction planning (CAMRP) program was used to calculate the optimal cutting length and number of fibula pieces and design the fixtures for mandible cutting, registration, and arrangement of the fibula segments. The mandible cutting and registering fixtures were then generated using an additive manufacturing system. The CAMRP calculated the optimal fibula cutting length and number of segments based on the location and length of the defective portion of the mandible. The mandible cutting jig was generated according to the boundary surface of the lesion resection on the mandible STL model. The fibular cutting fixture was based on the length of each segment, and the registered fixture was used to quickly arrange the fibula pieces into the shape of the defect area. In this study, the mandibular lesion was reconstructed using registered fibular sections in one step, and the method is very easy to perform.Results and conclusionThe application of additive manufacturing technology provided customized models and the cutting fixtures and registered fixtures, which can improve the efficiency of clinical application. This study showed that the cutting fixture helped to rapidly complete lesion resection and fibula cutting, and the registered fixture enabled arrangement of the fibula pieces and allowed completion of the mandible reconstruction in a timely manner. Our method can overcome the disadvantages of traditional surgery, which requires a long and different course of treatment and is liable to cause error. With the help of optimal cutting planning by the CAMRP and the 3D printed mandible resection jig and fibula cutting fixture, this all-in-one process of mandible reconstruction furnishes many benefits in this field by enhancing the accuracy of surgery, shortening the operation duration, reducing the surgical risk, and resulting in a better mandible appearance of the patients after surgery.

Reconstruction of a mandibular segmental defect with a customized 3-dimensional–printed titanium prosthesis in a cat with a mandibular osteosarcoma

“…7 Common techniques used in humans for reconstruction of segmental mandibular defects include vascularized free osteocutaneous grafts, [8][9][10] particularly fibular osteocutaneous grafts, and distraction osteogenesis. 11 The increase in the availability of CT planning has resulted in advances in the management of mandibular defects in humans, including creation of 3-D models of the affected mandible for surgical planning (such as prebending and improved fitting of titanium plates, optimization of bone-to-bone contact, and shorter duration of surgery), 9,[12][13][14][15][16][17][18][19] creation of prefabricated intraoperative guides (for optimization of the length and number of fibular grafts, improved fitting of titanium plates, and improved postoperative cosmetic appearance and function), 9,16,[19][20][21] and development of CAD-CAM customized and patientspecific 3-D-printed reconstruction plates 9,22 and prostheses. 23 Customized 3-D printing of mandibular prostheses provides several theoretical advantages over other techniques, such as the ability to design the prosthesis to match the geometry and weight of the original mandible to better withstand the bending, torsion, and shear forces associated with mastication as well as the incorporation of tissue engineering technology into the prosthesis to promote its osseous integration.…”

Regenerative Approach to Bilateral Rostral Mandibular Reconstruction in a Case Series of Dogs

“…Importantly, reconstruction of the rostral mandible can be challenging due to the complex anatomical geometry of this region. Particularly, the shape of the rostral mandibles in dogs resembles a sharp-angled arc, which is quite different from the geometric shape of the mandibular body and the rounded conformation in humans ( 11 ).…”

“…Mandibular reconstruction of critical-size defects requires rigid fixation, typically in the form of a plate and screws, and well-vascularized soft tissues. There are several strategies to fill the critical-size bone defects including autologous bone grafts, bone graft substitutes, and free-fibular flap tissue transfer ( 4 , 11 – 14 ). However, these methods are not ideal as they result in donor site morbidity, are limited by graft size (especially in small dogs), and are difficult to contour ( 12 , 15 , 16 ).…”

Reconstruction of the Three-Dimensional Mandibulofacial Defects Using a Single Cutaneous Perforator-Based Fibula Osteocutaneous Flap

“…Furthermore, single free flap with double skin paddle completely divided or de-epithelialized based on two different skin perforators was reported to reconstruct such composite defects [ 6 ]. A recent report showed a three-dimensional printing technique to obtain digital models and design the reconstructed mandible prior to the surgical procedure [ 7 ] and virtual surgical planning based on the CT and computer-aided design [ 8 ]. In the same vein, there have been numerous efforts to reduce the complications, including, among others, operative time and donor-site morbidity, especially with regard to insetting of the flap.…”