Abstract
The fibula free flap represents the gold standard for mandibular reconstruction. However,
when harvested as a single barrel, this flap does not allow the native mandibular
height to be restored, which is required for implant-supported dental rehabilitation
of the patient. The aim of this study was to present a new design for a patient-specific
three-dimensionally printed reconstructive plate (3DBO-PSI) that positions the fibula
bone at the height of the resected mandibular alveolar bone while restoring the mandibular
profile to ensure a correct morphological outcome. Twenty patients were enrolled prospectively
between January 2019 and May 2022. All patients underwent a segmental mandibular resection
and prosthetically guided reconstruction making use of a fibula free flap supported
by the 3DBO-PSI. The mean follow-up period was 20 months. All microvascular and implant-related
complications were recorded. Microvascular failure occurred in two patients. No PSI-related
complications were recorded during the postoperative follow-up. The proposed reconstructive
method was found to be reliable and reproducible. In all treated patients, the bony
flap appeared to be adequately positioned to maintain the preoperative intermaxillary
relationship, as planned. To date, dental rehabilitation has been completed in seven
patients.
Keywords
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References
- Fibula free flap: a new method of mandible reconstruction.Plast Reconstr Surg. 1989; 84: 71-79https://doi.org/10.1097/00006534-198907000-00014
- Reconstruction of mandibular defects.Semin Plast Surg. 2010; 24: 188-197https://doi.org/10.1055/s-0030-1255336
- Reconstruction of the segmental mandibular defect: current state of the art.Curr Opin Otolaryngol Head Neck Surg. 2012; 20: 231-236https://doi.org/10.1097/MOO.0b013e328355d0f3
- Mandibular reconstruction using fibula free flap harvested using a customised cutting guide: how we do it.Acta Otorhinolaryngol Ital. 2015; 35: 198-201
- Double-barrel fibula flap versus vascularized iliac crest flap for mandibular reconstruction.J Oral Maxillofac Surg. 2020; 78: 844-850https://doi.org/10.1016/j.joms.2020.01.003
- Morphological results of customized microvascular mandibular reconstruction: a comparative study.J Craniomaxillofac Surg. 2016; 44: 697-702https://doi.org/10.1016/j.jcms.2016.03.007
- Masticatory rehabilitation following upper and lower jaw reconstruction using vascularised free fibula flap and enossal implants—19 years of experience with a comprehensive concept.Clin Oral Investig. 2015; 19: 525-534https://doi.org/10.1007/s00784-014-1247-9
- Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions.Oral Oncol. 2011; 47: 1099-1104https://doi.org/10.1016/j.oraloncology.2011.07.016
- Mandibular reconstruction using the double barrel fibular graft.Microsurgery. 1995; 16: 450-454https://doi.org/10.1002/micr.1920160704
- Double-barrel fibula vascularized free flap with dental rehabilitation for mandibular reconstruction.J Oral Maxillofac Surg. 2011; 69: 2663-2669https://doi.org/10.1016/j.joms.2011.02.051
- Mechanical properties of three-dimensionally printed titanium plates used in jaw reconstruction: preliminary study.Int J Oral Maxillofac Surg. 2022; 51: 754-761https://doi.org/10.1016/j.ijom.2021.09.008
- Dynamic navigation in dental implantology: the influence of surgical experience on implant placement accuracy and operating time. An in vitro study.Int J Environ Res Public Health. 2020; 172153https://doi.org/10.3390/ijerph17062153
- PD074: dynamic navigation: a prospective clinical trial to evaluate the accuracy of implant placement.J Clin Periodontol. 2018; 4567https://doi.org/10.1111/jcpe.75_12914
- Complications in a consecutive series of 250 free flap operations.Ann Plast Surg. 2006; 56: 557-561https://doi.org/10.1097/01.sap.0000205830.39108.9a
- Accuracy of CAD/CAM mandibular reconstruction: a three-dimensional, fully virtual outcome evaluation method.J Craniomaxillofac Surg. 2018; 46: 1121-1125https://doi.org/10.1016/j.jcms.2018.05.010
- Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps.Int J Oral Maxillofac Surg. 2020; 49: 1153-1161https://doi.org/10.1016/j.ijom.2020.02.018
- Multicenter study on the use of patient-specific CAD/CAM reconstruction plates for mandibular reconstruction.Int J Comput Assist Radiol Surg. 2015; 10: 2035-2051https://doi.org/10.1007/s11548-015-1193-2
- Concomitant reconstruction of mandibular basal and alveolar bone with a free fibular flap.Int J Oral Maxillofac Surg. 2004; 33: 150-156https://doi.org/10.1054/ijom.2003.0487
- Double-barrel vascularised fibula graft in mandibular reconstruction: a 10-year experience with an algorithm.J Plast Reconstr Aesthet Surg. 2013; 66: 364-371https://doi.org/10.1016/j.bjps.2012.10.005
- Alveolar distraction osteogenesis for dental implant rehabilitation following fibular reconstruction: a case series.J Oral Maxillofac Surg. 2013; 71: 255-271https://doi.org/10.1016/j.joms.2012.09.028
- Virtual surgical planning, stereolitographic models and CAD/CAM titanium mesh for three-dimensional reconstruction of fibula flap with iliac crest graft and dental implants.J Clin Med. 2021; 101922https://doi.org/10.3390/jcm10091922
- Vascularized combined with nonvascularized fibula flap for mandibular reconstruction: preliminary results of a novel technique.J Craniofac Surg. 2019; 30: E365-E369https://doi.org/10.1097/SCS.0000000000005379
- Problems with dental implants that were placed on vertically distracted fibular free flaps after resection: a report of six cases.Br J Oral Maxillofac Surg. 2009; 47: 455-460https://doi.org/10.1016/j.bjoms.2009.06.002
- Mandibular reconstruction using a new design for a patient-specific plate to support a fibular free flap and avoid double-barrel technique.Acta Otorhinolaryngol Ital. 2021; 41: 230-235https://doi.org/10.14639/0392-100X-N0549
- New reconstructive technologies in skull base surgery: role of titanium mesh and porous polyethylene.Arch Otolaryngol Head Neck Surg. 2000; 126: 396-401
Article info
Publication history
Published online: August 26, 2022
Accepted:
August 9,
2022
Identification
Copyright
© 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
