title: CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery.
abstract: A surgical guide is projected to aid the repositioning of the mandibular segments in their original locations, and a reconstruction bone plate is provided to support the fibula free flap. Computer-aided mandibular reconstruction involves three steps: virtual surgical planning, CAD/CAM and rapid-prototyping procedures for the design and manufacture of the customised surgical device and surgery. The duration of the reconstructive phase (<1.5 h intraoperative time) was reduced in comparison with traditional secondary mandibular reconstruction. The bone plate permitted the maximal restoration of the original facial and mandibular contours and the more precise positioning of the residual mandibular ramus in comparison with conventional procedures. No complication was noted during the mean follow-up period of 12 months. The protocol presented in this paper offers some benefits: 1) The virtual environment permitted ideal preoperative planning of mandibular segment repositioning in secondary reconstruction; 2) Intraoperative time was not consumed by approximate and repeated bone plate modelling; 3) Using CT data obtained before primary surgery, the reconstruction bone plate was designed using the original external cortical bone as a template to reproduce the ideal mandibular contour; 4) Prototyped resin models of the bone defect allowed the surgeon to train preoperatively by simulating the surgery.
authors.affiliation: Department of Oral Science, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy. leonardo.ciocca@unibo.it
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ciocca
authors.forename: Simona
authors.initials: S
authors.lastname: Mazzoni
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fantini
authors.forename: Franco
authors.initials: F
authors.lastname: Persiani
authors.forename: Claudio
authors.initials: C
authors.lastname: Marchetti
authors.forename: Roberto
authors.initials: R
authors.lastname: Scotti
mesh_terms: D001860:Bone Plates; D003198:Computer Simulation; D017076:Computer-Aided Design; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007430:Intraoperative Care; D008297:Male; D008334:Mandible / Q000601:surgery; D008339:Mandibular Neoplasms / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000295:instrumentation*; D008875:Middle Aged; D008953:Models, Anatomic; D061330:Multidetector Computed Tomography / Q000379:methods; D061646:Operative Time; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012984:Software; D013524:Surgical Flaps / Q000637:transplantation*; D014584:User-Computer Interface