title: Mandibular reconstruction using computer-aided design and computer-aided manufacturing: an analysis of surgical results.
abstract: OBJECTIVE
  The purpose of this study was to analyze the accuracy of virtual surgical planning in mandibular reconstruction.
  
  
  METHODS
  This is a retrospective study involving 8 consecutive patients reconstructed with nonvascularized iliac crest bone grafts and free fibula osteomyocutaneous flaps. DICOM data from a maxillofacial skeleton computed tomography (CT) scan were sent to a medical modeling company and used to map the mandibular resection, anatomically place the mandibular reconstruction plate, and create surgical guides. After surgery a postoperative CT compared the virtual plan to the surgical result. Linear measurements [2 transverse and 1 anterior-posterior (A-P)] were performed to determine if the virtual surgical result was achieved. The transverse measurements were made from the condylar head to condylar head and from the gonial angle to gonial angle. The A-P analysis was made by measuring a perpendicular line drawn from the anterior inferior mandibular border to the center point on the condylar head to condylar head measurement.
  
  
  RESULTS
  The average surgical error in the A-P dimension for the iliac crest bone grafts and free fibula flap was 0.2 mm (range 0.0 mm to 0.7 mm) and 0.9 mm (range 0.2 mm to 1.9 mm), respectively. In the transverse dimension the average surgical error was 1.6 mm (range 0.7 mm to 2.4 mm) and 2.7 mm (range 1.9 mm to 4.5 mm) from condyle to condyle, and 1.7 mm (range 0.7 mm to 2.7 mm) and 2.5 mm (range 0.4 to 4.8 mm) from gonial angle to gonial angle.
  
  
  CONCLUSIONS
  The use of CAD-CAM (Medical Modeling, Golden, Colorado) technology for the fabrication of surgical resection guides and mandibular reconstruction plates resulted in an accurate surgical result.
authors.affiliation: Oral and Maxillofacial Surgery, Vanderbilt University, Nashville, TN 37209, USA. benjamin.d.foley@vanderbilt.edu
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Foley
authors.forename: Wesly P
authors.initials: WP
authors.lastname: Thayer
authors.forename: Adam
authors.initials: A
authors.lastname: Honeybrook
authors.forename: Samuel
authors.initials: S
authors.lastname: McKenna
authors.forename: Steven
authors.initials: S
authors.lastname: Press
mesh_terms: D000328:Adult; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods; D002508:Cephalometry / Q000379:methods; D017076:Computer-Aided Design; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008334:Mandible / Q000473:pathology; D008335:Mandibular Condyle / Q000473:pathology; D008337:Mandibular Fractures / Q000601:surgery; D063175:Mandibular Reconstruction / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014584:User-Computer Interface; D014948:Wounds, Gunshot / Q000601:surgery; D055815:Young Adult