title: Prosthetically guided maxillofacial surgery: evaluation of the accuracy of a surgical guide and custom-made bone plate in oncology patients after mandibular reconstruction.
abstract: BACKGROUND
  The aim of the present study was to evaluate the accuracy of prosthetically guided maxillofacial surgery in reconstructing the mandible with a free vascularized flap using custom-made bone plates and a surgical guide to cut the mandible and fibula.
  
  
  METHODS
  The surgical protocol was applied in a study group of seven consecutive mandibular-reconstructed patients who were compared with a control group treated using the standard preplating technique on stereolithographic models (indirect computer-aided design/computer-aided manufacturing method). The precision of both surgical techniques (prosthetically guided maxillofacial surgery and indirect computer-aided design/computer-aided manufacturing procedure) was evaluated by comparing preoperative and postoperative computed tomographic data and assessment of specific landmarks.
  
  
  RESULTS
  With regard to midline deviation, no significant difference was documented between the test and control groups. With regard to mandibular angle shift, only one left angle shift on the lateral plane showed a statistically significant difference between the groups. With regard to angular deviation of the body axis, the data showed a significant difference in the arch deviation. All patients in the control group registered greater than 8 degrees of deviation, determining a facial contracture of the external profile at the lower margin of the mandible. With regard to condylar position, the postoperative condylar position was better in the test group than in the control group, although no significant difference was detected.
  
  
  CONCLUSIONS
  The new protocol for mandibular reconstruction using computer-aided design/computer-aided manufacturing prosthetically guided maxillofacial surgery to construct custom-made guides and plates may represent a viable method of reproducing the patient's anatomical contour, giving the surgeon better procedural control and reducing procedure time.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Bologna, Italy From the Faculty of Medicine and Section of Prosthodontics, Department of Oral Science, Alma Mater Studiorum University of Bologna; and the Plastic Surgery Unit, S. Orsola-Malpighi Hospital.
authors.forename: Simona
authors.initials: S
authors.lastname: Mazzoni
authors.forename: Claudio
authors.initials: C
authors.lastname: Marchetti
authors.forename: Rossella
authors.initials: R
authors.lastname: Sgarzani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cipriani
authors.forename: Roberto
authors.initials: R
authors.lastname: Scotti
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ciocca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods; D002508:Cephalometry; D003198:Computer Simulation; D017076:Computer-Aided Design; D019094:Dental Prosthesis, Implant-Supported; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008339:Mandibular Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008341:Mandibular Prosthesis; D063175:Mandibular Reconstruction / Q000379:methods*; D008441:Maxillary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008447:Maxillofacial Prosthesis; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D012984:Software; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply* / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods; D014584:User-Computer Interface