title: Surgical planning and microvascular reconstruction of the mandible with a fibular flap using computer-aided design, rapid prototype modelling, and precontoured titanium reconstruction plates: a prospective study.
abstract: The standard of mandibular reconstruction has increased since the introduction of computer-assisted design (CAD) and rapid prototype modelling (RPM) for surgical planning. Between 2008 and 2013, a prospective pilot study of 20 patients was planned to compare the outcomes of patients treated by mandibular reconstruction who had CAD and RPM-guided operations using a precontoured titanium plate, with the outcomes of patients treated conventionally. We recorded the time taken for reconstruction, total operating time, and whether this type of planning could improve the results of mandibular reconstruction. We found significant differences in the incidence of dental malocclusion (p=0.03) and exposure of the titanium plate (p=0.009). The mean operating time for reconstruction in the preoperative planning group was 135 (37)min compared with 176 (58)min in the conventional group (p=0.04). Preoperative planning using CAD and RPM can increase the accuracy of microvascular mandibular reconstruction and reduce the operating time for reconstruction.
authors.affiliation: Oral and Maxillofacial Surgery Unit, Department of Plastic and Maxillofacial Surgery, University Hospital Clínic (Barcelona University), Escala 4. Planta 2, C/ Villarroel, 170, 08036 Barcelona, Spain. Electronic address: ramonsieiragil@me.com.
authors.forename: R
authors.initials: R
authors.lastname: Sieira Gil
authors.affiliation: Department of Oral and Maxillofacial Surgery, Bellvitge University Hospital (Barcelona University), Hospitalet de Llobregat, Feixa Llarga s/n, 08907, Barcelona, Spain. Electronic address: ebusitano@gmail.com.
authors.forename: A Marí
authors.initials: AM
authors.lastname: Roig
authors.affiliation: Department of Oral and Maxillofacial Surgery, Bellvitge University Hospital (Barcelona University), Hospitalet de Llobregat, Feixa Llarga s/n, 08907, Barcelona, Spain. Electronic address: 33220cao@comb.cat.
authors.forename: C Arranz
authors.initials: CA
authors.lastname: Obispo
authors.affiliation: Department of Oral and Maxillofacial Surgery, Bellvitge University Hospital (Barcelona University), Hospitalet de Llobregat, Feixa Llarga s/n, 08907, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Morla
authors.affiliation: Oral and Maxillofacial Surgery Unit, Department of Plastic and Maxillofacial Surgery, University Hospital Clínic (Barcelona University), Escala 4. Planta 2, C/ Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: C Martí
authors.initials: CM
authors.lastname: Pagès
authors.affiliation: Department of Statistics, Barcelona University, Av. Diagonal, 645, 08028 Barcelona, Spain.
authors.forename: J Llopis
authors.initials: JL
authors.lastname: Perez
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000737:chemistry*; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D017076:Computer-Aided Design; D005260:Female; D005360:Fibula / Q000637:transplantation; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008310:Malocclusion / Q000209:etiology; D063175:Mandibular Reconstruction / Q000295:instrumentation / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D010347:Patient Care Planning; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013997:Time Factors; D014025:Titanium / Q000737:chemistry*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D014025:Titanium
keywords: Computer assisted surgical planning; Fibula flap; Mandibular reconstruction; Microvascular; Operative time; Rapid prototyping; Surgical planning