title: Virtual Surgical Planning in Precise Maxillary Reconstruction With Vascularized Fibular Graft After Tumor Ablation.
abstract: OBJECTIVE
  Reconstruction of maxillary and midfacial defects due to tumor ablation is challenging to conventional operation. The purposes of this study are to evaluate the precise 3-dimensional position of the fibular flap in reconstruction of maxillary defects assisted by virtual surgical planning and to assess the postoperative outcomes compared with conventional surgery.
  
  
  METHODS
  We retrospectively reviewed 18 consecutive patients who underwent maxillary reconstruction with a vascularized fibular flap assisted by virtual surgical planning after maxillary or midfacial tumor ablation. Conventional surgery was performed in another 15 patients. Proplan CMF surgical planning (Materialise, Leuven, Belgium) was performed preoperatively in the virtual planning group. Fibular flaps were harvested and underwent osteotomy assisted by prefabricated cutting guides, and the maxilla and midface were resected and reconstructed assisted by the prefabricated cutting guides and templates in the virtual planning group. The operative time and fibular flap positions were evaluated in the 2 groups. Postoperative fibular positions of the maxillary reconstruction were compared with virtual plans in the virtual planning group. The postoperative facial appearance and occlusal function were assessed.
  
  
  RESULTS
  The operations were performed successfully without complications. The ischemia time and total operative time were shorter in the virtual planning group than those in the conventional surgery group (P < .05). High precision of the cutting guides and templates was found on both the fibula and maxilla in the virtual planning group. The positions of the fibular flaps, including the vertical and horizontal positions, were more accurate in the virtual planning group than those in the conventional surgery group (P < .05). Bone-to-bone contact between the maxilla and fibular segments was more precise in the virtual planning group (P < .05). Postoperative computed tomography scans showed excellent contour of the fibular flap segments in accordance with the virtual plans in the virtual planning group. All patients were alive with no evidence of disease. Functional mandibular range of motion, good occlusion, and an ideal facial appearance were observed in the virtual planning group.
  
  
  CONCLUSIONS
  Virtual surgical planning appears to achieve precise maxillary reconstruction with a vascularized fibular flap after tumor ablation, as well as an ideal facial appearance and function after dental rehabilitation. The use of prefabricated cutting guides and plates eases fibular flap molding and placement, minimizes operating time, and improves clinical outcomes.
authors: Attending, Department of Oral and Maxillofacial Surgery, Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors: You-Yuan
authors: YY
authors: Wang
authors: Attending, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors: Song
authors: S
authors: Fan
authors: Resident, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors: Han-Qing
authors: HQ
authors: Zhang
authors: Resident, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors: Zhao-Yu
authors: ZY
authors: Lin
authors: Associate Professor, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors: Jian-Tao
authors: JT
authors: Ye
authors: Professor, Department of Oral and Maxillofacial Surgery, Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Electronic address: lijs2015@yeah.net.
authors: Jin-Song
authors: JS
authors: Li
mesh_terms: D055011:Ablation Techniques; D005260:Female; D005360:Fibula / Q000637:transplantation*; D006801:Humans; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods*; D008437:Maxilla / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013524:Surgical Flaps