Morphological results of customized microvascular mandibular reconstruction: A comparative study.
BACKGROUND
Virtual planning and guided surgery with customized reconstructive plates are becoming more and more common for mandibular reconstruction with fibular free flaps. Although the literature describes many potential applications, no systematic analyses have been made about morphological results regarding computer-aided reconstruction compared to traditional freehand bent plate.


METHODS
In the present study, we propose a comparative study in this innovative field, analysing a case series of 30 CAD/CAM reconstructed mandibles, compared to traditional reconstructed mandibles, in terms of morphological results. All patients were evaluated by pre-operative and a post-operative CT scan. To evaluate the morphological results, several anatomical landmarks were measured on CT scan: 1) the midline deviation; 2) the amplitude variation, in grades, of the mandibular angle; 3) the bi-gonial diameter of the mandibular and 4) the chin protrusion.


RESULTS
The mean differences registered between pre-operative and post-operative CT scan were significantly better for test group regarding mandibular angle (p = 0.034), bi-gonial diameter (p = 0.041), chin protrusion (p = 0.05). No significant differences were registered for midline deviation (p = 0.092).


CONCLUSIONS
CAD/CAM reconstructive technique appears to be a valid method to accurately restore the pre-operative morphological situation.
Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy. Electronic address: achille.tarsitano2@unibo.it.
Achille
A
Tarsitano
Section of Prosthodontics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
Leonardo
L
Ciocca
Section of Prosthodontics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
Roberto
R
Scotti
Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
Claudio
C
Marchetti
D017076:Computer-Aided Design; D005360:Fibula / Q000637:transplantation; D058752:Free Tissue Flaps; D006801:Humans; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery; D008339:Mandibular Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D063175:Mandibular Reconstruction / Q000379:methods*; D011474:Prosthesis Design / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Computer-aided design; Computer-aided manufacturing; Mandible; Microsurgery; Morphological results; Reconstructive algorithm