title: Considerations and Protocols in Virtual Surgical Planning of Reconstructive Surgery for More Accurate and Esthetic Neomandible with Deep Circumflex Iliac Artery Free Flap.
abstract: OBJECTIVE
  The reconstruction of mandibular defects poses many difficulties due to the unique, complex shape of the mandible and the temporomandibular joints. With development of microvascular anastomosis, free tissue transplantation techniques, such as deep circumflex iliac artery (DCIA) flap and fibular free flap (FFF), were developed. The DCIA offers good quality and quantity of bone tissue for mandibular segmental defect and implant for dental rehabilitation. Virtual surgical planning (VSP) and stereolithography-guided osteotomy are currently successfully applied in three-dimensional mandibular reconstruction, but most use FFF. There are only a few articles on reconstruction with the DCIA that assess the postoperative results.
  
  
  METHODS
  Three patients admitted during a five month period (April of 2013 to August of 2013) underwent resection of mandible and DCIA musculo-osseous reconstruction using a VSP and stereolithographic modeling and assessment of outcomes included technical accuracy, esthetic contour, and functional outcomes.
  
  
  RESULTS
  This technique yielded iliac bone segment with excellent apposition and duplication of the preoperative plan. Flap survival was 100 percent and all patients maintained preoperative occlusion and contour.
  
  
  CONCLUSIONS
  Based on our experience, we offer considerations and logically consistent protocols by classification of mandibular defects, and demonstrate the benefits in VSP and stereolithographic modeling of mandibular reconstructive surgery with DCIA flap.
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University.
authors.forename: Nam-Kyoo
authors.initials: NK
authors.lastname: Kim
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University; Oral Cancer Research Institute, College of Dentistry, Yonsei University.
authors.forename: Hyung Jun
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University; Oral Cancer Research Institute, College of Dentistry, Yonsei University.
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Cha
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University; Oral Cancer Research Institute, College of Dentistry, Yonsei University.
authors.forename: Woong
authors.initials: W
authors.lastname: Nam
keywords: Cutting guides; Deep circumflex iliac artery flap; Mandibular reconstruction; Stereolithographic models; Virtual surgical planning