Pre-operative Virtual Planning Followed by Fabrication of Patient-Specific Guiding Instruments for Mandibular Deformity after Fibula Free Flap Reconstruction

Abstract

Background: Corrective osteotomy for secondary mandibular reconstruction is complex, and it is extremely difficult to achieve desirable three-dimensional positioning. The authors present a case for repositioning the mandibular segments of mandibular deformity after fibula free flap reconstruction using computerassisted surgical simulation and patient-specific guiding instruments.

Case description: A 69-year-old man developed severe mandibular deviation after segmental mandibulectomy and reconstruction with fibula free flap for basal cell carcinoma of the mental region. A virtual osteotomy was performed between the mandible and fibula on a 3D virtual model using simulation software. The proximal mandibular segments were placed in the ideal position using a 3D virtual model. The original contour of the mandible before the primary resection was used as a reference for repositioning. Patient-specific guiding instruments were fabricated for the pre-osteotomy and intraoperative positioning of the osteotomized mandible, enabling bone fragments to be repositioned and fixed using the pre-operative plan. Postoperative CT showed that the mandibular segments were precisely repositioned.

Conclusion: In this case, virtual planning and patient-specific guiding instruments were useful in corrective surgery for mandibular deformity after fibula free flap reconstruction.