New approach for virtual surgical planning and mandibular reconstruction using a fibula free flap

Maxillofacial reconstruction poses a major challenge to surgeons because of the associated anatomical complexity, the sensitivity of the involved systems and the need to maintain a pleasing facial appearance. Here, we present a detailed description of a new method for extensive mandibular reconstruction using open-source virtual design software and a desktop 3D printer. A surgeon segmented preoperative computed tomography angiography scans with the Amira program to create a digital model of the mandible, skull and fibula. These datasets were imported into Blender, an open-source computer-aided design software package, where arrangement of the fibula segments into aligned sections was performed. Then, a desktop 3D printer was used to produce a reconstructed mandible. After fixation of a plate onto the reconstructed mandible, cutting guides were digitally designed using Blender. Following this, the surgeon performed mandible resection using the fixed cutting guides, which were 3D-printed using biocompatible plastic (Med 610/Stratasys Inc.) and fixed to the prebent reconstructed mandible at a predetermined position. After cutting the fibula with the help of the cutting guides and aligning the fibular segments into mandibular space, the surgeon fixed the segments to the reconstruction plate. Postoperatively, multislice computed tomography scans were taken for control purposes. Our method for mandibular reconstruction offers the following benefits: shorter operation planning time, increased accuracy during osteotomy through the use of a special fibula cutting guide and low costs. In brief, this method is an easy, precise and highly flexible technique for mandibular reconstruction with a fibula flap.