Triple-Cut Computer-Aided Design-Computer-Aided Modeling: More Oncologic Safety Added to Precise Mandible Modeling

Area of Science:

• Oral and Maxillofacial Surgery
• Biomedical Engineering
• Reconstructive Surgery

Background:

• Computer-aided design-computer-aided modeling (CAD-CAM) is standard for mandibular reconstruction, offering improved outcomes.
• Intraoperative changes in reconstructive plans can render custom CAD-CAM devices inadequate.
• A novel adjunct is presented to enhance standard CAD-CAM techniques.

Purpose of the Study:

• To present an efficient adjunct to standard CAD-CAM techniques for mandibular reconstruction.
• To address the challenge of intraoperative plan modifications in prefabricated reconstructive devices.
• To improve the adaptability of CAD-CAM in mandibular reconstruction.

Main Methods:

• The
• triple-cut
• concept utilized customized surgical guides in 5 patients undergoing mandibular reconstruction with free fibula flaps.
• Patients had undergone mandibular resection (4 for squamous cell carcinoma, 1 for osteoradionecrosis).
• Mandibular and fibular cutting guides featured 3 distinct cutting levels per side.

Main Results:

• The 3 cutting levels on the mandible enabled precise resection tailored to intraoperative requirements.
• Corresponding cutting levels on the fibula facilitated the creation of perfectly matched vascularized bone segments.
• Excellent bony segment contact was achieved in all patients.

Conclusions:

• Prefabricated
• triple-cut
• cutting guides allow for modifications in bone resection dimensions.
• These guides maintain compatibility with the prefabricated CAD-CAM reconstructive plate.
• The technique enhances intraoperative flexibility in mandibular reconstruction.