In-house 3D treatment planning for mandibular reconstruction by free fibula flap in cancer: Our technique

Planning of free fibula flaps for mandibular reconstruction improves the quality of conformation and reduces the operating time. Many methods based on modeling and 3D printing have been described with excellent results, but planning and production of custom-made guides and/or plates are often time-consuming and expensive. In this article, we describe our 3D printing-assisted free fibula flap planning method, routinely performed exclusively by the surgical team in less than 72hours, compatible with urgent cancer management. Fibula and mandible models were printed by using preoperative CT data. The mandibular resection, the length of fibula and the number of osteotomies and their angles were planned on the printed models. Titanium fixation plates were then conformed on the printed model and sterilized prior to surgery and templates were made to guide fibula osteotomies. Preliminary analysis based on 7 cases shows a reduction of conformation time with good clinical and radiological results. This 3D printing-assisted planning technique is simple, cost-effective and readily reproducible, allowing mandibular reconstruction with good cosmetic and functional results.