Computer-assisted versus traditional technique in fibular free-flap mandibular reconstruction: A CT symmetry study

In the past few years, virtual planning has been increasingly used for mandibular reconstruction. The objective of our study was to evaluate and compare symmetry and the accuracy of morphologic reconstruction in patients undergoing mandibular reconstruction by fibular free flap between traditional freehand technique and computer-aided surgical cutting guides.

A single-center retrospective study included all cases of mandibular reconstruction using fibular free flap. In the three-dimensional (3D) group, virtual surgery planning with cut guides was used (Materialise ®), while the Control group underwent traditional freehand reconstruction. Morphometric comparisons were made to evaluate reconstruction accuracy between pre- and post-operative CT scans (mean deviations of 3 angles and 3 lengths). Mandible symmetry was calculated by comparing each angle and length in the affected and non-affected sides of the mandible.

Thirty-three patients treated between January 2015 and June 2018 were included: 25 patients in the 3D group and 8 in the control group. The average number of mandibular segments was 2.16±0.55 in the 3D group and 1.75±1.16 in the control group (p=0.005). Mean deviations between pre- and post-operative values of the coronal mandibular angle (angle formed by the line through the two condyles and the ramus), mandibular body height and mandibular ramus length on the affected side were significantly lower in the 3D group than in the control group. Sagittal mandibular angle symmetry was better in the 3D group than, in the control group (ratios of affected over non-affected sides: 1.07±0.04 vs 1.12±0.1; p=0.034).

Virtual surgical planning for fibula free-flap reconstruction helps to improve reconstruction accuracy and maintains a significantly greater symmetry than the traditional freehand technique, and should improve functional and esthetic outcome in mandibular reconstruction.