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Updated: Nov 19, 2025
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Comparing Contour Restoration of Mandibular Body Defects With Fibula, Iliac Crest, and Scapular Tip Flaps: A
Axel Sahovaler1, Marco Ferrari2, Harley Chan3
1Fellow, Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Fellow, Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
The scapular tip flap (STF) offers superior contour accuracy in virtual mandibular reconstructions compared to other common flaps. This finding suggests STF may be a more precise option for restoring mandibular body shape.
Area of Science:
- Oral and Maxillofacial Surgery
- Biomedical Engineering
- Reconstructive Surgery
Background:
- Mandibular body defects often require reconstructive surgery.
- Accurate contour restoration is crucial for functional and aesthetic outcomes.
- Various flaps are used, but their comparative accuracy in virtual models is not well-established.
Purpose of the Study:
- To compare the contour accuracy of commonly used flaps for mandibular body reconstruction.
- To utilize virtual measurements and conformance analyses for objective comparison.
Main Methods:
- Virtual mandibular defects were created using CT scans and 3D software.
- Digital harvesting and reconstruction were performed using scapular tip flaps (STF), iliac crest flaps (ICF), and fibula flaps (SS-FF and O-FF).
- Conformance analyses, including root mean square (RMS) calculations, assessed overall and contour accuracy.
Main Results:
- The scapular tip flap (STF) showed significantly better overall conformance (RMS = 2.03 mm) compared to ICF (4.53 mm), O-FF (2.37 mm), and SS-FF (2.76 mm).
- For contour conformance, STF (2.48 mm) outperformed ICF (4.50 mm) and SS-FF (3.28 mm), though osteotomized fibula flap (O-FF) demonstrated superior contour accuracy (1.85 mm).
- Statistical significance (p<.001) was observed for these comparisons.
Conclusions:
- The osseous component of the STF closely matches mandibular anatomy, potentially avoiding osteotomies required by fibula flaps.
- Virtual findings suggest STF is a highly accurate option for mandibular reconstruction.
- Further clinical studies are needed to confirm the clinical impact of these virtual results.
