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Related Experiment Video

Updated: Jul 6, 2025

A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
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Realizing in-house algorithm-driven free fibula flap set up within 24 hours: a pilot study evaluating accuracy with

Andreas Vollmer1, Babak Saravi2,3, Niko Breitenbuecher1

  • 1Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany.

Frontiers in Surgery
|January 1, 2024
PubMed
Summary

An open-source algorithm for mandibular reconstruction planning using fibula grafts demonstrated high accuracy and reduced ischemia time. This cost-efficient tool enhances surgical outcomes and healthcare accessibility.

Keywords:
computer-aided design and manufacturing (CAD/CAM)free osteocutaneous fibula graftischemia timemandibular reconstructionpreoperative planning

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Biomedical Engineering
  • Surgical Planning

Background:

  • Mandibular reconstruction is crucial for patients with defects from trauma or cancer.
  • Free osteocutaneous fibula grafts are commonly used, requiring precise pre-operative planning.
  • Current planning methods can be time-consuming and costly.

Purpose of the Study:

  • To evaluate the accuracy and effectiveness of a novel, open-source algorithm for in-house planning of mandibular reconstructions.
  • To quantify the anatomical accuracy of the planning process using specific metrics.
  • To assess the impact of this planning approach on surgical ischemia time.

Main Methods:

  • A pilot study included eight patients undergoing in-house planned computer-aided design and manufacturing (CAD/CAM) free fibula flaps.
  • Postoperative 3D imaging was used to compare planned versus actual outcomes.
  • The Hausdorff distance and Dice coefficient were employed to measure planning accuracy.

Main Results:

  • The algorithm demonstrated satisfactory anatomical accuracy, with a mean Hausdorff Distance of 1.22 ± 0.40 and a mean Dice Coefficient of 0.77 ± 0.07.
  • Higher accuracy correlated significantly with reduced ischemia time (Spearman's rho = -0.810 for Dice, p=0.015; Spearman's rho = 0.762 for Hausdorff, p=0.028).
  • Average ischemia time was 68.38 ± 27.95 minutes.

Conclusions:

  • The open-source planning algorithm achieves high anatomical accuracy in mandibular reconstruction.
  • This accuracy is directly linked to reduced surgical ischemia time, improving patient outcomes.
  • The algorithm's cost-efficiency and accessibility offer significant advantages for healthcare.