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Delayed Maxillary Reconstruction with Free Osteocutaneous Fibula Flap Using CAD-CAM Technology.

Madhusudhan Krishnappa1, Sunil Gaba1, Shagun Sharma2

  • 1Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
|March 13, 2025
PubMed
Summary

Virtual surgical planning (VSP) and 3D printing enable accurate maxillary reconstruction using free fibula flaps. Mock surgery with 3D models improves outcomes, reducing operative adjustments for a precise anatomical result.

Keywords:
CAD-CAMfree osteocutaneous fibula flapmaxillary reconstructionmucormycosisvirtual surgical planning

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Plastic and Reconstructive Surgery
  • Biomedical Engineering

Background:

  • Maxillary reconstruction presents significant challenges due to complex 3D anatomy, especially in secondary reconstructions where defect definition is difficult.
  • Free fibula flaps are a common choice for maxillary defects, but achieving precise anatomical restoration requires advanced planning techniques.

Purpose of the Study:

  • To evaluate the efficacy of virtual surgical planning (VSP), 3D printing, and mock surgery in free fibula flap reconstruction of maxillary defects.
  • To assess the accuracy of VSP and 3D printing in achieving anatomically correct reconstructions compared to postoperative imaging.

Main Methods:

  • A prospective study of 10 patients with maxillary defects undergoing delayed reconstruction with free fibula flaps.
  • Preoperative planning utilized computer-aided design and computer-aided manufacturing (CAD-CAM) for 3D model creation and virtual surgical simulation.
  • A mock surgery was performed on 3D printed models; accuracy was verified by comparing preoperative VSP data with postoperative CT scans.

Main Results:

  • Nine out of ten patients had successful reconstructions with high satisfaction.
  • Mean positional deviation between virtual planning and postoperative CT scans was less than 5 mm in all axes, indicating high accuracy.
  • Suggested strategies for flap inset improved bony and soft-tissue integration.

Conclusions:

  • Virtual surgical planning (VSP) and CAD-CAM technology are invaluable for creating anatomically accurate neo-maxillas in complex reconstructions.
  • Incorporating mock surgery and cutting guides into the workflow minimizes intraoperative unpredictability and reduces the need for intraoperative modifications.
  • Despite limitations, CAD-CAM technology is a crucial tool for reconstructive plastic surgeons performing maxillary reconstructions.