Customizable and Cost-effective Template for Fibular Osteotomies in Mandibular Reconstruction

The free fibula flap is the gold standard for mandibular reconstruction in head and neck tumors. Traditionally, a titanium reconstruction plate is shaped to measure and align with the mandibular defect after ensuring proper occlusion. These prebent plates are matched against the fibula to estimate osteotomy sites and angles. This technique often requires repeated adjustments for optimal in-setting and heavily depends on the surgeon's experience. Advanced technology now allows virtual surgical planning with 3-dimensional simulation, enabling precise planning of resections and reconstructions. Computer-aided design/computer-aided manufacturing produces customized cutting guides and reconstruction plates. Although these technologies improve functional and aesthetic outcomes, they increase costs and preoperative preparation time. In resource-limited settings such as Pakistan, patients often present with advanced-stage cancers, making delays in guide manufacturing impractical. Alternative templates, such as tongue depressors and rulers, have been introduced but have limitations. We propose using folded x-ray films as templates for fibular osteotomies, offering a cost-effective, readily available alternative that yields satisfactory results.