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Updated: Jun 30, 2026

Designing CAD/CAM Surgical Guides for Maxillary Reconstruction Using an In-house Approach
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Computer Aided Design/Computer Aided Manufacturing-Guided Scapular Tip Free Flap Reconstruction for Complex

Francesco Laganà1, Alice Marzi Manfroni1, Francesco Arcuri1

  • 1Maxillofacial Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

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|January 10, 2026
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Computer-Aided Design and Manufacturing (CAD/CAM) with scapular tip free flaps (STFF) improves complex maxillofacial reconstructions. This technique enhances surgical precision, reduces operative times, and leads to predictable functional and aesthetic outcomes for patients.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Plastic Surgery
  • Biomedical Engineering

Background:

  • Reconstructing complex maxillary and mandibular defects after cancer surgery presents significant challenges.
  • The scapular tip free flap (STFF) offers a viable solution due to its vascularity and bone stock.
  • Computer-Aided Design and Manufacturing (CAD/CAM) can optimize reconstructive surgery, but its application in STFF for supine harvesting and inset is novel.

Purpose of the Study:

  • To evaluate the advantages of using CAD/CAM technology to guide resection and reconstruction in complex maxillary and mandibular defects using STFF.
  • To assess the impact of CAD/CAM-assisted STFF on operative efficiency, functional recovery, and aesthetic outcomes.

Main Methods:

  • A retrospective analysis of nine patients who underwent maxillary or mandibular reconstruction with STFF between January 2023 and December 2024.
  • Preoperative virtual surgical planning using CAD/CAM for patient-specific guides and plates.
  • Assessment of functional outcomes (EORTC QLQ-HN35), morphological accuracy (3D imaging overlay), operative/ischemia times, complications, and patient satisfaction.

Main Results:

  • All reconstructions were successful with no major intraoperative complications.
  • CAD/CAM planning facilitated precise osteotomies and flap contouring, reducing ischemia time and improving workflow, especially in mandibular cases.
  • High concordance between pre- and postoperative imaging demonstrated satisfactory restoration of facial contour, with high patient satisfaction.

Conclusions:

  • CAD/CAM-assisted STFF reconstruction enables accurate 3D restoration, shortening operative and ischemia times.
  • This approach leads to predictable functional recovery and favorable aesthetic results in complex maxillofacial defects.
  • Despite increased planning, CAD/CAM enhances efficiency and reproducibility, offering a valuable option for selected patients.