Precise maxillectomy reconstruction with a scapula flap using novel in-house 3D-printed surgical guides

The effectiveness of computer-aided design and computer-aided manufacturing (CAD/CAM) and three-dimensional (3D) printed surgical guides in mandibular reconstruction has been widely demonstrated. Nevertheless, there are few reports on innovations in 3D-printed surgical guide for maxillectomy reconstruction. Although the scapula flap is valuable for maxillectomy reconstruction, its design and harvesting process are technically demanding and time-consuming. This technical note describes our new 3D-printed surgical guide for harvesting the scapula flap that was applied in a 50-year-old man after a left total maxillectomy. By incorporating a handle into the surgical guide to stabilize the scapula, more controlled and stable osteotomy of the scapula was achieved. By using our new surgical guide, 89.7% of the reconstructed bone was identified within a tolerance range of 3 mm relative to the preoperative plan. Optical 3D surface scanning of the facial surface demonstrated that the contour of the cheek in the frontal view and the height of the malar eminence were maintained relative to the preoperative state. This technical note demonstrates the potential of our 3D-printed surgical guide to enable precise maxillectomy reconstruction. Further application of the new surgical guide in a larger number of cases is required to evaluate its accuracy and clinical utility.