Development of a Novel Adjustable Osteotomy Guide for Use in Free Fibula Flap Osteotomies and Comparison With...

Area of Science:

• Oral and Maxillofacial Surgery
• Biomedical Engineering
• 3D Printing in Medicine

Background:

• Mandibular reconstruction often relies on virtual surgical planning (VSP) for accuracy.
• Traditional methods for fibula osteotomies lack precision and can be time-consuming.
• Patient-specific cutting guides are costly and logistically challenging.

Purpose of the Study:

• To evaluate an adjustable osteotomy guide (AOG) for VSP-guided fibula flap osteotomies.
• To compare the AOG technique with conventional wire-template methods.
• To assess improvements in symmetry and procedure duration.

Main Methods:

• CT DICOM data from 5 mandibular reconstruction cases were used to create 3D printed models.
• An adjustable osteotomy guide (AOG) was developed to translate VSP measurements.
• Duplicate models were tested with AOG (VSP-guided) and conventional wire-template techniques.
• Symmetry and procedure duration were measured and compared.

Main Results:

• The AOG technique significantly improved symmetry for angulus-gnathion distance (P=0.043) and midline-angulus distance (P=0.041).
• Procedure duration was reduced with the AOG technique (median 14 min vs. 20 min, P=0.042).
• The AOG demonstrated improved accuracy and efficiency on 3D printed models.

Conclusions:

• An adjustable, reusable osteotomy guide informed by VSP enhances symmetry and reduces shaping time in simulated mandibular reconstruction.
• This approach presents a practical, cost-effective alternative to patient-specific guides.
• The AOG technique shows promise for improving VSP-guided fibula osteotomies.