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Updated: Aug 11, 2026
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
AI-driven morphometric comparison of fibula vs. iliac flap in mandibular reconstruction
Chenyao Li1, Yan Guo2, Rong Yang3
1Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
Objective:
To compare the clinical outcomes of vascularized free fibula flap (FFF) and deep circumflex iliac artery (DCIA) flap for mandibular reconstruction, using a novel AI-driven dual-modality system for quantitative 3D morphological fidelity and facial symmetry analysis.
Methods:
We evaluated 56 patients with tumors (34 undergoing FFF and 22 undergoing DCIA) using a 3D U-Net deep learning model and Face Mesh. The U-Net model predicted mandibular shapes to generate patient-specific, anatomically plausible reference mandibles, and surface deviations were compared with the actual reconstructions. Facial symmetry was quantified using MediaPipe Face Mesh.
Results:
No significant differences in facial symmetry (S = 0.084 ± 0.013 vs. 0.083 ± 0.012, p = 0.781), functional recovery, or complications. DCIA showed lower morphological deviations for body defects: mean difference (1.42 ± 0.83 mm vs. 2.58 ± 0.62 mm, p = 0.001), maximum deviation (19.8 ± 2.7 mm vs. 21.4 ± 4.1 mm, p < 0.05).
Conclusion:
FFF and DCIA flaps achieve comparable facial symmetry, functional recovery and complication rates in mandibular reconstruction. DCIA flap offers significantly improved 3D geometric accuracy only for isolated mandibular body defects, while the clinical relevance of this statistical difference remains uncertain. The AI-based quantitative assessment system established in this study provides an objective tool for defect-specific flap selection in mandibular reconstruction.