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Updated: Oct 14, 2026
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Selective preoperative lower extremity computed tomography angiography before mandibular reconstruction: Identifying
Jannik Ketschau1, Jonathan Mohr2, Yannik Leonhardt3
1Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, School of Medicine and Health, TUM University Hospital, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany. jannik.ketschau@tum.de.
Purpose:
Not every patient undergoing mandibular continuity resection requires free fibula flap (FFF) reconstruction. Whether clinical judgment reliably identifies patients unlikely to benefit from preoperative lower-extremity computed tomography angiography (CTA) remains unknown, despite the relevance of this question for cost-conscious and resource-efficient imaging strategies.
Methods:
A retrospective outcome-based validation was conducted in patients undergoing mandibular continuity resection between July 2012 and June 2023. The primary outcome was secondary FFF reconstruction among patients not initially selected for CTA. Factors associated with CTA utilization were assessed by multivariable logistic regression.
Results:
316 consecutively operated patients were included. Prior radiotherapy (OR 2.67, p = 0.005) and smoking history (OR 1.98, p = 0.032) were independently associated with CTA utilization. Among 111 patients without primary FFF reconstruction, four (3.6%) required secondary FFF reconstruction, all of whom had undergone CTA. No patient managed without CTA subsequently required FFF reconstruction.
Conclusions:
In this cohort, clinical judgment was associated with successful identification of patients who did not subsequently require fibular reconstruction. Omission of CTA in carefully selected patients was not associated with subsequent reconstructive deficiency, though larger prospective studies are needed to confirm these findings.
