Conventional techniques for fibular osteotomy planning are intrinsically erroneous. 3D-printed osteotomy guides are time-consuming, require expensive software, and cannot accommodate changes in surgical plan. This study evaluated the form, function, and esthetics of patients who underwent fibular reconstruction using a novel technique for osteotomy planning.
Patients who required multi-segment fibular reconstruction of the mandible were enrolled. The unique 3D osteotomy guide was fabricated intraoperatively using wooden tongue depressors. Functional outcomes like the interincisal distance, occlusion, jaw deviation, and oral competence were measured at preoperative (T1), 1 month (T2), and 6 months post-op (T3). Esthetic outcomes assessed were facial symmetry and mandibular projection. The reconstructive accuracy was gauged by CT measurements of bigonial width, mandibular arch angle, and ramus length.
Thirty of the 61 patients met the inclusion criteria. The interincisal distance significantly improved from T1 to T2 and T3 (p < 0.001). The occlusion remained unchanged and oral competence was restored by T3. No discernible facial asymmetry or changes in mandibular projection were noted at T2 and T3. Bigonial width did not vary significantly (p = 0.573) from T1 to T2. The mandibular arch angles on the left (p = 0.573) and the right sides (p = 0.77) also did not differ significantly. Twelve patients underwent vertical ramus reconstruction, and no significant difference was noted between the normal and reconstructed sides at T1 and T2 (p = 0.339).
This technique is simple, cost-effective, accurate, and requires no technical expertise. It minimizes the preoperative waiting period and allows flexibility in the ablative plan.
Level of evidence: Level IV, therapeutic study.
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Hidalgo DA (1989) Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 84:71–79
Farwell D, Futran N (2000) Oromandibular reconstruction. Facial Plast Surg 16(02):115–126. https://doi.org/10.1055/s-2000-12573
Kroll S, Reece G (2001) Aesthetically successful mandibular reconstruction with a single reconstruction plate. Clin Plast Surg 28(2):273–282. https://doi.org/10.1016/s0094-1298(20)32363-4
Yap L, Constantinides J, Butler C (2008) Tongue depressor template for free fibular flap osteotomies in mandibular reconstruction. Plast Reconstr Surg 122(6):209e–210e. https://doi.org/10.1097/prs.0b013e31818d2084
Kane W, Olsen K (1996) Enhanced bone graft contouring for mandibular reconstruction using intraoperatively fashioned templates. Ann Plast Surg 37(1):30–33. https://doi.org/10.1097/00000637-199607000-00005
Strackee S, Kroon F, Spierings P, Jaspers J (2004) Development of a modeling and osteotomy jig system for reconstruction of the mandible with a free vascularized fibula flap. Plast Reconstr Surg 114(7):1851–1858. https://doi.org/10.1097/01.prs.0000142766.26117.5b
Marchetti C, Bianchi A, Mazzoni S, Cipriani R, Campobassi A (2006) Oromandibular reconstruction using a fibula osteocutaneous free flap: four different “preplating” techniques. Plast Reconstr Surg 118(3):643–651. https://doi.org/10.1097/01.prs.0000233211.54505.9a
Moro A, Cannas R, Boniello R, Gasparini G, Pelo S (2009) Techniques on modeling the vascularized free fibula flap in mandibular reconstruction. J Craniofac Surg 20(5):1571–1573. https://doi.org/10.1097/scs.0b013e3181b0db5c
Yadav P, Gazwan Q, Shankdhar V, Nambi G (2010) A simple and cost effective template for central segment reconstruction of mandible with free fibula flap. J Maxillofac Oral Surg 9(3):256–260. https://doi.org/10.1007/s12663-010-0077-9
Kang S, Old M, Teknos T (2016) Contour and osteotomy of free fibula transplant using a ruler template. Laryngoscope 126(10):2288–2290. https://doi.org/10.1002/lary.25925
Tarsitano A, Del Corso G, Ciocca L, Scotti R, Marchetti C (2015) Mandibular reconstructions using computer-aided design/computer-aided manufacturing: a systematic review of a defect-based reconstructive algorithm. J Cranio-maxillofac Surg 43(9):1785–1791. https://doi.org/10.1016/j.jcms.2015.08.006
Numajiri T, Nakamura H, Sowa Y, Nishino K (2016) Low-cost design and manufacturing of surgical guides for mandibular reconstruction using a fibula. Plast Reconstr Surg - Global Open 4(7):e805. https://doi.org/10.1097/gox.0000000000000682
Brown J, Barry C, Ho M, Shaw R (2016) A new classification for mandibular defects after oncological resection. Lancet Oncol 17(1):e23–e30. https://doi.org/10.1016/s1470-2045(15)00310-1
Menon A, Karikal A, Shetty V (2018) Does C-arm guidance improve reduction of zygomatic arch fractures?—A randomized controlled trial. J Oral Maxillofac Surg 76(11):2376–2386. https://doi.org/10.1016/j.joms.2018.05.026
Hayden R, Mullin D, Patel A (2012) Reconstruction of the segmental mandibular defect: current state of the art. Curr Opin Otolaryngol Head Neck Surg 20(4):231–236. https://doi.org/10.1097/moo.0b013e328355d0f3
Chan H, Siewerdsen J, Vescan A, Daly M, Prisman E, Irish J (2015) 3D Rapid prototyping for otolaryngology—head and neck surgery: applications in image-guidance, surgical simulation and patient-specific modeling. PLoS ONE 10(9):e0136370. https://doi.org/10.1371/journal.pone.0136370
Chim H, Salgado C, Mardini S, Chen H (2010) Reconstruction of mandibular defects. Semin Plast Surg 24(02):188–197. https://doi.org/10.1055/s-0030-1255336
The procedures used in this study adhered to the tenets of the Declaration of Helsinki. Approval was obtained from the Ethics Committee of the Balco Medical Center (2018/Dec/BMC-001).
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Informed consent was obtained from all participants included in the study.
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Patients signed informed consent regarding publishing their data and photographs.
Conflict of interest
Dipmalya Chatterjee, Akash Menon, Jayesh Sharma, Ziaur Rahman, and Harsha K N declare no competing interests.
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Chatterjee, D., Menon, A., Sharma, J. et al. The 3D tongue depressor guide: a low-cost alternative to 3D printing in fibula-based mandibular reconstruction. Eur J Plast Surg (2021). https://doi.org/10.1007/s00238-021-01859-5
- Free fibula
- 3D printing
- Osteotomy guides
- Custom guides
- Tongue depressor