Functional Reconstruction of Mandibular Segment Defects With Individual Preformed Reconstruction Plate and Computed Tomographic Angiography-Aided Iliac Crest Flap
Maorui Zhang, MD ∗, Pengcheng Rao, MD †, Delin Xia, MD, PhD ‡, Libo Sun, MD §, Xiaoxiao Cai, MD, PhD ‖, Jingang Xiao, MD, PhD ¶,∗,'Correspondence information about the author MD, PhD Jingang XiaoEmail the author MD, PhD Jingang Xiao
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DOI: https://doi.org/10.1016/j.joms.2019.01.017 |
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Abstract
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Purpose
With the development of imaging technology and computer-assisted surgery in oral and maxillofacial surgery, digital technology is widely used in vascularized bone flap grafts for mandibular reconstruction. The aim of this study was to use digital technology throughout the treatment process to show that digital techniques can provide a reliable and accurate match between the mandible and the iliac crest flap to achieve functional reconstruction of mandibular segment defects.

Materials and Methods
Twenty patients underwent 3-dimensional (3D) computed tomography (CT), mirroring technology, 3D model prototyping, and CT angiography (CTA) for treatment planning. Individual preformed reconstruction plates were fabricated and iliac crest flaps were designed preoperatively. After complete resection of the mandibular lesion, the iliac crest flap was shaped to reconstruct the mandibular defects.

Results
During follow-up (range, 12 to 36 months), the facial shape, facial symmetry, and mouth opening of all patients recovered well. The 3D CT reconstruction also was evaluated for height, width, length, and bone healing of the iliac crest flap. Postoperative examination showed ideal bone union between the iliac crest flap and the mandible at 6 months. Nine patients received implant-supported fixed dentures to restore dentition. After follow-up, all patients were satisfied with their facial esthetics and function. The new mandible provided a suitable 3D position for implant-supported fixed partial dentures.

Conclusion
Use of digital techniques throughout the course of treatment improves the predictability and convenience of functional mandibular reconstruction. Individual preformed reconstruction plates and CTA effectively guaranteed the accuracy of iliac flap preparation.