Novel Patient-Specific 3-Dimensional Printed Fixation Tray for Mandibular Reconstruction With Fibular Free Flaps

• Main Authors: Alexander, A.E (Author), Arce, K. (Author), Ettinger, K.S (Author), Waris, S. (Author)
• Format: Article
• Language: English
• Published: W.B. Saunders 2018
• Subjects: anatomic model; Article; biological model; computed tomographic angiography; computer aided design; computer assisted surgery; Computer-Aided Design; dental procedure; diagnostic imaging; Esthetics, Dental; ex vivo study; fibula; Fibula; fibula graft; Free Tissue Flaps; free tissue graft; human; Humans; Imaging, Three-Dimensional; jaw disease; jaw malformation; mandible reconstruction; Mandibular Diseases; Mandibular Reconstruction; Models, Anatomic; Patient-Specific Modeling; Printing, Three-Dimensional; procedures; soft tissue; Surgery, Computer-Assisted; three dimensional imaging; three dimensional printing; transplantation
• Online Access: View Fulltext in Publisher

 Segmental mandibular defects secondary to infectious, traumatic, and pathologic conditions can be debilitating because of their impact on function and facial esthetics. Several reconstructive techniques are available, with vascularized flaps commonly used for the reconstruction of large bony or composite segmental defects. The free fibular flap for mandibular reconstruction is well documented and remains a commonly used flap because of its bone length, versatility, distant location from the head and neck region that allows for a 2-team approach, and ability to simultaneously place endosseous implants. Virtual surgical planning (VSP) and guided resection and reconstruction of maxillofacial defects have facilitated complex 3-dimensional (3D) reconstruction. The accuracy and fidelity of VSP are dependent on the intraoperative execution of the VSP, with computer-aided design and computer-aided modeling of patient-specific cutting guides and hardware providing a template for its execution. The goal of this report is to describe the authors’ experience with the use of a novel 3D printed fixation tray designed from the VSP data. It provides dual functionality by aiding in alignment and stabilization of the fibular segments and concomitantly providing patient-specific anatomic references for indexing of bony and soft tissue components. This tray enables rapid ex vivo configuration of the fibula segment(s) with the reconstruction bar relative to the native mandibular segments and allows the compiled construct to be transferred to the head and neck for insetting as a precisely configured single unit. © 2018 American Association of Oral and Maxillofacial Surgeons