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Use of Virtual Surgery and Stereolithography-Guided Osteotomy for Mandibular Reconstruction with the Free Fibula

Antony, Anuja K. M.D., M.P.H.; Chen, Wei F. M.D.; Kolokythas, Antonia D.D.S.; Weimer, Katherine A. M.S.; Cohen, Mimis N. M.D.

Plastic and Reconstructive Surgery: November 2011 - Volume 128 - Issue 5 - p 1080–1084
doi: 10.1097/PRS.0b013e31822b6723
Reconstructive: Head and Neck: Ideas and Innovations

Summary: Fibular osteotomy remains a challenging aspect of mandibular microsurgical reconstruction, dependent largely on surgeon experience, intraoperative judgment, and technical speed. Virtual surgical planning and stereolithographic modeling is a relatively new technique that can allow for reduction in the learning curve associated with neomandible contouring, enhanced levels of accuracy, and acceleration of a time-consuming intraoperative step. The authors present a video (narrated and edited from planning sessions and intraoperative use of technique to illustrate the technology) and describe their favorable results. Five patients underwent composite resection of the mandible and free fibula osteocutaneous reconstruction over a 6-month period (December of 2009 to June of 2010) at a single institution using a virtual planning session and stereolithographic modeling. Outcomes assessed included technical accuracy, aesthetic contour, and functional outcomes. All patients achieved negative margins with cutting guide–directed resection. Use of this technique eliminated the need for intraoperative measurement and yielded fibular segments with excellent apposition and faithful duplication of the preoperative plan. Minimal adjustments were needed for inset. Flap survival was 100 percent. All patients have maintained preoperative occlusion and a symmetric mandibular contour on Panorex study, three-dimensional computed tomography, and clinical examination. Accuracy of the reconstructed contour was confirmed using computed tomographic image overlay. This virtual surgical planning technique combined with stereolithographic model–guided osteotomy is the mainstay of the authors' approach to fibular osteotomy when dealing with patients requiring mandibular reconstruction. The authors feel this technology facilitates realization of technical accuracy, aesthetic contour, and functional outcomes and may be particularly useful if free fibular mandibular reconstruction is performed less frequently.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

Chicago, Ill.; and Golden, Colo.

From the Division of Plastic and Reconstructive Surgery and the Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, and Virtual Surgical Planning Services, Medical Modeling, Inc.

Received for publication July 13, 2010; accepted March 23, 2011.

Disclosure: Katherine A. Weimer is a manager for Virtual Surgical Planning Services of Medical Modeling, Inc. None of the remaining authors has any financial or commercial associations to disclose.

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Anuja K. Antony, M.D., M.P.H.; Division of Plastic, Reconstructive, and, Cosmetic Surgery, MC 958, University of Illinois at Chicago, 820 South Wood Street, Chicago, Ill. 60612, akantony@uic.edu

©2011American Society of Plastic Surgeons