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Accuracy of Computer-Aided Design/Computer-Aided Manufacturing-Assisted Mandibular Reconstruction With a Fibula Free Flap

Geusens, Joris MD*; Sun, Yi MSc, PhD*; Luebbers, Heinz-Theo MD, DMD†,‡; Bila, Michel MD, DDS*; Darche, Vincent MD, DDS§; Politis, Constantinus MD, PhD*

doi: 10.1097/SCS.0000000000005704
Original Articles

Background: The recent increase in computer-aided design and computer-aided manufacturing (CAD/CAM)-assisted surgery has warranted a thorough evaluation of the accuracy of virtual plan execution. Mandibular reconstructions with a fibula free flap were evaluated by comparing the fibular segments postoperatively with the virtual surgical plans.

Methods: This study included computed tomography data for 20 patients (11 males; mean age 61.3 years, range 47–74) that received a mandibular reconstruction with a fibula free flap. Linear distances (superior and inferior borders) of 41 fibula segments and intercoronoid distances were measured.

Results: The mean difference was 3.11 ± 2.80 mm for superior borders (range 0.02–12.20 mm), and 2.75 ± 2.61 mm for inferior borders (range 0.22–13.58 mm). The mean intercoronoid difference was 3.57 ± 1.80 mm (range 0.91–6.11 mm).

Conclusion: This study confirmed the presumed accuracy regarding the use of fibular and mandibular cutting guides. CAD/CAM is an attractive technique which enhances efficiency and assurance during surgery and preoperative planning.

*OMFS IMPATH research group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium

Surgical Planning Lab, Harvard Medical School, Brigham and Women's Hospital, Boston, MA

Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Zurich, Switzerland

§Service de Chirurgie Orale et Maxillo-faciale CHR de Namur, Namur, Belgium.

Address correspondence and reprint requests to Yi Sun, MSc PhD, OMFS-IMPATH Research Group and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; E-mail:

Received 10 January, 2019

Accepted 6 May, 2019

The authors report no conflicts of interest.

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© 2019 by Mutaz B. Habal, MD.