Contribution of virtual surgical planning, computer-aided design, and computer-aided manufacturing to delayed mandibular reconstruction

Purpose: Achievement of the correct alignment of malpositioned mandibular segments with displaced condyles and soft-tissue contraction is relatively challenging in patients requiring secondary mandibular reconstruction. The aim of this study was to demonstrate the utility of virtual surgical planning (VSP) and forward engineering with computer-aided design (CAD)/computer-aided manufacturing (CAM) technology in late secondary mandibular reconstruction. Patients and Methods: The study sample included 14 patients aged 18–74 years and treated between 2012 and 2017 using secondary segmental mandibular reconstruction. VSP was used for precise condylar location in each mandibular segment, and cutting guides enabled forward engineering in cases treated with vascularized fibular bone grafts. Rapid medical prototyping of the mandible and/or CAD/CAM of temporary fixation guides were used in the remainder of cases for forward engineering purposes. Results: VSP and CAD/CAM technology reduced the amount of bone removed for reconstruction, decreased surgical time, increased intraoperative precision, and improved postoperative functional and esthetic outcomes. Conclusions: VSP allows seamless secondary mandibular reconstruction with fibular free tissue transfer, and utilization of combinations of mandibular and fibular cutting guides or temporary fixation templates allows for precise and efficient surgical reconstruction through forward engineering. Rapid medical prototyping of custom-made temporary mandibular fixation apparatus can be an alternative method for situations where the cutting guides and permanent fixation plates cannot be manufactured or where free fibular transfer is not the preferred treatment option.