Purpose : Reconstruction of oromandibular defects remains one of the most formidable surgical challenges the reconstructive head and neck surgeon faces. The purpose of this study is to illustrate the added value of 3D imaging and preoperative planning.

Methods : In this study 30 patients undergoing a free vascularized fibular bone graft were included. In 17 of these 30 patient 3D planning was performed using a triple template technique. The remaining 13 patients were treated without 3D planning in a conventional manner. Ischemic time was compared between both groups. Furthermore, the accuracy of the 3D planning was evaluated for all 17 patients of the first group by registration of the pre-operative planning and postoperative CBCT scan.

Results : The use of the 3D triple template technique resulted in an average shorter ischemic time, reduction of 28 min. A clear learning curve was visible. The accuracy between 3D planning and actual postoperative result illustrated a small average error of 3.5 mm.

Conclusion : Computer aided surgery and planning, using the triple template method, leads to an accurate and oncological safe reconstruction of the mandibular geometry by eliminating intra-operative decision making, reducing ischemic time of the fibular graft and reducing overall operative time.