Background/Objectives : Microvascular fibular free flap reconstruction of the maxillofacial complex is a popular method to return form and function after traumatic and pathologic tissue ablation. We hypothesized that computer-assisted surgery using computer-aided design/computer aided manufacturing (CAD/CAM) software and prefabricated guide stents was a successful alternative to intraoperative shaping of the neomandible or maxilla.
Methods : Retrospective review of all cases of computer-assisted reconstruction with fibular free flaps by multiple surgeons within the oral and maxillofacial surgery departments at two institutions. The following data were collected: demographics, diagnosis, previous treatments, affected jaw, ischemia time, failure and retake rate.
Results : Results are limited to descriptive statistics. There were 58 patients, 60 fibular reconstructions, 58% males, median age 56 (range 29–89). Pre-operative diagnoses: squamous cell carcinoma (48%) osteoradionecrosis (20%), osteomyelitis and post-traumatic (8% each), and one case each of sarcoma, adenoid cystic carcinoma, chondrosarcoma. 23% had previous radiation, 12% previous chemotherapy, 13% were recurrent cancers, and 17% had been previously reconstructed. 20% of the reconstructions were maxillary, 80% mandibular. Median ischemia time was 80 minutes (range 33-180). There were 3 retakes and 3 flap failures (5%).
Conclusions : Computer-assisted fibular free-flap reconstruction of maxillary and mandibular defects is a viable alternative to historical reconstructive techniques.
Key words : fibula; reconstruction; computer-aided surgery