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Comparison of symmetry and interfragmentary gap size in free fibular mandibular reconstruction: free-form versus 3D-planned
Mikell Yuhasz, BA, Elizabeth S. Craig, MD, Felix P. Koch, MD, DMD, Roger Lowlicht, DDS, Stefano Fusi, MD, Derek Steinbacher, MD, DMD.
Yale University School of Medicine, New Haven, CT, USA.

Background: Vascularized fibular transfer is the workhorse for mandibular reconstruction. Traditionally an en fos approach is taken to adapt a mandibular reconstruction plate and fashion the fibular graft accordingly. 3-dimensional planning, with use of cutting guides and pre-bent plates, has been introduced with possible benefits. The purpose of this study is to evaluate the interfragmentary gap size and symmetry between conventional free-hand fibular preparation and those using 3-dimensional planning.
Methods: A retrospective review was performed in concordance with Yale HIC (#1101007932). Mandibular reconstructions involving free fibular transfer performed by the senior authors (SF, DMS) at a single institution between 2010-2012 were included. Cases without CT scans in the early postoperative period were excluded. Demographic and intraoperative data was collected. Post-operative CT scans were analyzed using Materialise software. Interfragmentary gap distances were assessed (mm), as was symmetry (degrees). Results were analyzed using a two-sided t-test.
Results: Of 45 fibular reconstructions, 16 met the criteria for inclusion. The majority were male (13M:3F), with a mean age 56.7 (range of 14-82 years). 37 gaps were analyzed (26 non-3D; 11 3D). Fibula to native mandible gap-size was 1.63mm versus 1.60mm in non-3D to 3D, respectively (p=0.9621). Inter-fibular gaps measured 1.89mm versus 0.00mm in non-3D compared to 3D (p=0.024). Symmetry (a ratio between right and left angles) measured 1.024 versus 1.01 in non-3D compared to 3D (p= 0.8011).
Conclusions: 3D planning with use of intraoperative cutting guides and prebent plate lessens interfibular gap dimensions and may enhance axial symmetry. Space between native mandible and fibula is not appreciably altered using planning. Future efforts will focus on the accuracy and reproducibility of the 3D planned to actual results as well as clinical significance and efficiency benefits.


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