Three-Dimensional Computed Tomography-Based Contouring of a Free Fibula Bone Graft for Mandibular Reconstruction

• Published in: Journal of oral and maxillofacial surgery Vol. 66; no. 10; pp. 2185 - 2192
• Main Authors: Thankappan, Krishnakumar, MBBS, MS, DNB, Trivedi, Nirav Pravin, MBBS, MS, Subash, Pramod, MDS, DNB, MOMSRCPS, Pullara, Sreekumar Karumathil, MD, Peter, Sherry, MDS, FDSRCS, FRCS, Kuriakose, Moni Abraham, MD, FRCS, Iyer, Subramania, MCh, FRCS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2008; Elsevier
• Subjects: Adult; Biological and medical sciences; Bone Transplantation - methods; Child; Dentistry; Female; Fibula - surgery; Humans; Imaging, Three-Dimensional - methods; Male; Mandible - surgery; Mandibular Neoplasms - rehabilitation; Medical sciences; Middle Aged; Oral Surgical Procedures - methods; Otorhinolaryngology. Stomatology; Reconstructive Surgical Procedures - methods; Surgery; Surgical Flaps; Tomography, X-Ray Computed; Mandible; Fibula; Treatment; Radiodiagnosis; Stomatology; Bone graft; Surgery; Free graft; Medical imagery; Anatomical reconstruction; Computerized axial tomography
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2008.01.035

The fibula osteo-cutaneous free flap is considered the tissue of choice for mandibular reconstruction. The fibula, a linear bone, has to be contoured accurately by osteotomies to restore the 3-dimensional (3D) form and occlusal relationship with the opposing maxillary dentition, and to regain the form and function of the neo-mandible. The conventional method of reconstruction of the mandible involves contouring a metal plate before resection of the involved bone segment, and to use it as a template to contour the neo-mandible. This technique, however, is not possible in situations where the hemi-mandible is absent (Fig 1) or is distorted by pathology (Fig 2). We report on a technique of creating a virtual neo-mandible, and using it as a template to contour the fibula.