A Modified Method Using Double Computed Tomography Scan Procedure to Maintain Mandibular Width in Mandibular Reconstruction.

OBJECTIVE: The purpose of this study was to evaluate the use of a modified template system and double computed tomography scan procedure to maintain mandibular width in cases of mandibular reconstruction. STUDY DESIGN: Ten patients who underwent mandibular reconstruction with a fibular flap were enrolled. The surgeries were planned with a computer-aided surgical simulation (CASS) planning method. Following double computed tomography scan procedure, the template system was designed in a computer and was fabricated using a three-dimensional printing technique. The cutting guides were designed with the holes of the conventional reconstruction plate on the remnant mandibular segments. After surgery, the outcome evaluation was compared by first superimposing the post-operative computed tomography model onto the planned model and then measuring the differences between the planned and actual outcomes. RESULTS: All surgeries were completed successfully using the template system. With the use of the templates, the largest linear root-mean-square deviation (RMSD) between the planned and post-operative remnant segments was 1.01 mm, and the largest angular RMSD was 4.05 degrees . CONCLUSIONS: The authors conclude that this template system and double computed tomography scan procedure provides a reliable method to maintain mandibular width in mandibular reconstruction using a fibular flap.