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Clinical Case Example

Extensive reconstruction of 65% of the mandible using a custom-made 3D printed plate and vascularized free fibula flap

Challenge

A young woman was diagnosed with a malignant jaw tumour and extensive resection was necessary. Due to the fast progression of the disease urgent surgery had to be carried out.

Cancer involvement caused the decision of resection about 2/3 of the mandible. The condyloma and soft tissues were also needed to be removed. After such extensive resection of the lower face, surgical reconstruction was necessary.

Reconstruction of 65% of the mandible from the right condyle to the left mandibular body with free vascularized fibula grafts and individual titanium implant
Reconstruction of 65% of the mandible from the right condyle to the left mandibular body with free vascularized fibula grafts and individual titanium implant

Solution

Considering the patient’s young age reconstruction with autogenous transplant (bone with temporomandibular lobe) was chosen. To get the best possible result, 3D preoperative planning was performed using on-line surgical planning platform. During remote cooperation between surgeons and engineers, accurate resection range and reconstruction method were defined. Detailed reconstruction plan was made including: size, shape, location of bone grafts and form of reconstruction plate within articular surface. In addition to this customized design, special holes for muscle attachment were designed in the implant.

After these arrangements, 3D design of surgical templates was performed to ensure high accuracy during surgery. Personalized titanium implant, acrylic surgical guides and acrylic anatomical models of patients bones were 3D printed and delivered to the hospital with appropriate medical device documentation.

Surgery

9-hour surgery was performed by two teams of surgeons simultaneous: cancer resection with mandible reconstruction and fibula resection. Bone affected by tumour and fibula elements for reconstruction were resected with use of custom surgical guides. Holes for placing patient-specific reconstruction plate were performed using patient-specific drilling guide. The key point was the transfer of autographs with the musculoskeletal lobe to the place of reconstruction with microvascular anastomoses. After that, reconstruction of soft tissues was necessary.

Results

Because of the excellent skills of surgeons, microvascular anastomosis and application of new technologies the jaw was reconstructed successfully. Short term and 8-months after surgery patient outcomes were very good with no complications.

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