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BACKGROUND: We sought to review our institutions experience with dental implant placement in free flap jaw reconstruction to determine factors impacting restoration of dental occlusion. METHODS: Exactly 48 patients underwent free flap jaw reconstruction with or without dental restoration from 2017 to 2022. Primary outcome was achievement of restored dental occlusion after jaw free flap reconstruction. RESULTS: A total of 48 patients with a mean age of 59.8 ± 16.4 years underwent jaw reconstruction from 2017 to 2022. Ten patients (20.8%) received osteointegrated dental implants. Two patients received a temporary dental prosthesis, 12 ± 4 months after initial reconstruction. Three patients received a final prosthesis, with a mean time to final prosthesis of 17.7 ± 12.4 months. Five patients did not receive any prosthesis despite placement of implants. CONCLUSION: A minority of patients received dental implant placement with free flap jaw reconstruction and only a small subset of these received a definitive dental prosthesis.

Introduction: Osteoradionecrosis (ORN) of the mandible is an unfortunate potential sequela of radiotherapy for head and neck cancer. In advanced cases of ORN, mandibulectomy, and free fibula flap reconstruction are required. We hypothesized that patients undergoing fibula free flap reconstruction and mandibulectomy for ORN pose unique challenges and experience more complications than patients undergoing fibula free flaps after oncologic mandibulectomy. Methods: After IRB approval, we created a database of all free fibula flaps for mandible reconstruction from April 2005 through February 2019. Medical records were retrospectively reviewed for patient and surgical characteristics and postoperative outcomes. Results: Four‐hundred seventy‐nine patients met the inclusion criteria (168 ORN vs. 311 non‐ORN patients). Propensity‐matching was performed based on age, BMI, smoking status, preoperative chemotherapy, and virtual surgery planning use, which yielded 159 patients in each group. ORN patients received more double‐skin‐island fibula flaps than non‐OR patients (20.8% vs. 5.7%, p < 0.001). Recipient artery other than the facial artery was utilized more commonly in ORN patients (42.1% vs. 17.0%, p < 0.001). In the unmatched cohort, ORN patients had higher rates of delayed wound healing (26.2% vs. 16.8%, p = 0.01) and surgical site infections (21.4% vs. 13.2%, p = 0.02). Rates of flap loss, return to the operating room, hematoma, operative time, and length of stay were similar between the groups. On logistic regression analysis, osteoradionecrosis was an independent risk factor for delayed wound healing. Conclusion: Based on these data, mandibular reconstruction with fibula flaps for osteoradionecrosis appears more complicated than mandible reconstruction following de novo cancer resection. Surgeons should anticipate employing two skin islands for intraoral and extraoral resurfacing, utilizing unconventional recipient vessels, and managing the delayed wound healing that ensues more commonly than non‐ORN patients. [ABSTRACT FROM AUTHOR]

Background: Although vascularized bone graft (VBG) transfer is the current standard for mandibular reconstruction, reconstruction with a mandibular reconstruction plate (MRP) and with a soft‐tissue flap (STF) alone remain crucial options for patients with poor general conditions. However, objective aesthetic outcome evaluations for these methods are limited. Methods: In a retrospective analysis of 65 patients (VBG, 33; MRP, 19; and STF, 13), mandibular asymmetry value was calculated for each patient's photograph using facial recognition AI, with a higher value indicating worse asymmetry. Results: The MRP group had a value comparable to the VBG group regardless of mandibular defect types. The STF group had a significantly higher value than the VBG group. Conclusions: Regarding cosmesis, STF was inferior to VBG, whereas MRP was comparable to VBG, even for anterior defects for which rigid reconstruction is mandatory. However, MRP's risks of plate‐related complications limit its use to cases where VBG is contraindicated or with poor prognosis. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Segmental mandibulectomy and reconstruction of resulting defect can be performed via intraoral approach (IOA) or extraoral approach (EOA). Both approaches have advantages, disadvantages, indications, and contraindications to consider during their selection. To compare IOA vs EOA of segmental mandibulectomy and microvascular reconstruction with fibula free flap (FFF). We conducted a retrospective cohort study in which 51 patients who underwent segmental mandibulectomy and microvascular reconstruction with FFF from 2020 to 2024 were included, especially 17 patients by IOA and 34 patients by EOA, representing both groups of this study. Clinical characteristics, surgery parameters, and patients' prognosis were evaluated. Patients' satisfaction and Derriford Appearance Scale (DAS59) were assessed during follow-up. Ameloblastoma was the most frequent diagnosis (52.9% managed by IOA vs 70.6% by EOA); FFF was frequently positioned as double barrel (94.1% managed by IOA vs 88.2% by EOA). Compared with EOA group, IOA group had less intraoperative blood loss (mean difference [MD] = −112.2, 95% confidence interval [CI]: −178.9 to −45.5, p = 0.001), higher satisfaction score (MD = 1.3, 95% CI: 0.9 to 1.7, p ˂ 0.001), and lower DAS59 score (MD = −0.5, 95% CI: −0.7 to −0.2, p ˂ 0.001). Both IOA and EOA were found safe and feasible, presenting similar perioperative features and postoperative outcomes. Patients managed with IOA were more satisfied with aesthetic outcomes than patients managed with EOA. In the absence of simultaneous immediate implant during mandibular FFF reconstruction, after stability of FFF on the defect site, patients should always be referred to an implantologist and/or prosthodontist for teeth restoration to improve functional and aesthetic outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Mandibular continuity defects can cause functional and cosmetic deformities affecting a patient's quality of life. Reconstruction of such defects can be intricate even for the most seasoned maxillofacial surgeons. Reconstruction plates were the standard of care in the past, followed by a secondary reconstruction using autogenous grafts. Materials and methods: Novel technological upgrades like customized computer-designed patient-specific implants (PSIs) have overtaken these stock reconstruction plates to enhance the aesthetics and address the individual clinical situation. Affirmation of the above plate design using biomechanical analysis can further improve the efficacy of PSIs. Discussion: The present case report describes a novel combination of an autogenous graft and a low-cost patient-specific implant with the prosthesis design validated using finite element analysis. The authors have also reviewed the biomechanical evaluation of PSIs design and its uses in treating mandibular continuity defects. Conclusion: Use of FEA helped to inspect the potential weakness and stress distribution through out the implant due to this there was no sign of hardware failure. [ABSTRACT FROM AUTHOR]

Objective: Unknown etiology. Background: Ameloblastoma is a locally aggressive, benign, odontogenic tumor. Reports suggest that the chances of recurrence of this tumor are high if treated with a conservative approach. Concordantly, surgical removal of the lesion along with the affected adjacent tissues and bone structure is recommended to reduce the chances of recurrence. Post-surgical prosthetic rehabilitation is advised to improve speech, mastication, and aesthetic appearance. This case report highlights the treatment and reconstruction challenges that maxillofacial surgeons and their teams face in managing cases of large ameloblastoma. Case Report: A 41-year-old Sudani man was referred for the management of a large ameloblastoma associated with the left border of the mandible. Management consisted of surgical removal of the affected mandible along with prosthetically preserving the mandible with grafts and screws. Histopathological, computed tomography, and incisional biopsy evaluation confirmed the presence of ameloblastoma. Postoperatively, no complications were reported. Six months postoperatively, no sign of recurrence was seen. The patient was referred to a surgeon for placement of an endosseous implant. Conclusions: When dealing with large ameloblastoma, an interdisciplinary dental team is essential for improving the treatment results. This case highlights the importance of precise and timely primary care diagnosis and a collaborative approach to treatment. By embracing advancements in digital technologies, surgeons can enhance functional and aesthetic results, improving long-term quality of life. [ABSTRACT FROM AUTHOR]

Objective: Miniplates offer superior clinical handling and facilitate postoperative removal after mandibular reconstruction but unfavorable load distribution under high stress has been shown. This study aimed to compare the clinical outcome of patient-specific 3D-printed (PS-3D) titanium miniplate with reconstruction plate fixation in three-segmental LCL-type reconstructions for the first time. Methods: Patients undergoing three-segmental LCL-type mandibular reconstruction after malignant tumor resection between April 2017 and July 2023 were analyzed in a retrospective single-center study. Inclusion criteria were primary reconstruction using a fibula free flap and PS-3D titanium mini- or reconstruction plate fixation. Complication rates were recorded and analyzed within 6 months after surgery using the N -- 1 Chi²- and unequal variance t-test. Results: 38 patients (10 females, 28 males; mean age 61.4 ± 7.6 years) met the inclusion criteria. In 14 patients (36.8%) miniplates were used in the anterior region. Rates of fixation failure, plate exposure, incomplete osseous union, wound infection, soft tissue, and overall complications did not differ significantly between the two plate systems. Conclusion: Complication rates did not differ significantly between PS-3D miniand reconstruction plates in three-segmental LCL-type mandibular reconstructions. Given their advantages in clinical handling and postoperative removal, PS-3D miniplates can be a viable alternative also in larger mandibular reconstructio [ABSTRACT FROM AUTHOR]

Background: The Jaw‐in‐a‐Day (JIAD) procedure aims to achieve immediate functional occlusion via a single‐stage approach to maxillofacial reconstruction. While JIAD has gained popularity since its inception by Levine and colleagues, efficacy and outcome data remain limited. In this report, we discuss our experience with the JIAD technique at an Australian tertiary referral centre. Methods: A retrospective review of all JIAD procedures performed from April 2022 to December 2023 was conducted. Clinicopathologic data reviewed included demographic information, primary diagnosis, anatomical site of disease, and history of pre‐operative radiotherapy. Outcome measures of interest included operative time, number of implants placed, post‐operative complications and implant survival. Results: Nineteen patients were identified for the study. Two maxillary and 17 mandibular JIAD procedures were performed. The most common indications were squamous cell carcinoma (n = 8) and ameloblastoma (n = 5). Surgical complications included recipient site wound infection (n = 3), flap dehiscence (n = 2), haematoma formation (n = 1), and neck abscess associated with partial flap failure (n = 1). No total flap failures were identified. Of the 55 total implants placed, one implant failure occurred 2‐months post‐operatively. No loss of irradiated implants (n = 21) was observed. The median time to adjuvant radiotherapy was 57 days (range, 32–61). Eighteen of 19 patients (95%) achieved immediate dental rehabilitation, and 15/19 patients (79%) retained a functional prosthesis by the end of the follow‐up period. Conclusions: Our series supports the feasibility of single‐stage reconstruction for both benign and malignant indications. Further research is required to understand the long‐term functional, aesthetic, and health‐related quality‐of‐life outcomes with the JIAD technique. [ABSTRACT FROM AUTHOR]

Mandibular reconstruction for large bone defects is performed with consideration of patients' specific morphology and sufficient strength. Metal additive manufacturing techniques have been used to develop biomaterials for mandibular reconstruction. Titanium artificial mandibles with a lattice structure have been proposed, and the optimal conditions for their strength to withstand mechanical stress around the mandible have been reported. This study investigated the biocompatibility of a titanium artificial bone with a lattice structure fabricated under optimal conditions. The samples were fabricated using metal additive manufacturing. Body diagonals with nodes (BDN) were selected as suitable lattice structures. Dode medium (DM) was selected for comparison. The samples were implanted into rabbit tibial defects and resected with the surrounding bone at two and four weeks. Specimens were evaluated radiographically, histologically, and histomorphometrically. Radiopacity in each lattice structure was observed at two and four weeks. Histological evaluation showed trabecular bone-like tissue inside the BDN compared to the DM at four weeks. No significant differences were noted in the bone volume inside the structures. This study demonstrated the in vivo compatibility of artificial metallic bones with a BDN structure under mechanical stress conditions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the dimensional changes in free gingival grafts (FGG) at implant sites in mandibular reconstruction patients. Methods: Patients who received FGG 4 months after implant placement in the reconstructed mandible with no keratinized mucosa (KM) present were invited for re-examination after 36.7 ± 16.8 months (3.06 ± 1.4 years). Immediately after graft extraction (T0), graft width (GW), graft length (GL), graft thickness (GT), graft dimension (GD), and vertical bone height were documented. Re-examination (T1) included clinical examinations (GW, GL, GD, peri-implant probing depths, and modified Sulcus Bleeding Index), radiographic examination (marginal bone level), and medical chart review. Results: Twenty patients and 62 implants (47 in fibula flaps and 15 in iliac flaps) were included. A significant decrease in GW (51.8%), GL (19.2%), and GD (60.2%), were found between T0 and T1 (p <.001). The univariate analysis showed that GW change was not significantly associated with reconstruction technique, baseline GL, baseline GT, baseline GD, implant location, or type of prosthesis. Implant survival rate of 100% was observed at follow-up. Conclusions: Within the limitations of the study, free gingival grafts at implant sites in the reconstructed mandible undergo dimensional change that result in a reduction of approximately 60% of the original graft dimension. Graft width decreased over 50%. Clinical relevance: FGG is the standard of care intervention for increasing the amount of KM around implants. This study was the first to evaluate the dimensional change in FGG at implant sites in mandibular reconstruction patients after a medium-term follow-up. Clinical trial registration: Clinical trial registration is not applicable as this study comprehends a retrospective analysis. [ABSTRACT FROM AUTHOR]

This study is a preliminary investigation exploring the mechanical properties of three‐dimensional (3D)‐printed personalized mesh titanium alloy prostheses and the feasibility of repairing hemi‐mandibular defects. The ANSYS 14.0 software and selective laser melting (SLM) were used to produce personalized mesh titanium alloy scaffolds. Scaffolds printed using different parameters underwent fatigue property tests and scanning electron microscopy (SEM) of the fracture points. Models of hemi‐mandibular defects (encompassing the temporomandibular joint) were created using beagle dogs. Freeze–dried allogeneic mandibles or 3D‐printed personalized mesh titanium alloy prostheses were used for repair. Gross observation, computed tomography (CT), SEM, and histological examinations were used to compare the two repair methods. The prostheses with filament diameters of 0.5 and 0.7 mm could withstand 14,000 times and >600,000 cycles of alternating stresses, respectively. The truss‐structure scaffold with a large aperture and large aperture ratio could withstand roughly 250,000 cycles of alternating forces. The allogeneic mandible graft required intraoperative shaping, while the 3D‐printed mesh titanium alloy prostheses were personalized and did not require intraoperative shaping. The articular disc on the non‐operated sides experienced degenerative changes. No liver and kidney toxicity was observed in the two groups of animals. The 3D‐printed mesh titanium alloy prostheses could effectively restore the shape of the mandibular defect region and reconstruct the temporomandibular joint. [ABSTRACT FROM AUTHOR]

Purpose: The scapula is the second most popular donor site for mandibular reconstruction after the fibula. Scapula harvest is generally performed in the lateral decubitus position and the requirement of positional changes hamper the widespread use of the scapula. This study compared scapula harvest for immediate mandibular reconstruction between the supine and lateral decubitus positions. Methods: We reviewed the outcomes of 16 patients who underwent segmental mandibulectomy and immediate reconstruction of the scapula based on the angular branch of the thoracodorsal artery. The scapula was harvested in the lateral decubitus (lateral decubitus group) or supine position (supine group) in eight patients each. Several perioperative parameters were compared between the two groups. Results: One scapula was lost because of inadvertent injury of the angular branch in the supine group. The operative time was significantly shorter in the supine group than in the lateral decubitus group. Conclusion: Harvesting of the scapula in the supine position is a feasible option for immediate mandibular reconstruction. Although deep anatomic knowledge and technical expertise are necessary, this strategy can eliminate positional change and significantly reduce the operative time. [ABSTRACT FROM AUTHOR]

Objective: To investigate sociodemographic and healthcare system barriers to access and utilization of alternative treatments to positive airway pressure (PAP) in the management of adult obstructive sleep apnea (OSA). Data Sources: PubMed, Embase, and Web of Science databases were searched from 2003 to 2023 for English‐language studies containing original data on sociodemographic and healthcare system barriers to PAP‐alternative treatments for adult OSA. Review Methods: Studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses Extension for Scoping Reviews (PRISMA‐ScR) guidelines. Title and abstract screening, full‐text review, and data collection were conducted by two investigators independently. Results: Out of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP‐alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m2, fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea. Conclusion: Cumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 134:3903–3909, 2024 [ABSTRACT FROM AUTHOR]

Introduction: The scapular osseous free flap (SOFF) is being increasingly used for complex head and neck reconstructions. This study examined the surgical outcomes, focusing on post-operative complications and sequelae in patients who underwent SOFF for maxillary and mandibular reconstructions. Material and Methods: This retrospective, observational, population-based study included patients who underwent SOFF reconstruction at a tertiary referral centre, the Department of Otorhinolaryngology-Head and Neck Surgery, Skåne University Hospital, Sweden, from November 2016 to March 2023. All patients were followed-up for at least six months after surgery. Results: Forty-two of the 44 consecutive patients (60 % men) consented to the study and were evaluated with a median follow-up time of 49 months (range 8–85 months). The study divided the patients into two groups; maxillary (n = 29) and mandibular (n = 13) reconstructions. The World Health Organisation performance status and the Charlson comorbidity index were lower in the maxillary group (p = 0.025 and p = 0.011, respectively). The maxillary group experienced high complication rates including six total flap failures and nine oronasal fistulas. Conversely, the mandibular group had no flap failures but a similar rate of general post-operative complications were observed. Dental rehabilitation was more common in the maxillary group. Conclusion: The SOFF is an option for complex reconstructions of the maxilla but is associated with a relatively high rate of complications. Methods that can prevent or minimise sequelae, e.g., oronasal fistulas, in future patients are warranted. The SOFF is an excellent alternative for mandibular reconstructions.

Abstract Background Computer-aided modeling and design (CAM/CAD) of patient anatomy from computed tomography (CT) imaging and 3D printing technology enable the creation of tangible, patient-specific anatomic models that can be used for surgical guidance. These models have been associated with better patient outcomes; however, a lack of CT imaging guidelines risks the capture of unsuitable imaging for patient-specific modeling. This study aims to investigate how CT image pixel size (X-Y) and slice thickness (Z) impact the accuracy of mandibular models. Methods Six cadaver heads were CT scanned at varying slice thicknesses and pixel sizes and turned into CAD models of the mandible for each scan. The cadaveric mandibles were then dissected and surface scanned, producing a CAD model of the true anatomy to be used as the gold standard for digital comparison. The root mean square (RMS) value of these comparisons, and the percentage of points that deviated from the true cadaveric anatomy by over 2.00 mm were used to evaluate accuracy. Two-way ANOVA and Tukey-Kramer post-hoc tests were used to determine significant differences in accuracy. Results Two-way ANOVA demonstrated significant difference in RMS for slice thickness but not pixel size while post-hoc testing showed a significant difference in pixel size only between pixels of 0.32 mm and 1.32 mm. For slice thickness, post-hoc testing revealed significantly smaller RMS values for scans with slice thicknesses of 0.67 mm, 1.25 mm, and 3.00 mm compared to those with a slice thickness of 5.00 mm. No significant differences were found between 0.67 mm, 1.25 mm, and 3.00 mm slice thicknesses. Results for the percentage of points deviating from cadaveric anatomy greater than 2.00 mm agreed with those for RMS except when comparing pixel sizes of 0.75 mm and 0.818 mm against 1.32 mm in post-hoc testing, which showed a significant difference as well. Conclusion This study suggests that slice thickness has a more significant impact on 3D model accuracy than pixel size, providing objective validation for guidelines favoring rigorous standards for slice thickness while recommending isotropic voxels. Additionally, our results indicate that CT scans up to 3.00 mm in slice thickness may provide an adequate 3D model for facial bony anatomy, such as the mandible, depending on the clinical indication.

Objectives: To investigate soft-to-hard tissue response following mandibular reconstruction and to develop a predictive model for projecting soft tissue movement. Materials and methods: In this retrospective study, 18 patients receiving mandibular reconstruction using a vascularized iliac flap were enrolled. Various indicators for characterizing the movement of tissues were considered to identify the effective predictors for projecting soft tissue movements. Face-region-specific linear regression models for prediction were constructed and evaluated. Results: The arithmetic mean of hard tissue movement in an extended area had the strongest correlation with the movement of the focal soft tissue, while the arithmetic mean in a regional area (Ram) was a more effective predictor. The linear regression model using Ram, global extrema and distances between them as the predictors performed the best in the lower margin of the face, with an average error of 1.51 ± 1.38 mm. Soft tissue movement in the alveolar process was not correlated with the existence of dentition, only can be predicted by the soft tissue movement below it. The area of the masseter was strongly correlation with Ram, but no other factors. Conclusions: An accurate prediction of soft tissue movements in the lower margin and the alveolar process of the face can be achieved by considering hard tissue and adjacent soft tissue movements. No effective predictor in the masseter area was identified. Clinical relevance: We investigated the relationship between hard tissue movements and the soft tissue responses in the facial area. Through building predictive models for projecting postoperative soft tissue movements, we derive insights for the aesthetic outcome of face surgeries. Clinical trial registration: This study was registered on the Chinese Clinical Trial Registry (registration number: ChiCTR2100054103). [ABSTRACT FROM AUTHOR]

The deep circumflex iliac artery (DCIA) flap is one of the bone flaps commonly used for mandibular reconstruction. Observation of the skin paddle and Doppler ultrasound are methods that are usually used to monitor DCIA flaps after mandibular reconstruction surgery. The aim of this study was to introduce a novel DCIA flap with a perforator-supported external oblique abdominal muscle (EOAM) island for postoperative flap monitoring. This study included five patients who underwent mandibular reconstruction using this modified technique. The DCIA flap and the EOAM island supplied by the ascending branch of the DCIA were harvested during the surgery. After mandibular reconstruction, the EOAM island was placed in the submandibular region to monitor the blood supply to the DCIA flap after surgery. The blood supply to the DCIA flap was monitored by observing the colour, texture, and bleeding condition of the EOAM island. After the monitoring period, the EOAM was removed and the ascending branch of the DCIA was ligated. The outcome was successful in all patients. The EOAM island supported by the ascending branch of the DCIA is reliable and safe, thus providing a robust option to monitor the blood supply to the DCIA flap. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the surgical and postoperative management strategies that contribute to minimizing the need for prophylactic tracheostomy for airway management in advanced oral cancer surgery. Methods: A retrospective review of the patients who underwent surgery for advanced oral cancer, in our institution from February 2015 to January 2024. Results: In the present review, 66 patients (males, n = 54; females, n = 12; mean age 50.3 years) who were operated for advanced oral cancer (T3, T4 oral squamous cell carcinoma and osteosarcoma of the mandible requiring mandibular resection) in our institution were included. 60 patients (90.9%) had reconstruction after segmental resection of the mandible without the need for prophylactic tracheostomy. Out of these, eighteen patients (27.27%) required segmental resection of the mandible crossing midline. Six patients (9.1%) underwent prophylactic tracheostomy, of which two patients had unilateral tumor and four patients had tumor crossing midline. Comparison of hospital stays between patients who underwent prophylactic tracheostomy and those who did not yielded mean durations of 13.3 days and 7.6 days, respectively. Conclusion: Except a subset of patients with old age, obesity, bulky neck, and those with respiratory compromise, following the present guidelines, prophylactic tracheostomy can be avoided in patients undergoing surgery for advanced oral cancer. [ABSTRACT FROM AUTHOR]

Mandibular reconstructive surgery is necessary for large bone defects. Although various reconstruction methods have been performed clinically, there is no mandibular reconstruction method that meets both sufficient strength criteria and the patient's specific morphology. In this study, the material strength of the cylindrical lattice structures formed by electron-beam melting additive manufacturing using titanium alloy powder was investigated for mandibular reconstruction. The virtual strengths of 28 lattice structures were compared using numerical material tests with finite element method software. Subsequently, to compare the material properties of the selected structures from the preliminary tests, compression test, static bending test and fatigue test were conducted. The results showed that there were correlations with relative density and significant differences among the various structures when comparing internal stress with deformation, although there was a possibility of localized stress concentration and non-uniform stress distribution based on the lattice structure characteristics. These results suggest that the lattice structure of body diagonals with nodes and a cell size of 3.0 mm is a potential candidate for metallic artificial mandibles in mandibular reconstruction surgery. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the factors most associated with early and late complications following microvascular free tissue transfer (MVFTT) after mandibulectomy. Methods: A retrospective review of patients undergoing MVFTT after segmental mandibulectomy from September 2016 to February 2021 was performed across a single academic institution. Surgical variables were collected, including the location of the resultant mandibular defect (anterior vs posterior) and flap type (osseous or non-osseous). The primary outcome variables included postoperative complications (early, <90 days; and late, >90 days) and the patients' functional status (return to oral intake). Descriptive statistics, chi-square test, Fischer's exact test, and 2-sample t tests were used to analyze differences among variables. Results: We analyzed a cohort of 114 consecutive patients with mandibular defects, comprising 57 anterior and 57 posterior defects. Bony free flaps with hardware were used to reconstruct 98% of anterior defects compared to 58% of posterior defects (P <.001). All soft tissue only flaps did not utilize any hardware during the reconstruction. Anterior defects demonstrated more late complications requiring additional surgery (30% vs 9%, P =.04). A secondary analysis of posterior mandibular reconstructions compared soft tissue only flaps and bony free flaps with hardware and showed equivalent rates of early (12% vs 13%, P >.99) and late (9% vs 8%, P >.99) complications requiring additional surgery while demonstrating a similar return to full oral competence (55% vs 46%, P =.52) and recovery of a 100% oral diet (67% vs 54%, P =.53). Conclusion: Osseous free tissue transfer for segmental mandibular defects remains the gold standard in reconstruction. In our patient cohort, anterior mandibular defects are associated with greater late (>90 day) complications requiring additional surgery. Comparable outcomes may be achieved with soft tissue only versus osseous free flap reconstruction of posterior mandibular defects. [ABSTRACT FROM AUTHOR]

In patients with extensive jaw defects, jaw functions, such as mouth opening and occlusion, should be considered during jaw reconstruction in anticipation of implant placement and prosthetic treatment. Herein, we report a case of temporomandibular joint and mandibular bony reconstruction using custom-made trays and particulate cancellous bone and marrow, followed by implant placement. We succeeded in restoring both temporomandibular joint function and occlusion using the reconstruction plate with the condylar head, a mesh tray, and particulate cancellous bone and marrow in a patient with left mandibular reconstruction plate fracture and bony adhesion of the left TMJ. [ABSTRACT FROM AUTHOR]

Background: Segmental bone defects of the mandible result in the complete loss of the affected region. We had incorporated the pressure‐reducing device (PRD) designs into the customized mandible prostheses (CMP) and conducted a clinical trial to evaluate this approach. Methods: Seven patients were enrolled in this study. We examined the association among the history of radiotherapy, the number of CMP regions, the number of chin regions involved, and CMP exposure. Results: We included five men and two women with an average age of 55 years. We excised tumors with an average weight of 147.8 g and the average weight of the CMP was 68.5 g. No significant difference between the two weights was noted (p = 0.3882). Three patients received temporary dentures and the CMP remained stable in all patients. Conclusion: The use of PRD in CMP may address the previous challenges associated with CMP, but further research is necessary. [ABSTRACT FROM AUTHOR]

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Background: Computer-aided modeling and design (CAM/CAD) of patient anatomy from computed tomography (CT) imaging and 3D printing technology enable the creation of tangible, patient-specific anatomic models that can be used for surgical guidance. These models have been associated with better patient outcomes; however, a lack of CT imaging guidelines risks the capture of unsuitable imaging for patient-specific modeling. This study aims to investigate how CT image pixel size (X-Y) and slice thickness (Z) impact the accuracy of mandibular models. Methods: Six cadaver heads were CT scanned at varying slice thicknesses and pixel sizes and turned into CAD models of the mandible for each scan. The cadaveric mandibles were then dissected and surface scanned, producing a CAD model of the true anatomy to be used as the gold standard for digital comparison. The root mean square (RMS) value of these comparisons, and the percentage of points that deviated from the true cadaveric anatomy by over 2.00 mm were used to evaluate accuracy. Two-way ANOVA and Tukey-Kramer post-hoc tests were used to determine significant differences in accuracy. Results: Two-way ANOVA demonstrated significant difference in RMS for slice thickness but not pixel size while post-hoc testing showed a significant difference in pixel size only between pixels of 0.32 mm and 1.32 mm. For slice thickness, post-hoc testing revealed significantly smaller RMS values for scans with slice thicknesses of 0.67 mm, 1.25 mm, and 3.00 mm compared to those with a slice thickness of 5.00 mm. No significant differences were found between 0.67 mm, 1.25 mm, and 3.00 mm slice thicknesses. Results for the percentage of points deviating from cadaveric anatomy greater than 2.00 mm agreed with those for RMS except when comparing pixel sizes of 0.75 mm and 0.818 mm against 1.32 mm in post-hoc testing, which showed a significant difference as well. Conclusion: This study suggests that slice thickness has a more significant impact on 3D model accuracy than pixel size, providing objective validation for guidelines favoring rigorous standards for slice thickness while recommending isotropic voxels. Additionally, our results indicate that CT scans up to 3.00 mm in slice thickness may provide an adequate 3D model for facial bony anatomy, such as the mandible, depending on the clinical indication. [ABSTRACT FROM AUTHOR]

Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. Methods: The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. Results: Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. Conclusions: The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery. [ABSTRACT FROM AUTHOR]

Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling holes in robotic surgery minimize potential sources of error and yield highly accurate outcomes. Methods: Ten mandibular replicas were evaluated after cutting-guided saw osteotomy and robot-guided laser osteotomy following reconstruction with patient-specific implants. The descriptive data analysis summarizes the mean, standard deviation (SD), median, minimum, maximum, and root mean square (RMS) values of the surface comparison for 3D printed models regarding trueness and precision. Results: The saw group had a median trueness RMS value of 2.0 mm (SD ± 1.7) and a precision of 1.6 mm (SD ± 1.4). The laser group had a median trueness RMS value of 1.2 mm (SD ± 1.1) and an equal precision of 1.6 mm (SD ± 1.4). These results indicate that robot-guided laser osteotomies have a comparable accuracy to cutting-guided saw osteotomies, even though there was a lack of statistical significance. Conclusions: Despite the limited sample size, this digital high-tech procedure has been shown to be potentially equivalent to the conventional osteotomy method. Robotic surgery and laser osteotomy offers enormous advantages, as they enable the seamless integration of precise virtual preoperative planning and exact execution in the human body, eliminating the need for surgical guides in the future. [ABSTRACT FROM AUTHOR]

Background: Mandibular defects resulting from oncological treatment pose significant aesthetic and functional challenges due to the involvement of bone and soft tissues. Immediate reconstruction is crucial to address complications such as malocclusion, mandibular deviation, temporomandibular joint (TMJ) changes, and soft tissue retraction. These issues can lead to functional impairments, including difficulties in chewing, swallowing, and speech. The fibula flap is widely used for mandibular reconstruction due to its long bone segment and robust vascular supply, though it may not always provide adequate bone height for optimal dental rehabilitation. This systematic review aims to determine if the double-barreled fibula flap (DBFF) configuration is a viable alternative for mandibular reconstruction and to evaluate the outcomes of dental implants placed in this type of flap. Materials and Methods: This study adhered to the Cochrane Collaboration criteria and PRISMA guidelines and was registered on the International Platform of Registered Systematic Review and Meta-Analysis Protocols Database (INPLASY2023120026). We included clinical studies published in English, Spanish, or French that focused on adult patients undergoing segmental mandibulectomy followed by DBFF reconstruction and dental rehabilitation. Data sources included Medline/PubMed, the Cochrane Library, EMBASE, Scopus, and manual searches. Two reviewers independently screened and selected studies, with discrepancies resolved by a third reviewer. Data extraction captured variables such as publication year, patient demographics, number of implants, follow-up duration, flap survival, implant failure, and aesthetic outcomes. The risk of bias was assessed using the JBI appraisal tool, and the certainty of evidence was evaluated using the GRADE approach. Results: A total of 17 clinical studies were included, evaluating 245 patients and 402 dental implants. The average patient age was 43.7 years, with a mean follow-up period of 34.3 months. Flap survival was high, with a 98.3% success rate and only four flap losses. The implant failure rate was low at 1.74%. Esthetic outcomes were varied, with only three studies using standardized protocols for evaluation. The overall certainty of evidence for flap survival was moderate, low for implant failure, and very low for aesthetics due to the subjective nature of assessments and variability in reporting. Conclusions: The primary limitations of the evidence included in this review are the observational design of the studies, leading to an inherent risk of bias, inconsistency in reporting methods, and imprecision in outcome measures. Additionally, the subjective nature of aesthetic evaluations and the variability in assessment tools further limit the reliability of the findings. The DBFF technique demonstrates excellent outcomes for mandibular reconstruction, with high flap survival and low implant failure rates, making it a viable option for dental rehabilitation. However, the evidence for aesthetic outcomes is less certain, highlighting the need for more rigorous and standardized research. This review supports the DBFF as a good alternative for mandibular reconstruction with successful dental implant integration, although further studies are needed to enhance the reliability of aesthetic evaluations. [ABSTRACT FROM AUTHOR]

Keratocyst is known to be a benign lesion with aggressive behavior, rapid growth and a high recurrence rate. They are commonly asymptomatic, except when there is significant bone expansion with deformation and compression of the tissues surrounding the lesion. The objective of this report is to describe the surgical treatment of keratocyst in atrophic mandible. [ABSTRACT FROM AUTHOR]

Background: Mandibular reconstruction patients often suffer abnormalities in the mandibular kinematics. In silico simulations, such as musculoskeletal modelling, can be used to predict post‐operative mandibular kinematics. It is important to validate the mandibular musculoskeletal model and analyse the factors influencing its accuracy. Objectives: To investigate the jaw opening‐closing movements after mandibular reconstruction, as predicted by the subject‐specific musculoskeletal model, and the factors influencing its accuracy. Methods: Ten mandibular reconstruction patients were enrolled in this study. Cone‐beam computed tomography images, mandibular movements, and surface electromyogram signals were recorded preoperatively. A subject‐specific mandibular musculoskeletal model was established to predict surgical outcomes using patient‐averaged muscle parameter changes as model inputs. Jaw bone geometry was replaced by surgical planning results, and the muscle insertion sites were registered based on the non‐rigid iterative closest point method. The predicted jaw kinematic data were validated based on 6‐month post‐operative measurements. Correlations between the prediction accuracy and patient characteristics (age, pathology and surgical scope) were further analysed. Results: The root mean square error (RMSE) for lower incisor displacement was 31.4%, and the error for peak magnitude of jaw opening was 4.9 mm. Age, post‐operative infection and radiotherapy influenced the prediction accuracy. The amount of masseter detachment showed little correlation with jaw opening. Conclusion: The mandibular musculoskeletal model successfully predicted short‐range jaw opening functions after mandibular reconstruction. It provides a novel surgical planning method to predict the risk of developing trismus. [ABSTRACT FROM AUTHOR]

Purpose: Mandibular reconstruction remains a challenging procedure despite the availability of various flaps and grafts. The ultimate objective is to restore oral functioning and attain acceptable morphological outcomes while considering donor site morbidity. This study describes the vascular supply and harvesting technique of a pedicled clavicular bone. The proximity of the clavicle is conducive to a mandibular replacement and allows the use of vascularized bone with a single surgical field. Methods: The osteoperiosteal clavicular pedicled flap was harvested on the right side of ten fresh cadaver specimens. The cervical transverse artery was injected with colored latex in some cases and methylene blue in others. Results: The vascular periosteal supply of the clavicular flap was highlighted. The clavicular bone was linked to its pedicle which was composed of vascular and adipose-fascial tissues, without any overlying skin paddle. Its vasculature was supplied by a reverse flow from the ascending cervical artery. The pedicled clavicular bone readily reached the mandible in all dissections. Conclusion: The osteoperiosteal vasculature of the clavicular flap is based on the transverse cervical artery which receives a reverse blood supply from the ascending cervical artery. This vascular pattern is reliable because of the existence of the sub-occipital microvascular network named the "Bosniak node." This pedicled clavicular flap seems to be a robust perspective in both mandibular and facial bone reconstruction. We do not claim that it will replace the existing approaches, but it will expand the surgical panel of mandibular reconstruction. Its clinical realisation will judge its functionality. [ABSTRACT FROM AUTHOR]

This case report presents a mandible reconstruction with temporomandibular joint (TMJ) prothesis for treatment of osteomyelitis infection following a bimaxillary orthognathic and genioplasty surgeries. The patient, a 41-year-old female, presented with facial pain, difficulty in opening her mouth, and mandibular deviation four months after the initial orthognathic surgery. During the four months, the patient had experienced two more surgerys post-operative for treatment of the complications. Examination revealed mobility between osteotomy segments of the right mandibular osteotomomie between body and ramus, and Computer Tomographic scan analysis revealed osteomyelitis and non-union within the osteotomy side of the right mandible from the previous surgery. Due to the advanced state of the disease and significant bone resorption, treatment was planned in two stages, involving bone debridement and then reconstruction with a custom made extended temporomandibular joint prosthesis. The patient had no postoperative complications and achieved satisfactory functional and aesthetic outcomes. This case emphasizes the importance of careful monitoring and prompt management of postoperative complications following orthognathic surgery to prevent rare but serious complications such as osteomyelitis. [ABSTRACT FROM AUTHOR]

ObjectiveMiniplates offer superior clinical handling and facilitate postoperative removal after mandibular reconstruction but unfavorable load distribution under high stress has been shown. This study aimed to compare the clinical outcome of patient-specific 3D-printed (PS-3D) titanium miniplate with reconstruction plate fixation in three-segmental LCL-type reconstructions for the first time.MethodsPatients undergoing three-segmental LCL-type mandibular reconstruction after malignant tumor resection between April 2017 and July 2023 were analyzed in a retrospective single-center study. Inclusion criteria were primary reconstruction using a fibula free flap and PS-3D titanium mini- or reconstruction plate fixation. Complication rates were recorded and analyzed within 6 months after surgery using the N – 1 Chi2- and unequal variance t-test.Results38 patients (10 females, 28 males; mean age 61.4 ± 7.6 years) met the inclusion criteria. In 14 patients (36.8%) miniplates were used in the anterior region. Rates of fixation failure, plate exposure, incomplete osseous union, wound infection, soft tissue, and overall complications did not differ significantly between the two plate systems.ConclusionComplication rates did not differ significantly between PS-3D mini- and reconstruction plates in three-segmental LCL-type mandibular reconstructions. Given their advantages in clinical handling and postoperative removal, PS-3D miniplates can be a viable alternative also in larger mandibular reconstructions.

Advancements in reconstructive surgical techniques in the head and neck area have significantly improved the aesthetic and functional reconstruction of patients. Microsurgical techniques, virtual surgical planning (VSP), CAD-CAM technology, intraoperative dynamic navigation, and advanced implantology have greatly enhanced mandible reconstruction. The authors present a case report of a 30-year-old male who suffered a severe mandibular deformity from a gunshot injury. He underwent a complex reconstruction process that involved initial soft tissue repair followed by VSP for customized titanium prosthesis implantation and dental rehabilitation. Advanced software was used to aid in precise surgical and prosthetic design, ultimately restoring the patient's mandibular structure, chin alignment, and facial harmony. This innovative approach, which demonstrates the effectiveness of integrating digital technologies with surgical precision for intricate mandibular reconstructions following trauma, has a profound impact. It provides superior functional and aesthetic results compared to conventional methods, significantly improving the patient's quality of life.

Introduction: The present study evaluates the influence of virtual surgical planning with a preoperative 3D resin model on aesthetic and functional outcomes in patients treated by segmental mandibulectomy and reconstruction with fibula-free flap for oral cancer. Methods: All consecutive patients who underwent segmental mandibulectomy and mandibular reconstruction with a fibula-free flap using a 3D template at our department from January 2021 to January 2023 were included in the study. "Patients control" were patients treated by reconstruction with a fibula-free flap without using a 3D template. Three-dimensional modeling was performed by converting from preoperative computed tomography to a stereolithography format to obtain the resin 3D models. Qualitative analysis of anatomical and aesthetic results consisted of the evaluation of the patients' aesthetic and functional satisfaction and the symmetry of the mandibular contour observed at clinical examination. Quantitative analysis was based on the assessment of the accuracy and precision of the reconstruction by comparing preoperative and postoperative computed tomograms as objective indicators. Results: Seven patients (five males and two females, mean age of 65.1 years) were included in the study. All patients showed a symmetric mandibular contour based on the clinical examination. After recovery, six patients (85.7%) considered themselves aesthetically satisfied. The quantitative analysis (assessed in six/seven patients) showed that the mean difference between preoperative and postoperative intercondylar distance, intergonial angle distance, anteroposterior dimension, and gonial angle improved in the 3D template-assisted group. Conclusion: The 3D-printed template for mandibular reconstruction with microvascular fibula-free flap can improve aesthetic outcomes in comparison with standard approaches. [ABSTRACT FROM AUTHOR]

Objectives: Fibula free flaps (FFF) are the standard approach to mandibular reconstruction after partial resection, with the goal of restoring aesthetics and masticatory function. The graft position affects both and must be carefully selected. Correlations between sagittal positioning and upper airway anatomy are known from orthognathic surgery. This study aims to evaluate changes in mandibular position and upper airway anatomy after reconstructive surgery with FFF and corresponding correlations. Materials and methods: Mandibular position after reconstruction was evaluated using three-dimensional datasets of pre- and postoperative computed tomography scans of patients treated between 2020 and 2022. Three-dimensional measurements were performed on both condyles and the symphyseal region. Changes in upper airway volume and minimum cross-sectional area (minCSA) were analysed. Intra-rater reliability was assessed. Correlations between changes in upper airway anatomy and sagittal mandibular position were tested. Results: The analysis included 35 patients. Intra-rater reliability was good to excellent. Condylar deviations and rotations were mostly rated as small. Changes in symphyseal position were considerably greater. Median airway volume decreased in the oropharynx and hypopharynx. Posterior deviation of the symphysis was associated with a decreasing minCSA in the hypopharynx and vice versa. Conclusions: The overall accuracy of mandibular reconstructions with FFF is high, but there is room for optimization. The focus of research should be extended from masticatory to respiratory rehabilitation. Clinical relevance: Effects on respiratory function should be considered prior to graft positioning. The clinical relevance of upper airway changes within the complex rehabilitation of reconstructive surgery patients needs to be further investigated. [ABSTRACT FROM AUTHOR]

Background: This study compares early outcomes of osteofascial fibula free flap (OF‐FFF) with donor‐site primary closure and osteocutaneous (OC) FFF with donor‐site skin grafting in segmental mandibular reconstruction. Methods: A retrospective chart review of FFF mandibular reconstruction patients (2006–2022) divided into OF‐FFF and OC‐FFF groups. Clinical data, operative parameters, and early postoperative outcomes (≤ 90 days) were analyzed. Results: The study included 67 patients (39 OF‐FFF, 28 OC‐FFF). OF‐FFF had significantly lower donor‐site complications (12.8% vs. 53.6%, p < 0.001) and revision surgeries (7.7% vs. 35.7%, p = 0.004) compared to OC‐FFF. Recipient‐site (28.2% vs. 25%, p = 0.77) and flap (15.4% vs. 17.9%, p > 0.99) complications were comparable. Conclusions: OF‐FFF mandibular reconstruction with donor‐site primary closure is a safe and reliable technique associated with superior donor‐site and comparable flap and recipient‐site outcomes to OC‐FFF, thus may be considered as a viable alternative to OC‐FFF for selected patients. [ABSTRACT FROM AUTHOR]

Objective(s): The purpose of this study was to compare computer‐assisted mandibular plating to conventional plating using quantitative metrics. Methods: Patients scheduled to undergo mandibular reconstruction were randomized to three‐dimensional modelling for preoperative plate bending or intraoperative freehand bending. Preoperative and postoperative head and neck computed tomography scans were obtained to generate computer models of the reconstruction. The overall plate surface contact area, mean plate‐to‐bone distance, degree of conformance, and position of the condylar head within the glenoid fossa between pre‐ and post‐operative scans were calculated. Results: Twenty patients were included with a mean age of 57.8 years (standard deviation [SD] = 13.6). The mean follow‐up time was 9.8 months (range = 1.6–22.3). Reconstruction was performed with fibular (25%) or scapular free flaps (75%). The percentage of surface contact between the reconstructive plate and mandible was improved with three‐dimensional models compared to freehand bending (93.9 ± 7.7% vs. 78.0 ± 19.9%, p = 0.04). There was improved overall plate‐to‐bone distance (3D model: 0.7 ± 0.31 mm vs. conventional: 1.3 ± 0.8 mm, p = 0.06). Total intraoperative time was non‐significantly decreased with the use of a model (3D model: 726.5 ± 89.1 min vs. conventional: 757.3 ± 84.1 min, p = 0.44). There were no differences in condylar head position or postoperative complications. Conclusion: Computer‐assisted mandibular plating can be used to improve the accuracy of plate contouring. Level of Evidence: 2 Laryngoscope, 134:2182–2186, 2024 [ABSTRACT FROM AUTHOR]

This study aimed to compare the functional and esthetic results in patients following mandibular reconstruction with a free fibula flap (FFF) by virtual surgical planning (VSP) versus the conventional technique. Patients who had undergone mandibular reconstruction with a FFF by VSP or the conventional technique were retrospectively assessed. The two groups were compared regarding functional and esthetic variables with appropriate scales preoperatively, intraoperatively, and postoperatively. Twenty-four patients were evaluated in two groups: conventional (n = 8) and VSP (n = 16). The mean amount of mandibular asymmetry was 2.62 mm (SD = 1.59) in the conventional group and 1.19 mm (SD = 1.32) in the VSP group. Of the patients who underwent conventional surgery, 12.5% had mandibular asymmetry of <2 mm and 87.5% had asymmetry of 2–5 mm. Of the VSP patients, 61.5% had mandibular asymmetry of <2 mm and 38.5% had mandibular asymmetry of 2–5 mm (p = 0.03). The mean difference in size of mandibular angle on the surgical and control sides was not significantly different between the two groups (p = 0.62). The difference in mean length of the mandibular body on the surgical side relative to the control side was not significant between the two groups (p = 0.75). Differences in functional variables between the two groups were not significant. Within the limitation of the study, it seems that the VSP technique resulted in better facial symmetry and superior esthetic outcomes compared with the conventional technique. [ABSTRACT FROM AUTHOR]

Various methods currently exist to guide fibular osteotomy positioning in fibula free flap mandibular reconstruction, but patient-specific navigation methods and cutting guides require experience, and may be time-consuming and/or expensive. This study describes a robot-guided osteotomy technique for mandible reconstruction using a fibula free flap according to virtual preoperative planning. The method was assessed on five 3D-printed models and a cadaveric model. The precision of the robot-guided osteotomy was evaluated by measuring the deviations between the lengths and angles of the fragments obtained and those of the virtual planning. The average deviation of the anterior and posterior crest lengths was 0.42 ± 0.29 mm for the 3D-printed models and 1.00 ± 0.53 mm for the cadaveric model. The average angle deviation was 1.90 ± 1.22° and 1.94 ± 0.69° for the 3D-printed and cadaveric models, respectively. The results of this preclinical study revealed that fibular osteotomy positioning guidance using a robot-positioned cutting guide may be a precise, easy-to-use technique that could be tailored for fibula free flap mandibular reconstruction. [ABSTRACT FROM AUTHOR]

The Mandible can be damaged by pathological factors, tumors, trauma, infection, and needs a surgical operation for reconstruction and restoring function. There are different methods for the reconstruction of mandible. Based on the surgical approach, primary reconstruction of mandible by reconstruction plate after resection is necessary for maintaining mandibular symmetric and esthetic of the lower third of the face. A finite element model of mandible and masticatory muscles was produced from a normal person (male with 35-year-old). The normal model was resected from the left sixth tooth to the second tooth. The pathological model was reconstructed in different conditions by macro plate. Different conditions were analyzed and compared based on bite force on right fifth tooth, stress developed on screws and macro plate. The finite element analysis results showed that maximum bite force and lower stress on screws were seen in the pathological model (condition 5) when one macro plate and six screws were inserted in the mid-body. The findings showed that the use of two macro plates causes lower stress on it than when we use one. Use of one macro plate and six screws is the best choice in mandibular immobilization which decrease the stress applied on bone and increase the bite force. Because of less stress developed on macro plates and screws, use of two macro plates or one macro plate in mid-body area are also preferred. [ABSTRACT FROM AUTHOR]

Background: To compare an in‐house and a commercially available surgical planning solution for mandibular reconstruction in terms of postoperative reconstruction accuracy and economic benefit. Methods: Twenty‐nine consecutive patients with advanced oral squamous cell carcinoma (OSCC) requiring segmental mandibular reconstruction were enrolled. Fifteen patients underwent in‐house surgical planning and 14 patients underwent a commercially available planning solution. A morphometric comparison of preoperative and postoperative computed tomography (CT) data sets and a cost–benefit comparison were performed. Results: Volumes of planned and reconstructed bone segments differed significantly for both in‐house planning (p = 0.0431) and commercial planning (p < 0.0001). Significant differences in osteotomy angles were demonstrated for in‐house planning (p = 0.0391). Commercial planning was superior to in‐house planning for total mandibular deviation (p = 0.0217), intersegmental space volumes (p = 0.0035), and lengths (p = 0.0007). No significant difference was found between the two planning solutions in terms of intersegmental ossification and the incidence of wound healing disorders. In‐house planning took less time than commercial planning (p < 0.0001). Component manufacturing costs (p < 0.0001) and total cumulative costs (p < 0.0001) were significantly lower for in‐house planning. Conclusions: In‐house surgical planning is less accurate but has a cost advantage and could be performed in less time. [ABSTRACT FROM AUTHOR]

Background: Reconstruction of large mandibular defects requires reestablishment of mandibular continuity with bone and soft tissue. The microvascularized fibula flap (MFF) has the advantage of providing both, with adequate length, low resorption rate, low infection risk and possibility of dental implant insertion. It can be adapted to mandibular defects in many different ways. Purpose: This retrospective study will present and evaluate the results of the male–female joint technique for flap positioning and fixation. Methods: The technique consists of designing osteotomies on the binding edge of the MFF and recipient jaw, increasing bone contact from one to five faces. Patients submitted to mandibular reconstruction through this technique were included and evaluated regarding systemic compromise, complication occurrence as well as primary and long-term stability. Results: Ten patients underwent mandibular reconstruction with the male–female joint technique. Sixteen joints were applied, and excluding an early loss due to vascular failure, all remaining 14 joints healed uneventfully. None showed signs of early or late mobility. Conclusion: Fitting the MFF through a male–female joint that provides greater bone contact may improve stability and reduce screw loosening and mini-plate removal rates. [ABSTRACT FROM AUTHOR]

Introduction: Mandibular reconstruction with the free fibula flap (FFF) has become a standardized procedure. The situation is different with oral rehabilitation, so the purpose of this study was to investigate the frequency of implant placement and prosthetic restoration. Additionally, the patients' situation, motivation, and treatment course were structurally assessed. Materials and methods: All cases between January 2013 and December 2018 that underwent mandibular reconstruction in our department with a free fibula flap and gave written informed consent to participate were interviewed with two structured questionnaires about their restoration and quality of life. Additionally, medical records, general information, status of implants and therapy, and metric analyses of the inserted implants were performed. Results: In total 59 patients were enrolled and analyzed in this monocentric study. Overall, oral rehabilitation was achieved in 23.7% at the time of investigation. In detail, implants were inserted in 37.3% of patients and showed an 83.3% survival of dental implants. Of these implanted patients, dental implants were successfully restored with a prosthetic restoration in 63.6. Within this subgroup, satisfaction with the postoperative aesthetic and functional result was 79.9% and with the oral rehabilitation process was 68.2%. Satisfaction with the implant-borne prosthesis was 87.5%, with non-oral-squamous-cellcarcinoma patients being statistically significantly more content with the handling (p=0.046) and care (p=0.031) of the prosthesis. Discussion: Despite the well-reconstructed bony structures, there is a need to increase the effort of achieving oral rehabilitation, especially looking at the patient's persistent motivation for the procedure. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the differences in the accuracy of immediate intraoral, immediate extraoral, and delayed dental implant placement with surgical guides (static computer‐aided implant surgery) in patients treated with mandibular reconstruction. Methods: This was a retrospective study. The patients were divided into three groups: immediate intraoral placement (IIO), immediate extraoral placement (IEO), and delayed placement (DEL). Four variables were used to compare the planned and actual implant positions: angular deviation, three‐dimensional (3D) deviation at the entry point of the implant, 3D deviation at the apical point of the implant, and depth deviation. Results: The angular deviation was significantly higher in the IIO group than in the IEO (p <.05) and DEL (p <.05) groups. The 3D deviation at the entry point was significantly higher in the IIO group than in the IEO (p <.05) and DEL (p <.01) groups. The 3D deviation at the apical point was significantly higher in the IIO group than in the IEO (p <.01) and DEL (p <.01) groups. The depth deviation was significantly higher in the IIO group than in the IEO (p <.05) and DEL (p <.05) groups. There was no statistical difference between the IEO and DEL group in angular and 3D deviation. Conclusion: With surgical guides, among the different approaches for implant placement, delayed implant placement remains the most accurate approach for patients treated with mandibular reconstruction. [ABSTRACT FROM AUTHOR]

Simple Summary: This study evaluated the clinical and economic impacts of immediate versus delayed reconstruction of the mandible in patients following resection. Data from two German oral and maxillofacial surgery university departments provided insights into patient demographics, surgical details, medical histories, and flap survival rates. Our analysis of 177 reconstructions (72 immediate, 105 delayed) revealed no significant difference in flap survival based on timing or radiotherapy. However, immediate reconstruction is less cost-intensive. The findings aim to inform surgical decision-making, balancing patient health and cost-effectiveness. Crucially, only 18% of patients achieved functional masticatory rehabilitation, underscoring the need for improved post-surgical care pathways. In this retrospective study, the clinical and economic implications of microvascular reconstruction of the mandible were assessed, comparing immediate versus delayed surgical approaches. Utilizing data from two German university departments for oral and maxillofacial surgery, the study included patients who underwent mandibular reconstruction following continuity resection. The data assessed included demographic information, reconstruction details, medical history, dental rehabilitation status, and flap survival rates. In total, 177 cases (131 male and 46 females; mean age: 59 years) of bony free flap reconstruction (72 immediate and 105 delayed) were included. Most patients received adjuvant treatment (81% with radiotherapy and 51% combined radiochemotherapy), primarily for tumor resection. Flap survival was not significantly influenced by the timing of reconstruction, radiotherapy status, or the mean interval (14.5 months) between resection and reconstruction. However, immediate reconstruction had consumed significantly fewer resources. The rate of implant-supported masticatory rehabilitation was only 18% overall. This study suggests that immediate jaw reconstruction is economically advantageous without impacting flap survival rates. It emphasizes patient welfare as paramount over financial aspects in clinical decisions. Furthermore, this study highlights the need for improved pathways for masticatory rehabilitation, as evidenced by only 18% of patients with implant-supported dentures, to enhance quality of life and social integration. [ABSTRACT FROM AUTHOR]

We evaluated the subjective donor-site morbidity and quality of life in patients with a free fibula flap (FFF) reconstruction in terms of self-reported symptoms, function and quality of life, and we compared inclusion vs. exclusion of the flexor hallucis longus (FHL) muscle in the graft, primary wound closure vs. skin graft and the occurrence vs. absence of donor-site complications. In this cross-sectional study, patients who underwent a mandibula or maxilla reconstruction with a FFF between 2011 and 2021, were included. Symptoms and function were measured with the Foot and Ankle Outcome Score (FAOS) and quality of life with both FAOS and a Visual Analogue Scale (VAS). Thirty-four patients were included in the analyses (mean age 59 years, 59% males). Most patients underwent a mandibular reconstruction for a malignancy. The median FAOS domain scores ranged between 92.9 (interquartile range (IQR) 77.7–100.0) and 100.0 (IQR 88.2–100.0) points, and the median VAS score was 86.5 points. No statistically significant differences were found between inclusion vs. exclusion of the FHL, primary wound closure vs. graft and occurrence vs. absence of donor-site complications. An unfavorable trend was seen for inclusion of the FHL in the flap on recreational functioning, and quality of life. Patients who underwent a FFF experience little donor-site morbidity and high quality of life, as measured by FAOS and VAS. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to introduce and evaluate a modified one-and-a-half-barrel fibular technique guided by occlusion for functionally reconstructing mandibular defects. Materials and Methods: Fifteen patients underwent mandibular reconstruction with the modified one-and-a-half-barrel technique and simultaneous insertion of dental implants. A vascularized fibular segment was used to reconstruct the alveolar ridge of the neomandible with dental implants loaded simultaneously. The inferior border was reconstructed with a nonvascularized segment. Panoramic radiographs were taken 1 week, 6 months, and 12 months after the surgery to measure the vertical height of the fibular segment, calculate the bone resorption rate at different time points, and observe the implant marginal bone loss and crown-to-implant ratio. The OHIP-14 questionnaire was employed to evaluate the perceived outcomes of oral rehabilitation. Results: The vertical height of the vascularized and nonvascularized fibular segments 1 week, 6 months, and 12 months after the surgery was 14.51 ± 1.93, 14.19 ± 1.88, and 13.81 ± 1.78 mm; and 8.65 ± 0.98, 7.72 ± 0.94, and 7.25 ± 0.93 mm, respectively. The bone resorption rate of vascularized and nonvascularized fibular segments was 2.20% ± 1.04% and 10.69% ± 5.73%, respectively, in the first 6 months, and 2.67% ± 1.44% and 6.16% ± 2.75%, respectively, in the latter 6 months, showing a significantly higher resorption rate in the nonvascularized segment (P < .05). The implant marginal bone loss after functional loading was significantly greater than that before dental rehabilitation (P = .001). The OHIP-14 total scores were 20.07 ±10.24, 19.00 ± 7.82, and 3.93 ± 1.87 before surgery, at 6 months, and at 12 months after surgery, respectively (P = .000). Conclusion: The proposed technique not only guarantees the esthetic appearance of patients but also achieves a suitable vertical height to facilitate the placement of the implant at the same time. [ABSTRACT FROM AUTHOR]

Background and objective. The free fibula flap is currently considered the gold standard for mandibular reconstruction, since it provides an adequate amount of bone tissue which can be modeled through osteotomies, as well as a vascular pedicle of adequate length and caliber; however, long-term side effects are rarely reported. The objective of our work is to describe the radiological findings found in the temporomandibular joint of a series of 5 patients undergoing mandibular reconstruction with a free fibula flap, as well as to analyze the factors that influence these modifications, with the aim of preventing deleterious changes to this structure Methods. Retrospective and descriptive review of clinical records and comparative assessment of pre- and post-operative tomographic studies of patients undergoing mandibular reconstruction with a microvascularized fibula flap between 2014 to 2022. The data review included general characteristics of the patient, assessment of functional results, tomographic changes in the temporomandibular joint and symptoms associated with these changes. Results. A total of 5 patients were included, 4 women and 1 man, 4 of them were in their third years of life at the time of their surgical intervention. All patients showed greater or lesser extent tomographic changes in the temporomandibular joints, and 4 of them occasionally reported one or more of the following symptoms: painful jaw movement, headache, cervical pain or stiffness, clicking or grinding noises within the temporomandibular joint. Conclusions. In our series, the tomographic changes in the temporomandibular joint of patients undergoing mandibular reconstruction with free fibula flaps are evidence of incipient damage that, if left untreated, can progress to generate chronic pain and functional disability. [ABSTRACT FROM AUTHOR]