Applying computer techniques in maxillofacial reconstruction using a fibula flap: a messenger and an evaluation method.

While the application of computer-assisted maxillofacial surgery becomes increasingly popular, the translation from virtual models and surgical plans to actual bedside maneuvers and the evaluation of the repeatability of virtual planning remain to be major challenges. The objective of this study was to experiment the technique of using a resin template as a messenger in maxillofacial reconstruction involving a fibula flap. Another aim was to find a quantitative and objective method to evaluate the repeatability of preoperative planning. Seven patients who underwent maxillary or mandibular reconstruction were included in this study. The mean age was 25 years, and the mean follow-up period was 18.7 months. Virtual planning was carried out before surgery. A resin template was made according to the virtual design of bone graft through rapid prototyping technique and served as a guide when surgeons shaped the fibula flap during surgery. The repeatability of the virtual plan was evaluated based on the matching percentage between the actual postoperative model and the computer-generated outcome. All patients demonstrated satisfactory clinical outcomes. The mean repeatability was 87.5% within 1 mm and 96.5% within 2 mm in isolated bone graft. It was 71.4% within 1 mm and 89.9% within 2 mm in reconstructed mandible or maxilla. These results demonstrated that a resin template based on virtual plan and rapid prototyping technique is a reliable messenger to translate from computer modeling to bedside surgical procedures. The repeatability of a virtual plan can be easily and quantitatively evaluated through our three-dimensional differential analysis method.