3d Model, 3d Printing, Facial Symmetry, Free Fibular Flap, Mandibular Reconstruction
Conditions
Keywords
3d printing, facial symmetry, free fibular flap, 3d model, mandibular reconstruction
Brief summary
Three-dimensional (3D) printing is increasingly used in surgery to help doctors plan and perform complex operations with greater accuracy. In this study, the investigators used 3D-printed jaw models to assist in rebuilding the lower jaw (mandible) after tumor removal, using bone taken from the lower leg in a procedure called a free fibular flap. The investigators compared two types of 3D-printed mandibular guides. One used a complete model of the patient's healthy mandible to guide reconstruction, while the other rebuilt the jaw by dividing the leg bone into planned segments and fitting them precisely into the jaw defect. All 3D design and printing were performed in-house by the surgical team using free computer software. After surgery, the investigators evaluated facial symmetry using standardized photographs taken before surgery and three months afterward. Both techniques helped surgeons achieve good reconstruction results. However, the segmented model produced more consistent facial symmetry, while results from the whole-mandible model varied more between patients. Overall, this study shows that in-house 3D printing is a practical and affordable tool for jaw reconstruction surgery. Although both approaches were effective, segmented models may offer more reliable results. Larger studies are needed to confirm these findings and improve future patient care.
Interventions
DEVICE3D-printed surgical guide - segmented model
In this technique, a 3D scan of the patient's mandible was isolated, the defect excised, mimicking post-surgical resection mandible. Then, the 3D scan of the patient's fibula was isolated and arranged into segments to match the post-resection defect of the mandible. The final result would resemble the patient's mandible after reconstruction with free fibular flap.
DEVICE3D-printed surgical guide - whole mandible model
In this technique, the patient's mandibular anatomy was segmented from the preoperative 3D scan, and the diseased portion of the mandible was digitally removed. The unaffected hemimandible was then mirrored across the sagittal plane to generate a symmetrical, anatomically normal mandibular contour. When the defect extended beyond the midline, a standardized normal mandibular model was digitally trimmed and adapted to the patient's anatomy by adjusting the intercondylar distance and mandibular curvature. The finalized model was positioned within the patient's mandibular fossa to ensure accurate anatomical alignment and optimal fit.
Sponsors
Indonesia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
1. Patients undergoing segmental mandibular reconstruction with a free fibular flap. 2. Mandibular defects resulting from benign tumors, malignant tumors, trauma, or osteonecrosis requiring reconstruction. 3. Availability of preoperative high-resolution CT imaging suitable for virtual surgical planning and 3D modeling. 4. Agreed and signed the consent forms
Exclusion criteria
1. Contraindications to free fibular flap harvest (e.g., significant peripheral vascular disease, prior fibular surgery). 2. History of previous mandibular reconstruction or major maxillofacial surgery altering baseline anatomy. 3. Preexisting severe facial asymmetry unrelated to the mandibular defect. 4. Inadequate imaging data or incomplete medical records. 5. Incomplete or poor-quality postoperative photographs preventing accurate asymmetry measurement.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| FACIAL SYMMETRY | From enrollment to 1 month postoperatively | Postoperative assessment of facial symmetry was performed using clinical photographs and plain radiograph of the head (AP) taken 1 month after surgery. The facial asymmetry index (AI) was calculated using the formula: AI (%) = (R - L)/(R + L) × 100%, based on cephalometric landmarks including sella-nasion (Sn), angle of the mouth (Am), and soft tissue pogonion (Po) (Figure 3), in accordance with the method described by Nakamura et al.⁴. This index represents the proportional difference between the right and left sides of each landmark relative to total facial width, expressed as a percentage. Higher AI values indicate greater facial asymmetry. |
Countries
Indonesia
Outcome results
None listed