Patient-specific guided Deep Circumflex Iliac Artery free flap for mandibular reconstruction in an ameloblastoma case. Case report and insights on the current state of customized surgery in H&N reconstruction in China.

Abstract

This article presents a case of recurrent mandibular ameloblastoma treated with customized reconstructive surgery using a microvascularized DCIA bone flap. Virtual surgical planning and customized surgery, which has become increasingly adopted in head and neck reconstruction, enhances precision in tumor resection, flap design, and fixation, leading to superior functional and aesthetic outcomes. The patient, initially treated with curettage in China (2017) and Japan (2021), presented with recurrence upon relocating to Shanghai. Imaging confirmed the diagnosis, and customized surgery was planned due to the complexity of the case. The surgical approach involved patient-specific cutting guides for both the mandibular resection and iliac crest flap harvesting, ensuring precise bone segmentation and reconstruction. Contouring guides were used to optimize bone alignment, and a pre-bent titanium reconstruction plate was employed. Despite the advantages of customized surgery, its widespread implementation in China faces regulatory and financial challenges. Restrictions on patient-specific implants and high costs limit accessibility, but alternative techniques, such as contouring guides, help improve outcomes. As regulations evolve and technology advances, customized surgery is expected to become a standard approach, improving reconstructive care in complex cases. Key words:Mandibular ameloblastoma, guided surgery, customized reconstruction, head and neck, surgery in China.