Computer-Aided transoral partial mandibulectomy and reconstruction: Case Report

Virtual planning software and three-dimensional printing technology have improved the operation time and surgical accuracy. We performed partial mandibulectomy and reconstruction via the intraoral approach with relatively acceptable clinical results in two patients with ameloblastoma. Preoperative preparations were full skull computed tomography, virtual surgical cuttings, pre-bent load-sharing titanium plates that conformed to the additive stereolithographic models, and complex computer-aided design/computer-assisted manufacturing surgical guide for intraoperative screw placement and plate fixation. Procedures were performed transorally, but two tiny stab skin incisions were made on the unilateral posterior cheek for transbuccal screw fixation on proximal segments. Bony defects due to ameloblastoma were created by load-sharing plates and autogenous iliac bone grafts plus platelet rich plasma/fibrin followed by 6-week intermaxillary fixation. Transplanted autogenous bone grafts consolidated uneventfully, occlusion remained well and stable with intact facial profile, frontal symmetry, and inconspicuous incision marks on posterior cheeks. In selected cases, we resected huge pathologic lesions of the mandible and immediate reconstruction through a relatively conservative approach, attaining less donor site morbidities, reasonable functional and esthetic outcomes, and maintenance of adequate life quality. The perfusion status of the soft tissue matrix around the affected bone segment helps determine whether to adopt this protocol. *Correspondence to: Michael Yuanchien Chen, Division of Oral & Maxillofacial Surgery, Dental Department, China Medical University Hospital, Taichung, Taiwan, Dental College, China Medical University, Taichung, Taiwan, Tel: +886928182949; Fax: +886-0422037746; E-mail: mychen@mail.cmuh.org.tw