gms | German Medical Science

Jaw reconstruction remains a challenge in modern maxillofacial surgery. It involves restoration of form and function, including chewing, swallowing, phonation, and facial expression. Fibular free flap is considered the workhorse in jaw reconstruction. The DCIA-flap, to a less extent, is also a valuable alternative in some instances. Correct shaping and placement of the microvascular bone graft is pivotal for success and quality of the reconstruction. Up to recently, this was largely relied to the skills and experience of the performing surgeon.

The use of virtual simulation and surgical planning (CAD/CAM) to plan jaw reconstruction with microvascular bone grafts and the collaboration of two reconstructive surgical Departments improved surgical results and outcome dramatically. In the last 3 years we had 14 cases of complex Jaw defects which were reconstructed with a free fibula flap and 10 cases which were reconstructed with a DCIA Flap. In this study we share our experience in Jaw reconstruction with the CAD/CAM Technique, showing our multidisciplinary team approach in the planning and execution of these complex cases. Our experience demonstrated that CAD/CAM-assisted technique offers a very accurate anatomical reconstruction of the jaw. The procedures using these techniques guarantee intraoperatively an exact shaping and placement of the microvascular bone graft in order to reconstruct even complex defects of the jaw bone.

The interdisciplinary approach of the two reconstructive surgery disciplines oral- and maxillofacial and plastic surgery is incorporated in our setting from the beginning of the planning phase to the surgery itself. Planning and performance of the CAD/CAM assisted reconstructive jaw surgery with two surgical teams with the individual expertise in reconstructive surgery has proven to be a most efficient team approach to these complex cases with reducing the surgery time significantly.