Computer-Aided Design and Manufacturing in Free Fibula Reconstruction of the Mandible: Comparison of Long-Term Outcomes.

[BACKGROUND] Preoperative computer-aided design and computer-aided manufacturing (CAD/CAM) revolutionized head and neck reconstruction after extirpative surgery. However, studies performing head-to-head comparison to the conventional technique have limited long-term follow-up. The authors aimed to compare short and long-term outcomes between conventional and CAD/CAM approaches for mandibular reconstruction with free fibula flaps.

[METHODS] Patients undergoing free flap reconstruction from 2012 to 2021 were included. Data regarding patient demographics, medical history, surgical details, complications, and reconstructive outcomes were collected. Patients who had CAD/CAM were compared with the patients who underwent reconstruction with the conventional technique. The cumulative incidence of hardware maintenance was displayed using the Kaplan-Meier method.

[RESULTS] A total of 215 patients (conventional, n = 79; CAD/CAM, n = 136) were included. Both cohorts had similar demographics, but the CAD/CAM cohort was younger ( P = 0.043). The mean operative duration was 54 minutes shorter with the use of CAD/CAM ( P = 0.014). Total and partial flap loss rates were similar. Patients with CAD/CAM had significantly lower rates of early wound dehiscence ( P = 0.037). Median (interquartile range [IQR]) follow-up duration was similar (931 days [IQR, 1854 days] in conventional versus 728 days [IQR, 841 days] days in CAD/CAM; P = 0.084). After excluding patients with major surgical complications in the first 30 days, the CAD/CAM cohort had a lower hardware removal rate (28.8% versus 13.9%; P = 0.011). The significance persisted after including only the patients with more than 2 years of follow-up.

[CONCLUSION] The use of preoperative CAD/CAM may reduce operative duration, while allowing for longer maintenance of hardware with reduced removal rates because of complications.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, III.