Novel Plate Design to Improve Mandibular and Maxillary Reconstruction with the Osteocutaneous Fibula Flap

The osteocutaneous free fibula flap is the ideal solution for complex reconstruction of the mandible and maxilla. Virtual surgical planning (VSP) can be used to optimize osteotomies and fibula position to achieve goals of bone union, dental rehabilitation, and facial aesthetics. Furthermore, VSP reduces operative timesand costs. Prefabricated, patient-specific, cutting guides allow accurate osteotomies of both the facial skeleton and the fibula according to the virtual plan. Still, perfect positioning of the bony elements (fibula and mandible or maxilla) have distinct challenges. For the lower jaw, maintaining correct alignment of the remaining segments of the mandible to avoid temporomandibular joint misarticulation is paramount. This is difficult to achieve once the mandible has lost continuity. Accurate placement of the fibula in maxillary reconstruction is difficult because there is limited space in the midface.