Composite Design of In-House Manufactured Patient-Specific Instruments for Precision Mandibular Reconstruction Using Fibula Free Flap

Mandibular reconstruction requires precise surgical approaches, not only to achieve anatomical restoration but also to recover functional occlusion and aesthetic appearance. In our hospital, computer-assisted surgery (CAS) is used for preoperative simulation in maxillofacial reconstruction. Patient-specific instruments (PSIs) are designed with computer-aided design software and fabricated using a 3D printer. A 78-year-old male with left mandibular gingival cancer underwent fibular free flap reconstruction. Cutting, repositioning, and fibula assembly guides were designed to maintain mandibular position. Surgery was successfully performed using PSIs. Although CAS and PSIs enabled efficient reconstruction, differences between preoperative simulation and postoperative morphology were observed, indicating the need for further refinement.