MAXILLARY AND MANDIBULAR RECONSTRUCTION USING VSP AND 3D PRINTING TECHNOLOGY: A REVIEW OF 42 PATIENTS

Backround: Accuracy of the reconstructed bony structures is the key for achieving favorable aesthetic and functional results in head and neck reconstruction. For precision of the preoperative planning in oncological resections, trauma, composite flap harvesting and reconstruction, we have applied 3D Printing technology. Material and Methods: 42 patients treated (25 male and 17 female) over a 6 years time by a single surgeon. 34 had neoplasia and 8 traumas. 40 Fibula flaps and 2 DCIA were used. Each patient underwent a CT scan following an appropriate scanning protocol. The image data (DICOM) converted to a 3D virtual model using appropriate medical software (MIMICS and BLENDER) and the resection and reconstruction surgery were virtually performed. Cutting guides for both donor and recipient site were printed. The reconstructed maxilla /mandible with the bony flap were also printed in order to pre-bent the reconstruction plate. Results: The flap success rate was 97,6%. Two flaps appeared with venous congestion, but both salvaged after urgent re-exploration in OR. 1(2,4%) Flap loss. There were 2(7.4%) donor site hematomas and one (3.4%) orocutaneous fistula of the neck. Flap warm ischemia time was significantly reduced and accuracy in bony reconstruction was achieved. Dental implants we successfully placed in 29 patients. Conclusions: The process of 3d printing allowed the accurate flap fabrication in situ (osteotomies), prior to division of the pedicle, thereby minimizing warm ischemia time, accurate fixation of the composite flap, maintaining the condyles in place and achieving accurate occlusion.