BRP for mandibular reconstruction with iliac bone

[SteveMaisi]

Hi everyone. It is been a long time. Now have the time to share something valuable with BRP This patient has a large mandibular tumour on the right side requiring hemandibulectomy (including removal of the right condyle).

although hemimandibulectomy only requires 1 osteotomy cut (extraction socket of the first molar), it is noted there is another cutting guide located near the right condyle. This cutting guide (condyle) is not necessary intraoperatively, however, to generate a boolean operation for the mandibular cutting guide it is compulsory to construct 2 saw boxes as per BRP steps. The prototype STL is exported to Meshmixer software where both condyle cutguide and long mandibular bridge are removed.

Right hemimandibulectomy is performed virtually

Reconstruction of the right mandible using the left iliac.

pre and post-op day3 photos

pre and post-op 3months OPG

Intra-op photos The right angle of the mandible is trimmed off to achieve acceptable facial symmetry. Sorry for the low-quality intra-op photos.

[SteveMaisi]

Another case reconstruction with iliac bone.

The left iliac bone is used to reconstruct the mandibular defect

[mauigna06]

Thanks for sharing @SteveMaisi :)

Could you explain how do you get the virtual reconstructions like below:

It may be possible to add another BRP feature for the above.

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Did you use the mandible workflow to get this surgical guide:

Could you please provide more details? :)

[SteveMaisi]

Hi I used the same workflow for mandibular reconstruction with fibula. The only different is I segment the iliac bone to become ‘fibula segment’. Issues I found so far: Iliac bone is curve. I set the ‘fibula line’ and it is off from the iliac bone due to its cuvature. I have no problem to reconstruct mandible with 1 iliac segment with 2 mandibular planes. however, for multiple segments, the fibula planes will be out of alignment and impossible to create cutting guides. I think this problem can be solved by creating a curve ‘fibula line’?

This is when i try to make 2 segments.

[mauigna06]

This is when i try to make 2 segments.

Thanks for the feedback @SteveMaisi

BRP could surely be improved further in the future to support 2 segments reconstruction with ileac :)

[SteveMaisi]

Good to hear.