| Objective:The mandibular defect caused by tumor seriously affects the function and beauty of the patient’s maxillofacial region.As a new operation,computer-assisted free fibula mandibular reconstruction can accurately restore the shape and function of the mandible and improve the efficiency of the operation.In this study,we collected general clinical data,preoperative and postoperative CBCT images of patients who underwent computer-assisted free fibular mandible reconstruction in the Department of Oral and Maxillofacial surgery of our hospital due to mandibular defects after tumor resection.The purpose of this study was :（1）Evaluate the clinical effect of computerassisted free fibula mandible reconstruction.（2）Establish a standardized,repeatable and simple digital evaluation method to accurately evaluate the accuracy of computerassisted free fibula mandible reconstruction,and to provide guidance for preoperative virtual design.Methods:From January 2015 to January 2020,20 cases of mandibular defect caused by mandibular tumor underwent computer-assisted free fibula mandibular reconstruction in the Department of Oral and Maxillofacial surgery of our hospital were selected as the objects of this study.（1）The basic clinical data of this subjects were collected,including age,sex,pathological diagnosis,types of defect,intraoperative blood loss,length of hospital stay and complications.The data were collected and analyzed by SPSS 26.0 software to analyze the clinical effect of computer-assisted free fibula mandibular reconstruction.（2）The CBCT images of the subjects were collected one week before operation and one month after operation.With the aid of Mimics Research 21.0 and 3-matic Research 13.0 software,the coronal,sagittal and axial mandibular angles before and after reconstruction were measured and analyzed,the postoperative effect of computer-assisted free fibula mandibular reconstruction was evaluated.Results:（1）Among the 20 patients with computer-assisted free fibula mandibular reconstruction,there were 10 males and 10 females,the maximum age was 59 years old,the youngest age was 17 years old,the average age was 38.70 ±13.72 years old.Pathological diagnosis included ameloblastoma（n = 15）,keratocystic tumor（n = 2）and ossifying fibroma（n = 3）.The average intraoperative blood loss was 230 m L ±76.35 m L.The average length of stay was 30.25 d ±5.85 d.There were 7 cases of type Ⅰ defect,5 cases of type Ⅱ defect and 8 cases of type Ⅱc defect.Complications occurred in 5cases,including 3 cases of donor site infection,1 case of recipient area infection and 1case of postoperative dyspnea.（2）There was no significant difference in gender,age,pathological diagnosis,intraoperative blood loss,length of hospital stay and postoperative complications among different types of mandibular defect（P > 0.05）.（3）Among the 20 patients with computer-assisted free fibula mandibular reconstruction,no significant difference was observed in the coronal and axial mandibular angles between the healthy and affected sides before operation（P>0.05）.By contrast,a significant difference in sagittal mandibular angle was noted（P<0.05）.No significant difference was found in the coronal,sagittal,and axial mandibular angles between the healthy and affected sides after operation（P> 0.05）.Conversely,a significant difference was recorded in the absolute value of the coronal,sagittal,and axial mandibular angles between the healthy and affected sides pre-operation and postoperation（P<0.01）.There was a significant difference in the sagittal mandibular angle between the healthy side and the affected side before operation and the axial mandibular angle between the healthy side and the affected side after operation in type I defect（P<0.05）.There was no significant difference in the three-dimensional mandibular angle between the healthy side and the affected side before and after operation in other types（P>0.05）.There was no significant difference between the sagittal mandibular angle of the unaffected side and the affected side of type Ⅰ defect before operation,and there was no significant difference between the unaffected side and the affected side of II defect before operation（P > 0.05）.There were a significant difference in the absolute values of three-dimensional mandibular angle between the healthy side and the affected side before and after operation in other types（P<0.05）.Conclusion:（1）Computer-assisted free fibula mandibular reconstruction has a great clinical effect on the repair and reconstruction of mandible defect caused by tumor,and can effectively restore the function and beauty of the patient’s maxillofacial region.（2）computer-assisted free fibula mandibular reconstruction can significantly improve the three-dimensional mandibular deformities caused by tumors,and can effectively restore the accurate symmetry of mandibular anatomical structure.the evaluation method of this study can accurately evaluate the postoperative effect of mandibular reconstruction and provide guidance for preoperative design. |
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