Standardized Templates for Shaping the Fibula Free Flap in Mandible Reconstruction

Conversion of the straight fibula bone flap into the parabolic mandible shape can be performed using customized acrylic templates made from a 1:1 mandible computed tomography scan and lateral cephalogram. The premise of the current study is to objectively quantify the variability in a series of acrylic templates used for mandible reconstruction to assess the feasibility of creating a standardized template. In this study acrylic templates of 48 consecutive adult dentate patients who underwent fibula flap mandible reconstruction from 1994 to 1999 were evaluated. Osteotomy angles for the mandibular angle, midbody and parasymphysis, and length of each bony segment were determined using a metric ruler and protractor. Values were reported as means standard deviation. The mean mandibular angle measured 122.6 +/- 6.4 degrees, while the midbody and parasymphysis angles were 153 +/- 4.5 degrees and 130 +/- 4.2 degrees, respectively. Mean bone segment lengths were: ramus 64.5 +/- 9.8 mm, distal body 47.6 +/- 4.2 mm, mesial body 40.6 +/- 3.2 mm, and symphysis 18.5 +/- 2.2 mm. It was concluded that the evaluation of patient acrylic templates used in a series of mandible reconstructions demonstrates osteotomy angles vary minimally (3-5%). Bone segment lengths vary from 10 to 15%, suggesting heterogeneity in mandible size. A standard template can be used to shape the fibula in most mandible reconstructions eliminating the need for routine preoperative imaging or costly fabricated computer-aided design/computer-aided manufacturing cutting guides.