CAD/CAM and conventional reconstruction of the mandibular condyle by fibula free flap: a clinical and radiological evaluation

The aim of this study was to analyse the radiological and clinical outcomes of condylar reconstruction by fibula free flap (FFF), comparing conventional freehand and CAD/CAM techniques. Fifteen patients (nine CAD/ CAM, six freehand) who underwent condylar reconstruction with a FFF were reviewed retrospectively regarding pre-and postoperative computed tomography/cone beam computed tomography scans and clinical function. After surgery, all patients were free of temporomandibular joint pain. Mean postoperative mouth opening was 30.80 mm, with no significant difference between the freehand and CAD/CAM groups. In all patients, laterotrusion was decreased to the contralateral side (P = 0.002), with no difference between freehand and CAD/CAM, while the axis of mouth opening deviated to the side of surgery (P < 0.001). All patients showed significant radiological deviation of the fibular neocondyle in the laterocaudal direction (lateral: P = 0.015; caudal: P = 0.001), independent of the technique. In conclusion, reconstruction of the mandibular condyle by FFF provided favourable functional results in terms of mouth opening, reduction of pain, and mandibular excursions. Radiological deviation of the neocondyle and deviation of laterotrusion and mouth opening did not impair clinical function. CAD/CAM planning facilitated surgery, decreased the surgery time, and improved the fit of the neocondyle in the fossa.

Automated summary

The aim of this study was to compare the outcomes of condylar reconstruction using fibula free flap (FFF) with conventional freehand and CAD/CAM techniques. Fifteen patients who underwent FFF condylar reconstruction were evaluated using pre- and postoperative imaging scans and clinical function assessment. The results showed that both freehand and CAD/CAM techniques had similar outcomes in terms of pain reduction and mouth opening, but there was a deviation of the jaw movement to the side of surgery. The CAD/CAM technique facilitated surgery and improved the fit of the neocondyle in the fossa.