Segmental Mirroring: Does It Eliminate the Need for Intraoperative Readjustment of the Virtually Pre-Bent Reconstruction Plates and Is It Economically Valuable?

Purpose: The aim of this study was to compare segmental mirroring with mirroring of the entire unaffected side to determine which method obviates intraoperative readjustment of virtually planned pre-bent plates and to evaluate the effect on costs. Materials and Methods: Patients eligible for inclusion in this prospective study had unilateral mandibular discontinuity defects. Patients were randomly divided into 2 groups. In group I, models were constructed by mirroring the entire unaffected side of the mandible at the midsagittal plane. In group II, only the resected segments were cut and replaced by the corresponding mirrored healthy segments. The lesions were resected, and their sites were reconstructed using pre-bent reconstruction plates. The need for intraoperative plate readjustment, plate placement time, operation time, and operation costs were reviewed. Results: Fifty patients were enrolled in this study. All but 5 plates in group I required readjustment. In group II, plates were placed without intraoperative handling. Average operating times were 4.20 +/- 0.56 hours in group I and 3.186 +/- 0.28 hours in group II (P = .00002). Mean times for plate placement were 33.36 +/- 8.20 and 21.88 +/- 5.73 minutes in groups I and II, respectively. The difference resulted in an average time gain of 11.48 minutes. Average personal costs per minute were US$740.77 for group I and US$560.87 for group II. The difference resulted in an average saving of approximately US$179.90. Conclusion: Segmental mirroring is superior in reflecting the bone anatomy in 3-dimensional models, thus eliminating intraoperative plate readjustment and providing better plate adaptation with better contour. It decreases operating time and costs and thus can be recommended for lesions that do not cross the midline. (C) 2016 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 74: 621-630, 2016