A 3D Analysis of Plating Strategies in Mandibular Reconstruction: A Randomized Control Pilot Study

Objective(s): The purpose of this study was to compare computer-assisted mandibular plating to conventional plating using quantitative metrics.Methods: Patients scheduled to undergo mandibular reconstruction were randomized to three-dimensional modelling for preoperative plate bending or intraoperative freehand bending. Preoperative and postoperative head and neck computed tomography scans were obtained to generate computer models of the reconstruction. The overall plate surface contact area, mean plate-to-bone distance, degree of conformance, and position of the condylar head within the glenoid fossa between pre- and post-operative scans were calculated.Results: Twenty patients were included with a mean age of 57.8 years (standard deviation [SD] = 13.6). The mean follow-up time was 9.8 months (range = 1.6-22.3). Reconstruction was performed with fibular (25%) or scapular free flaps (75%). The percentage of surface contact between the reconstructive plate and mandible was improved with three-dimensional models compared to freehand bending (93.9 +/- 7.7% vs. 78.0 +/- 19.9%, p = 0.04). There was improved overall plate-to-bone distance (3D model: 0.7 +/- 0.31 mm vs. conventional: 1.3 +/- 0.8 mm, p = 0.06). Total intraoperative time was non-significantly decreased with the use of a model (3D model: 726.5 +/- 89.1 min vs. conventional: 757.3 +/- 84.1 min, p = 0.44). There were no differences in condylar head position or postoperative complications.Conclusion: Computer-assisted mandibular plating can be used to improve the accuracy of plate contouring.