USE OF 3D PRINTING AND VIRTUAL 3D IMAGING TO AID MANDIBULAR RECONSTRUCTION; A LOW COST, EASY AND REPRODUCIBLE METHODOLOGY AT OUR CENTER

ABSTRACT 3D printing and virtual planning can be an effective tool to help in planning osteotomies and implant designs in mandibular reconstruction using free fibula flap. Unfortunately, in developing countries it is considered as an expensive and time-consuming affair requiring highly skilled technicians to finish the job. We have devised a cheap (less than 30£), rapid and reproducible method for this process, which can be performed by residents with the help of the operating surgeon using freely available online software. The study was conducted in the span of 4 years from 2016-2019 in the Department of Plastic Surgery, SMS Hospital, Jaipur. 40 Patients were randomly categorised in two groups of 20 each, one of which underwent Conventional Free Fibula Flap and the other group consisted of those where 3D Printing was used. Comparative study clearly demonstrated a significantly better aesthetic outcome of 3D Printing and virtual planning group. The modality significantly reduced surgeons operative time where reconstruction time was 83.9 mins in the Cases group 124 mins in the control group. 3D printing and virtual 3D Imaging helps to improve the quality of mandibular reconstruction giving a better aesthetic outcome. Besides, it also reduces the operative time and gives us a chance to use pre bent implants used for reconstruction. Our methodology is simple, cost effective and fast therefore we believe that this tool should be incorporated often in Free Fibula Flaps for mandibular reconstruction in developing countries like ours. We know that Free Fibula Flap is now regarded as the gold standard for reconstruction following mandibular resection for oncological conditions. ( 1 , 2 ) However, the results are often confounded due to inappropriate estimation of the defect and/or angulation of osteotomy. When we talk about problems of traditional methods of reconstruction we observe that it requires surgeons experience as a guide to accurate planning of the fibular graft. This is difficult to control and often the surgeons are met with dissatisfying results.