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Journal of Stomatology Oral and Maxillofacial Surgery
Volume 120, n° 2
pages 167-171 (avril 2019)
Doi : 10.1016/j.jormas.2018.09.004
Received : 7 June 2018 ;  accepted : 26 September 2018
Case Reports

The significance of computer-assisted surgery in avoiding double-barrel fibula grafts in reconstruction of the horizontal mandibular ramus

R. Prevost a, , J. Kimakhe b, D. Diep c, J. Drouet d, H. Benateau e, A. Veyssiere e
a Department of maxillofacial surgery and odontology, Hospital “Saint Louis” of La Rochelle, rue du Docteur Albert-Schweitzer, 17000 La rochelle, France 
b Department of maxillofacial and plastic surgery, Caen university hospital, 14000 Caen, Medicine faculty of Caen, university of Caen Basse Normandie, 14032 Caen cedex 5, France 
c Department of maxillofacial and plastic surgery, Caen university hospital, 14000 Caen, France 
d Department of maxillofacial and plastic surgery, Caen university hospital, Medicine faculty of Caen, university of Caen Basse Normandie, 14032 Caen cedex 5, France 
e Department of maxillofacial surgery, Caen university hospital, medecine faculty of Caen, University of Caen Basse Normandie, 14032 Caen Cedex 5, France 

Corresponding author.

It is recognized that the mandibular reconstruction with free flap allows for both functional and aesthetic restoration. The flap must be used for reconstruction of a smooth lower mandibular contour and also the alveolar bone to allow dental rehabilitation. The double-barrel fibula free flap does respond well to these imperatives, but it increases risk of vascular complications. To overcome these risks, we propose a single-barrel fibula free flap, positioned at the alveolar level and a customized 3D implant, designed by computer-assisted surgery, at the basilar level. The interest of the single-barrel fibula associated with a customized 3D implant compared to the double-barrel fibula free flap is twofold: it decreases the vascular risks associated with the plication of the second pedicle and allows patients to have a pedicle of greater length. It also allows them to have a good cortical bone placed in the alveolar bone to rehabilitate the mastication function.

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Keywords : Computer-Aided Design, Free tissue flap, Jaws, Titanium plate

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