AUTHOR=Pu Jingya Jane , Choi Wing Shan , Yeung Wai Kan , Yang Wei-Fa , Zhu Wang-Yong , Su Yu-Xiong 

TITLE=A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.743389

DOI=10.3389/fonc.2021.743389

ISSN=2234-943X

ABSTRACT=Objectives: Although computer-assisted surgery using fibula flap has been widely applied for oncologic jaw reconstruction in recent years, the inaccurate positioning of the fibula harvest guide brings sliding and rotational errors, which leads to compromised accuracy in simultaneous implant placement and dental rehabilitation. This study aimed to develop a novel 3D-printed patient-specific fibula malleolus cap to increase oncologic reconstruction accuracy. 
Methods: In this prospective comparative study with a recent historical control cohort, patients in need of oncologic jaw reconstruction with fibula free flaps were recruited. In the study group, the fibula was harvested with the guide of the malleolus cap, whereas the control group without the malleolus cap. Deviations of location and angulation of distal fibula osteotomies, jaw reconstruction segments, and simultaneous dental implants were compared. 
Results: Twenty patients were recruited with ten in each arm. The application of the malleolus cap significantly reduced the deviations in locations and angles of distal fibula osteotomies, from 9.5mm to 4.1mm and 25.3 to 8.7 degrees. For the simultaneous dental implants placed in the fibula flaps, there was a significant increase in the accuracy of implant platform locations (the average deviation from 3.2mm to 1.3mm), apex locations (from 3.8mm to 1.5mm), and angles (from 11.3 to 4.6 degrees). No significant difference was detected in the accuracy of fibula reconstruction segments. 
Conclusions: We developed a novel fibula malleolus cap to overcome the sliding and rotational errors during fibula flap harvesting for oncologic jaw reconstruction, with increased accuracy in simultaneous dental implants. This is a step forward to achieve a satisfactory functional outcome of jaw reconstruction with dental rehabilitation.