Standardized Osteotomy Guides for Free Flap Reconstruction of Continuous Defects of the Jaws - a Simplified Method

Subjects The participants in this retrospective survey were consecutive head- and neck malignancy patients referred 2002-2021 to Skåne University Hospital, Lund, Sweden with an osseous proximity or malignancy. The treatment consisted of combined surgical resection and radiotherapy. Patients will be identified through the use of ICD-coding. All patients included underwent a primary functional and aesthetical reconstruction of continuous defects of the jaws with free vascularized tissue transfer adopted to the area of resection with the aid of a standardized osteotomy guide. The subjects eligible for inclusion in this project should present at least 1-year postoperative follow-up.

Patients eligible for inclusion will be notified in newspaper announcement. One announcement in a national newspaper and one announcement in the member newspaper of the Association for oral and neck cancer patients. Patients that are not agreeing to take part in this project are expected to declare this to the primary investigator. A drop-out analysis will be performed on 30 of the not included subjects according to age and gender.

Surgical Method Reconstruction of resected osseous anatomy was performed on the same occasion as tumour resection. Increased resection margins were decided after marginal intraoperative frozen autopsies. The reconstruction was performed aiming for maximal function with the best possible aesthetic outcome. All patients were initially planned to finalize the reconstructive phase with a dental rehabilitation of dentition lost during the oncological treatment. When applicable, a full dental rehabilitation was performed at least 12 months after resection.

Surgically, a non-customized template with dimensions taken from The Brånemark Novum® concept was used. Hence, the in-house template and cutting guide design was based upon a mean dimension of the size and form in a fully-grown individual. A sectioning of the transplant into three pieces, one frontal and two lateral, for reconstruction of the mandibular body was used as the base for the design. The angle between the segments was designed into aslant of thirty degrees.

The template and cutting guide were initially designed for mandibular reconstruction with an osseo-musculo-cuttaneous vascularized fibula graft. With time, the design was also suitable and used for reconstruction of maxillary and midface reconstruction and in cases with other flaps, like the tip and lateral rim of scapula.