Mandibular Symphysis Reconstruction Using Multi-segment Deep Circumflex Iliac Artery Flap and Customized Workflow with Surgical Templates.

BACKGROUND

Reconstruction of mandibular symphysis defects using deep circumflex iliac artery (DCIA) flap remains challenging due to the unique morphology and high technical requirements. Virtual surgical planning (VSP) and template-guided workflows may improve accuracy and efficiency.

METHODS

This retrospective study evaluated clinical outcomes of patients with mandibular symphysis defects applied with DCIA flap. The primary outcome was morphological accuracy of actual post-operative model (APM) relative to virtual preoperative model (VPM), including deviations in superimposition, graft length, intercondylar (ICL) and intergonial (IGL) length, coronal (CMA), axial (AMA) and sagittal (SMA) mandibular angles. The secondary outcome was perioperative complication rates and functional outcomes.

RESULTS

Thirty-one patients were included between 2018 and 2023 (18 with double-segment and 13 with triple-segment bone graft). All cases utilized VSP and Resection & Cutting-Osteotomy-Trimming (Re-COT) template system. Baseline and peri-operative parameters were comparable between groups. Double-segment procedures took significantly less time than triple-segment procedures (P=0.028). Superimposition deviations of neo-mandible and bone graft were negligible between the groups (P=0.357 and 0.242, respectively). The linear deviations were all similar between the two groups: bone graft length (P=0.224), ICL (P=0.722) and IGL (P=0.488). Left-side CMA deviation was significantly lower in double-segment group compared with triple-segment group (1.35 (0.68, 1.78) vs. 1.80 (1.50, 2.20), P=0.015). Rest of the angular deviations, including right-side CMA, AMA and SMA in both sides, all showed comparable results (P>0.05).

CONCLUSIONS

DCIA flap reconstruction guided by VSP and Re-COT template system is a reliable method for restoring symphyseal mandibular defects, ensuring high anatomical accuracy and procedural efficiency.