Preoperative finite element analysis of fibula myocutaneous flap for segmental mandibular reconstruction

doi:10.19438/j.cjoms.2021.04.007

Abstract

Abstract: PURPOSE: To explore the biomechanical reasons of mandible deviation after vascularized fibular myocutaneous flap repair and reconstruction of large-area segmental defect of mandible by using finite element static analysis method, and to verify the effectiveness of the analysis through postoperative follow-up, so as to obtain a research method that can provide reference for the design of operation plan before operation. METHODS: Ten cases of traditional surgery and 10 cases of digital technology for mandibular segmental resection and vascularized fibula reconstruction were included in this study. Based on a case of digital preoperative three-dimensional surgery, the three-dimensional finite element analysis model of mandible reconstruction was established to analyze the strain trend. Then cone-beam CT (CBCT) data of postoperative follow-up and preoperative CBCT data were compared. GraphPad Prism 8 software package was used for statistical analysis. RESULTS: There was no significant difference between the two groups before and after operation; but compared with the traditional group, the change of joint space of the affected side in the digital group was significantly reduced(P<0.05). Based on the preoperative operation plan of a case using digital technology, the finite element analysis model was successfully established, and the results showed that the condyle of the affected side (right side) rotated clockwise in the transverse position; the epicondyle rotated inward in the coronal position; the coronal process shifted outward and downward in the sagittal position. The CBCT images before and 6 months after operation were compared, and the jaw displacement trend was consistent with the findings of finite element analysis. CONCLUSIONS: Finite element analysis can qualitatively analyze the deviation of mandible after reconstruction of mandible defect with vascularized fibula flap using improved digital guide plate technology, and provide reference for the design of operation plan before operation.

Key words: Mandible, Fibular flap, Computer assist surgery, Finite element analysis

CLC Number:

R782.2

WANG Yi-zhou, CAI Man, SUN Li-fan, ZHU Qing-hai, HOU Chen-xing, HAN Wei, TANG Yu-ting, SUN Nan-nan, WANG Chen-xing, LI Huai-qi, YE Jin-hai. Preoperative finite element analysis of fibula myocutaneous flap for segmental mandibular reconstruction[J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(4): 325-331.

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