Mandibular Reconstruction Using a Self-Designed Surgical Cutting Guide Based on Free Software: A Case Report

Abstract

　While mandibular reconstruction procedures using a free fibula flap are well-established, intraoperative bone cutting and plate adjustment remain technically demanding and time-consuming. Recent reports demonstrate the efficacy of computer-aided design and manufacturing (CAD/CAM) systems in reducing operative time and complications, but their use is often limited owing to high costs and dependence on commercial vendors. We created a low-cost surgical cutting guide using free three-dimensional (3D) computer graphics software and applied it to mandibular reconstruction surgery for a 63-year-old woman. Computed tomography data were converted into stereolithography (STL) format using Synapse Vincent and imported for virtual reconstruction planning. A cutting guide, designed with gripping holes, was fabricated using a 3D printer. In clinical application, the guide fit well to the fibula, allowing accurate osteotomies. Shaping the bone and fixing the plate took 23 minutes (conventional average time, 104–132 minutes) , and ischemia time was reduced to 86 minutes. Postoperative plain radiographs confirmed correct bone alignment of the reconstructed mandible and no complications were observed during postoperative follow-up. This workflow enabled efficient and accurate mandibular reconstruction without the use of costly CAD/CAM systems and could serve as a practical alternative for institutions not able to purchase expensive, commercially available software.