Mandibular Reconstruction using Simulation Surgery with 3D RP Model in Osteoradionecrosis Patient: A Case Report

  • Park, Tae-Jun ;
  • Kim, Hong-Joon ;
  • Ahn, Kang-Min
  • Received : 2015.11.15
  • Accepted : 2015.11.18
  • Published : 2015.12.19


One of the most serious complications after head and neck radiation is osteoradionecrosis (ORN) of the jaw. The etiology of ORN is extraction, minor dental procedure or dental implant surgery. When ORN of the jaw progressed to stage III, free fibular flap is the most useful methods for reconstruction. In this case report, a 67-year-old ORN patient who underwent fibular free flap reconstruction using simulation surgery with 3-dimensional rapid prototype (3D RP) model was reviewed. After partial mandibulectomy, a osteocutaneous fibula flap was used for reconstruction. Oro-cutaneous fistula was resolved after operation. Patients reported improved food intake after operation without pus discharge. Functional and esthetic results showed successful reconstruction.


3D RP model;Simulation surgery;Fibula free flap;Reconstruction;Osteoradionecrosis


  1. Rogers SN, D'Souza JJ, Lowe D, Kanatas A. Longitudinal evaluation of health-related quality of life after osteoradionecrosis of the mandible. The British Journal of Oral & Maxillofacial Surgery 2015
  2. He Y, Liu Z, Tian Z, Dai T, Qiu W, Zhang Z. Retrospective analysis of osteoradionecrosis of the mandible: Proposing a novel clinical classification and staging system. International Journal of Oral and Maxillofacial Surgery 2015
  3. Studer G, Bredell M, Studer S, Huber G, Glanzmann C. Risk profile for osteoradionecrosis of the mandible in the imrt era. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft ... [et al] 2015
  4. Jeong WS, Choi JW, Choi SH. Computer simulation surgery for mandibular reconstruction using a fibular osteotomy guide. Arch Plast Surg 2014;41:584-587
  5. Hillerup S, Elberg JJ, Thorn JJ, Andersen M. Reconstruction of irradiated mandible after segmental resection of osteoradionecrosis-a technique employing a microvascular latissimus dorsi flap and sub-sequent particulate iliac bone grafting. Craniomaxillofacial Trauma & Reconstruction 2014;7:190-196
  6. Sawhney R, Ducic Y. Management of pathologic fractures of the mandible secondary to osteoradionecrosis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology- Head and Neck Surgery 2013;148:54-58
  7. Kim HJ, Hwang JH, Ahn KM. Fibula free flap for mandibular reconstruction using simulation surgery in bisphosphonate related osteonecrosis of the jaw. J Int Soc Simul Surg 2015;2:1-6
  8. Levine JP, Bae JS, Soares M, Brecht LE, Saadeh PB, Ceradini DJ, et al. Jaw in a day: Total maxillofacial reconstruction using digital technology. Plastic and reconstructive surgery 2013;131:1386-1391
  9. Oh HK, Chambers MS, Martin JW, Lim HJ, Park HJ. Osteoradionecrosis of the mandible: Treatment outcomes and factors influencing the progress of osteoradionecrosis. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2009;67:1378-1386
  10. Fan S, Wang YY, Lin ZY, Zhang DM, Yu X, Chen WX, et al. Synchronous reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular osteocutaneous flap in patients with nasopharyngeal carcinoma. Head & Neck 2015
  11. Curi MM, Oliveira dos Santos M, Feher O, Faria JC, Rodrigues ML, Kowalski LP. Management of extensive osteoradionecrosis of the mandible with radical resection and immediate microvascular reconstruction. Journal of oral and maxillofacial surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons 2007;65:434-438
  12. Cornelius CP, Smolka W, Giessler GA, Wilde F, Probst FA. Patientspecific reconstruction plates are the missing link in computer-assisted mandibular reconstruction: A showcase for technical description. Journal of cranio-maxillo-facial surgery: Official Publication of the European Association for Cranio-Maxillo-Facial Surgery 2015;43:624-629
  13. Hannen EJ. Recreating the original contour in tumor deformed mandibles for plate adapting. International journal of Oral and Maxillofacial Surgery 2006;35:183-185
  14. Logan H, Wolfaardt J, Boulanger P, Hodgetts B, Seikaly H. Exploratory benchtop study evaluating the use of surgical design and simulation in fibula free flap mandibular reconstruction. Journal of Otolaryngology- Head & Neck Surgery = Le Journal D'oto-rhinolaryngologie et de chirurgie Cervico-Faciale 2013;42:42