Computer-Aided Surgical Simulation in Severe Atrophic Mandibular Fractures: A New Method for Guided Reduction and Temporary Stabilization Before Fixation.

ABSTRACT

In severe atrophic mandibular fractures, the absence of stable occlusion, as well as poor bone volume at the fracture site, constitutes a lack of references during surgery to achieve accurate fracture reduction. Unsuccessful reduction and stabilization can lead to several complications, such as fracture misalignments, malunion, and facial asymmetry. An alternative to avoid the aforementioned issues is fracture reduction based on virtual surgical planning (VSP) technology. However, there is little information regarding VSP protocols for the management of mandible fractures. Herein, a new technique with low cost is reported in which VSP and computer-aided manufacturing of a positioning guide were applied in a 72-year-old female patient with bilateral fractures in her atrophic mandible in the body region. The positioning guide was used during fracture reduction on the inferior surface of the mandible as per the virtual reduction. A 3-dimensional mandible model was also printed, facilitating the prebent 2.4-mm reconstructive plate. The surgical procedure was performed with no complications, resulting in the accurate fit of both the bent plate and the guide. A postoperative computed tomography scan showed good condylar position, fracture reduction, and hardware adaptation. A follow-up approximately 2 years later showed that she was successfully rehabilitated with the dental prosthesis. Therefore, VSP is a valuable tool for attaining a predictable result in the treatment of severe atrophic mandibular fracture, with a reduced operative duration, acceptable precision of fracture reduction, and low cost.