Reciprocating Rasp for Use in Mandibular Anterior Subapical Osteotomy.

The article describes a reciprocating rasp used in the mandibular anterior subapical osteotomy. Over the past 2 years, reciprocating rasp osteotomy was introduced in the Oral and Craniomaxillofacial Surgery Department of Shanghai Ninth People's Hospital. No complication such as bleeding, wound infection, or tissue necrosis has been encountered. The use of reciprocating rasp avoids iatrogenic damage to adjacent structures and reduces the time spent operating mandibular anterior subapical osteotomy. Therefore, it is recommended for mandibular anterior subapical osteotomy.

Collaborative Control Method and Experimental Research on Robot-Assisted Craniomaxillofacial Osteotomy Based on the Force Feedback and Optical Navigation.

OBJECTIVE: Surgical robot has advantages in high accuracy and stability. But during the robot-assisted bone surgery, the lack of force information from surgical area and incapability of intervention from surgeons become the obstacle. The aim of the study is to introduce a collaborative control method based on the force feedback and optical navigation, which may optimally combine the excellent performance of surgical robot with clinical experiences of surgeons. MATERIALS AND METHODS: The CMF ROBOT system was integrated with the force feedback system to ensure the collaborative control. Force-velocity control algorithm based on force feedback was designed for this control method. In the preliminary experimental test, under the collaborative control mode based on force feedback and optical navigation, the craniomaxillofacial surgical robot entered the osteotomy line area according to the preoperative surgical plan, namely, right maxillary Le Fort I osteotomy, left maxillary Le Fort I osteotomy, and genioplasty. RESULTS: The force sensor was able to collect and record the resistance data of the cutting process of the robot-assisted craniomaxillofacial osteotomy assisted in real time. The statistical results showed that the repeatability of collaborative control mode was acceptable in bilateral maxillary Le Fort I osteotomies (right, P =0.124>0.05 and left, P =0.183>0.05) and unfavorable in genioplasty ( P =0.048<0.05). CONCLUSION: The feasibility of robot-assisted craniomaxillofacial osteotomy under the collaborative control method based on the force feedback and optical navigation was proved in some extent. The outcome of this research may improve the flexibility and safety of surgical robot to meet the demand of craniomaxillofacial osteotomy.

Modified Gap Arthroplasty for Temporomandibular Joint Ankylosis Following Radiotherapy for Rhabdomyosarcoma: Report of an Unusual Case and Brief Literature Review.

Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient's problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy.

A Self-Supervised Deep Framework for Reference Bony Shape Estimation in Orthognathic Surgical Planning.

Virtual orthognathic surgical planning involves simulating surgical corrections of jaw deformities on 3D facial bony shape models. Due to the lack of necessary guidance, the planning procedure is highly experience-dependent and the planning results are often suboptimal. A reference facial bony shape model representing normal anatomies can provide an objective guidance to improve planning accuracy. Therefore, we propose a self-supervised deep framework to automatically estimate reference facial bony shape models. Our framework is an end-to-end trainable network, consisting of a simulator and a corrector. In the training stage, the simulator maps jaw deformities of a patient bone to a normal bone to generate a simulated deformed bone. The corrector then restores the simulated deformed bone back to normal. In the inference stage, the trained corrector is applied to generate a patient-specific normal-looking reference bone from a real deformed bone. The proposed framework was evaluated using a clinical dataset and compared with a state-of-the-art method that is based on a supervised point-cloud network. Experimental results show that the estimated shape models given by our approach are clinically acceptable and significantly more accurate than that of the competing method.

Unsupervised learning of reference bony shapes for orthognathic surgical planning with a surface deformation network.

PURPOSE: The purpose of this study was to reduce the experience dependence during the orthognathic surgical planning that involves virtually simulating the corrective procedure for jaw deformities. METHODS: We introduce a geometric deep learning framework for generating reference facial bone shape models for objective guidance in surgical planning. First, we propose a surface deformation network to warp a patient's deformed bone to a set of normal bones for generating a dictionary of patient-specific normal bony shapes. Subsequently, sparse representation learning is employed to estimate a reference shape model based on the dictionary. RESULTS: We evaluated our method on a clinical dataset containing 24 patients, and compared it with a state-of-the-art method that relies on landmark-based sparse representation. Our method yields significantly higher accuracy than the competing method for estimating normal jaws and maintains the midfaces of patients' facial bones as well as the conventional way. CONCLUSIONS: Experimental results indicate that our method generates accurate shape models that meet clinical standards.

Estimating Reference Bony Shape Models for Orthognathic Surgical Planning Using 3D Point-Cloud Deep Learning.

Orthognathic surgical outcomes rely heavily on the quality of surgical planning. Automatic estimation of a reference facial bone shape significantly reduces experience-dependent variability and improves planning accuracy and efficiency. We propose an end-to-end deep learning framework to estimate patient-specific reference bony shape models for patients with orthognathic deformities. Specifically, we apply a point-cloud network to learn a vertex-wise deformation field from a patient's deformed bony shape, represented as a point cloud. The estimated deformation field is then used to correct the deformed bony shape to output a patient-specific reference bony surface model. To train our network effectively, we introduce a simulation strategy to synthesize deformed bones from any given normal bone, producing a relatively large and diverse dataset of shapes for training. Our method was evaluated using both synthetic and real patient data. Experimental results show that our framework estimates realistic reference bony shape models for patients with varying deformities. The performance of our method is consistently better than an existing method and several deep point-cloud networks. Our end-to-end estimation framework based on geometric deep learning shows great potential for improving clinical workflows.

Estimating Reference Shape Model for Personalized Surgical Reconstruction of Craniomaxillofacial Defects.

OBJECTIVE: To estimate a patient-specific reference bone shape model for a patient with craniomaxillofacial (CMF) defects due to facial trauma. METHODS: We proposed an automatic facial bone shape estimation framework using pre-traumatic conventional portrait photos and post-traumatic head computed tomography (CT) scans via a 3D face reconstruction and a deformable shape model. Specifically, a three-dimensional (3D) face was first reconstructed from the patient's pre-traumatic portrait photos. Second, a correlation model between the skin and bone surfaces was constructed using a sparse representation based on the CT images of training normal subjects. Third, by feeding the reconstructed 3D face into the correlation model, an initial reference shape model was generated. In addition, we refined the initial estimation by applying non-rigid surface matching between the initially estimated shape and the patient's post-traumatic bone based on the adaptive-focus deformable shape model (AFDSM). Furthermore, a statistical shape model, built from the training normal subjects, was utilized to constrain the deformation process to avoid overfitting. RESULTS AND CONCLUSION: The proposed method was evaluated using both synthetic and real patient data. Experimental results show that the patient's abnormal facial bony structure can be recovered using our method, and the estimated reference shape model is considered clinically acceptable by an experienced CMF surgeon. SIGNIFICANCE: The proposed method is more suitable to the complex CMF defects for CMF reconstructive surgical planning.

Context-guided fully convolutional networks for joint craniomaxillofacial bone segmentation and landmark digitization.

Cone-beam computed tomography (CBCT) scans are commonly used in diagnosing and planning surgical or orthodontic treatment to correct craniomaxillofacial (CMF) deformities. Based on CBCT images, it is clinically essential to generate an accurate 3D model of CMF structures (e.g., midface, and mandible) and digitize anatomical landmarks. This process often involves two tasks, i.e., bone segmentation and anatomical landmark digitization. Because landmarks usually lie on the boundaries of segmented bone regions, the tasks of bone segmentation and landmark digitization could be highly associated. Also, the spatial context information (e.g., displacements from voxels to landmarks) in CBCT images is intuitively important for accurately indicating the spatial association between voxels and landmarks. However, most of the existing studies simply treat bone segmentation and landmark digitization as two standalone tasks without considering their inherent relationship, and rarely take advantage of the spatial context information contained in CBCT images. To address these issues, we propose a Joint bone Segmentation and landmark Digitization (JSD) framework via context-guided fully convolutional networks (FCNs). Specifically, we first utilize displacement maps to model the spatial context information in CBCT images, where each element in the displacement map denotes the displacement from a voxel to a particular landmark. An FCN is learned to construct the mapping from the input image to its corresponding displacement maps. Using the learned displacement maps as guidance, we further develop a multi-task FCN model to perform bone segmentation and landmark digitization jointly. We validate the proposed JSD method on 107 subjects, and the experimental results demonstrate that our method is superior to the state-of-the-art approaches in both tasks of bone segmentation and landmark digitization.

Evaluation of the postoperative stability of a counter-clockwise rotation technique for skeletal class II patients by using a novel three- dimensional position-posture method.

The aim of this study is to evaluate the postsurgical stability of skeletal class II patients after performing a counter-clockwise rotational (CCWR) procedure for the maxilla-mandibular complex (MMC) by using a novel Three-dimensional (3D) Position-Posture(P-P) measuring method. Twenty-five patients (5 males and 20 females) were included in this study. The postoperative CT scans of the skull were taken before surgery(T0), 3-7 days (T1), 3 months (T2), and 6 months (T3) after surgery. Specific anatomic landmarks were chosen to determine the position of the segments, while three equally perpendicular planes were created to describe their posture. The results show that the linear relapse of maxillary landmarks during the follow-up were acceptable (≤0.5 mm). The relapse of maxillary pitch plane at 6-months follow-up is 1.52°, which is acceptable. There was a significant pitch plane relapse of the mandibular-body segment with an average of 1.86° between T1 and T2 models, 3.28° between T1 and T3 models. There was no significant difference between roll and yaw planes during the follow-up. We therefore conclude that the P-P method could be used to accurately analyze the postsurgical stability of skeletal class II orthognathic surgery cases. For CCWR procedures, it was also shown that the there is a tendency for recurrence most specially on the body of the mandible.

3D bioprinting and in vitro study of bilayered membranous construct with human cells-laden alginate/gelatin composite hydrogels.

Extrusion-based 3D bioprinting of cell-laden hydrogels is a potential technology for regenerative medicine, which enables the fabrication of constructs with spatially defined cell distribution. However, the limited assessment of rheological behaviors of hydrogel before printing is still a major issue for the advancement of 3D bioprinting. In this work, we systematically investigated the rheological behaviors (i.e. viscosity, storage modulus (G'), and loss modulus (G")) of alginate/gelatin composite hydrogels first for 3D printing complex constructs. The rheological studies revealed that viscosity of alginate/gelatin hydrogels is temperature-dependent and shear thinning. Sol-gel transition (intersection of G' and G") study provided indication for printing temperature, which are in the range of 18.8 °C (H2/7.5) to 24.5 °C (H2/24.5). The alginate (2 wt%) /gelatin (15 wt%) composite hydrogel sample was chosen to print the constructs and subsequent bioprinting. Complex constructs (i.e. nose and ear) were obtained with high printing resolution (151 ±â€¯13.04 µm) in a low temperature (4 °C) chamber and crosslinking with 2 wt% CaCl2 subsequently without extra supports. Human amniotic epithelial cells (AECs) showed superior potential to differentiate into epithelial cells, while Wharton's jelly derived mesenchymal stem cells (WJMSCs) showed a superior angiogenic potential and fibroblastic phenotype. For the in vitro study, AECs and WJMSCs as seed cells, encapsulated in alginate/gelatin composite hydrogels, were bioprinted to form biomimetic bilayered membranous construct. High cell viability (> 95%) were observed up to 6 days after printing. The presented 3D bioprinting of human AECs and WJMSCs-laden alginate/gelatin composite hydrogels provides promising potentials for future skin tissue engineering.

Course of the mandibular canal in hemifacial microsomia: a retrospective computed tomography study.

OBJECTIVE: The aim of this study was to evaluate the anatomic course of the mandibular canal in patients with hemifacial microsomia (HM). STUDY DESIGN: In this retrospective study, 77 patients were included and stratified according to the Pruzansky-Kaban classification. The mandibular canal and the mandible were reconstructed on the basis of computed tomography data. The entrance, route, and exit of the mandibular canal (representing the entrance, route, and exit of the inferior alveolar nerve [IAN], respectively), and the antilingula were analyzed in different types of mandibular deformities in patients with HM. RESULTS: No significant difference in the course of the mandibular canal was detected between the affected and unaffected sides in patients with type I and type IIa HM. Abnormalities were observed in some patients with type IIb and type III HM. Significant differences were found between patients with type IIb and type III HM in the entrance (P = .015) and route (P = .001) of the canals. The antilingula was identified only in patients with type IIb and type III HM and was more common in patients with type III HM than in those with type IIb HM. CONCLUSIONS: Variation of the anatomic course of mandibular canal exists in patients with Pruzansky-Kaban type IIb and type III HM. Evaluation of the course of the canal in patients with HM is recommended before surgical intervention to avoid IAN damage.

Overexpression of Dlx2 enhances osteogenic differentiation of BMSCs and MC3T3-E1 cells via direct upregulation of Osteocalcin and Alp.

Genetic studies have revealed a critical role of Distal-homeobox (Dlx) genes in bone formation, and our previous study showed that Dlx2 overexpressing in neural crest cells leads to profound abnormalities of the craniofacial tissues. The aim of this study was to investigate the role and the underlying molecular mechanisms of Dlx2 in osteogenic differentiation of mouse bone marrow stromal cells (BMSCs) and pre-osteoblast MC3T3-E1 cells. Initially, we observed upregulation of Dlx2 during the early osteogenesis in BMSCs and MC3T3-E1 cells. Moreover, Dlx2 overexpression enhanced alkaline phosphatase (ALP) activity and extracellular matrix mineralization in BMSCs and MC3T3-E1 cell line. In addition, micro-CT of implanted tissues in nude mice confirmed that Dlx2 overexpression in BMSCs promoted bone formation in vivo. Unexpectedly, Dlx2 overexpression had little impact on the expression level of the pivotal osteogenic transcription factors Runx2, Dlx5, Msx2, and Osterix, but led to upregulation of Alp and Osteocalcin (OCN), both of which play critical roles in promoting osteoblast maturation. Importantly, luciferase analysis showed that Dlx2 overexpression stimulated both OCN and Alp promoter activity. Through chromatin-immunoprecipitation assay and site-directed mutagenesis analysis, we provide molecular evidence that Dlx2 transactivates OCN and Alp expression by directly binding to the Dlx2-response cis-acting elements in the promoter of the two genes. Based on these findings, we demonstrate that Dlx2 overexpression enhances osteogenic differentiation in vitro and accelerates bone formation in vivo via direct upregulation of the OCN and Alp gene, suggesting that Dlx2 plays a crucial role in osteogenic differentiation and bone formation.

Mussel-Inspired Polydopamine Coating: A General Strategy To Enhance Osteogenic Differentiation and Osseointegration for Diverse Implants.

Surface modifications play an important role in endowing implant surface with excellent biocompatibility and bioactivity. Among the bioinspired surface modifications, the mussel-inspired polydopamine (PDA) has aroused great interest of researchers. Herein, we fabricated PDA on diverse implant surfaces, including biopolymer, biometal, and bioceramic. Then the effects of PDA coating on cell responsive behaviors in vitro and bone formation capacity in vivo were evaluated in detail. The results showed that PDA coating was fabricated on diverse samples surface successfully, which could significantly improve the hydrophilicity of different material surfaces. Furthermore, the results indicated that PDA coating exerted direct enhancing on the adhesion, proliferation and osteogenic differentiation of bone marrow derived mesenchymal stromal cells (BMSCs) through FAK and p38 signaling pathways. During the process, the focal adhesion protein expression and osteogenic-related genes expression level (e.g., ALP, BMP2, BSP, and OPN) were considerably upregulated. Most importantly, the in vivo study confirmed that PDA coating remarkably accelerated new bone formation and enhanced osseointegration performance. Our study uncovered the biological responses stimulated by PDA coating to make a better understanding of cell/tissue-PDA interactions and affirmed that PDA, a bioinspired polymer, has great potential as a candidate and functional bioactive coating medium in bone regeneration and orthopedic application.

Amorphous carbon modification on implant surface: a general strategy to enhance osteogenic differentiation for diverse biomaterials via FAK/ERK1/2 signaling pathways.

Bone implants play a crucial role in bone repairing. Nevertheless, low capability of osteoinductivity and osteogenic differentiation for bone regeneration are disadvantages of bone implants. Therefore, it is imperative to develop a general and facile technology to promote the bioactivity of existing implants. Herein, a facile amorphous carbon-coating approach was developed to stimulate osteogenesis on diverse biomaterials, including bioceramics, biometals, and biopolymers via magnetron sputtering deposition. The results confirmed that the amorphous carbon-coating-modified surfaces could significantly enhance osteogenesis of bone marrow mesenchymal stem cells (BMSCs) on every kind of biomaterial surface. Furthermore, it was demonstrated that the FAK/ERK1/2 signaling pathways were involved in the osteogenic effects of this amorphous carbon coating. The bone regeneration ability using the calvarial bone defect model of rats confirmed that the amorphous carbon coating induced faster bone formation and mineralization, which suggested the effect of amorphous carbon coating on stimulating osteogenesis in vivo. These results suggest that the approach involving modifying a surface with amorphous carbon provides a general and simple strategy to enhance the osteogenesis for diverse biomaterials, and this has promising potential for bone repairing applications.

Dlx2 overexpression enhanced accumulation of type II collagen and aggrecan by inhibiting MMP13 expression in mice chondrocytes.

Genetic studies revealed a crucial role of Distal-homebox (Dlx) genes in skeletal development, and our previous study demonstrated overexpressing Dlx2 in neural crest cells led to abnormal cartilage structure, including ectopic cartilage in the maxillary region and nasal bone in mice. The aim of this study was to investigate how Dlx2 overexpression affects chondrogenesis in mouse chondroblast cell line TMC23 and the underlying mechanism. We first demonstrated that Dlx2 expression was upregulated during chondrogenesis in TMC23 cells. Moreover, forced overexpression of Dlx2 in TMC23 cells led to increased accumulation of aggrecan and type II collagen, markers of early chondrocyte differentiation, but had little effect on mRNA and protein levels of Aggrecan and Col2α1, type II collagen gene. Importantly, Dlx2 overexpression decreased mRNA and protein levels of MMP13, a major collagenase degrading aggrecan and type II collagen during late stages of chondrogenesis. Luciferase-reporter and Chromatin-immunoprecipitation analysis demonstrated that MMP13 promoter contained two Dlx2-response elements, and Dlx2 inhibited MMP13 expression by directly binding to these two elements. Based on these observations, we propose that forced overexpression of Dlx2 enhances early chondrocyte differentiation by increasing accumulation of type II collagen and aggrecan, but interferes later stages of chondrocyte differentiation through inhibiting MMP13 expression.

Segmental Maxillary Distraction Osteogenesis With a Hybrid-Type Distractor in the Management of Wide Alveolar Cleft.

OBJECTIVE: To investigate segmental maxillary distraction osteogenesis (DO) with hybrid-type distractor in the management of wide alveolar cleft. PATIENTS AND METHODS: Six patients underwent segmental DO with a hybrid-type distractor. After the success of DO and 3-month consolidation period, removal of the distractor was accompanied by alveolar bone graft with iliac bone. Panoramic radiograph and computed tomography scanning were taken preoperatively (T0) and the day after distractor removal (T1). The crest distance between the long axis of cleft nearby teeth was measured. RESULT: All patients completed the DO period, and the succeeding alveolar bone graft healing was uneventful. The mean cleft distance decrease was 12.05 mm (range: 10.1-13.5 mm). As for the mobility degree record of abutment tooth in the transport segment recorded, 6 patients were grading I° at T0, while 5 patients were grading I° and 1 patient was grading II° at T1. CONCLUSION: Segmental maxillary DO with the hybrid-type distractor is successful to reduce the cleft width in these cases, and it is promising in the treatment of wide dental alveolar cleft, especially for the adult patient.

Joint Craniomaxillofacial Bone Segmentation and Landmark Digitization by Context-Guided Fully Convolutional Networks.

Generating accurate 3D models from cone-beam computed tomography (CBCT) images is an important step in developing treatment plans for patients with craniomaxillofacial (CMF) deformities. This process often involves bone segmentation and landmark digitization. Since anatomical landmarks generally lie on the boundaries of segmented bone regions, the tasks of bone segmentation and landmark digitization could be highly correlated. However, most existing methods simply treat them as two standalone tasks, without considering their inherent association. In addition, these methods usually ignore the spatial context information (i.e., displacements from voxels to landmarks) in CBCT images. To this end, we propose a context-guided fully convolutional network (FCN) for joint bone segmentation and landmark digitization. Specifically, we first train an FCN to learn the displacement maps to capture the spatial context information in CBCT images. Using the learned displacement maps as guidance information, we further develop a multi-task FCN to jointly perform bone segmentation and landmark digitization. Our method has been evaluated on 107 subjects from two centers, and the experimental results show that our method is superior to the state-of-the-art methods in both bone segmentation and landmark digitization.

Computer-Assisted Distraction Osteogenesis in the Treatment of Hemifacial Microsomia.

PURPOSE: To investigate the application of computer-assisted surgical planning and virtual guide in distraction osteogenesis for patients with hemifacial microsomia. METHODS: Eight patients diagnosed with unilateral hemifacial microsomia were enrolled in this study. Preoperative surgical planning and simulation were performed on three-dimensional model. Distraction was simulated on virtual model and the new morphology of the mandible was predicted. Mandibular ramus osteotomy and distractor implant was performed under the guidance of tooth-borne virtual guide. Postoperative evaluation of the intervention was performed by comparison of surgical planning and actual result. RESULTS: Preoperative planning, simulation, osteotomy and distractor implant under the guidance of virtual guide were performed successfully on all patients. Tooth-borne guide defined the osteotomy line and accurate position of distractor. Facial symmetry was greatly improved. The osteogenesis and neomandible contour was checked by postoperative computed tomography, and a good matching with the preoperative planning was achieved. CONCLUSIONS: Computer-assisted surgical planning and intraoperative virtual guide shows its great value in improving the accuracy of distraction osteogenesis and restoring facial symmetry. It is regarded as a valuable technique in this potentially complicated procedure.

Computer-assisted navigation: its role in intraoperatively accurate mandibular reconstruction.

OBJECTIVE: This article presents our experiences of computer-assisted navigation in mandibular reconstruction and evaluates its effectiveness. STUDY DESIGN: Eight patients who underwent navigation-guided mandibular reconstruction with a fibula free flap were reviewed. Under intraoperative navigation, the ideal positions of the mandibular angles and condyles were confirmed by the navigation probe. The surgical results were evaluated through postoperative panoramic radiographs, coronal computed tomography scans, and image fusion. RESULTS: Navigation-guided mandibular reconstructions were successfully completed on the basis of preoperative planning and simulation. The surgical discrepancy in the mandibular angle between the actual surgical results and the preoperative designs was 1.92 ± 0.97 mm. Panoramic radiographs and coronal computed tomography scans illustrated that all the condyles fitted into their glenoid fossae. All patients were satisfied with their functional and aesthetic outcomes. CONCLUSIONS: Computer-assisted navigation is a viable technology for improving surgical outcomes in mandibular reconstruction, which can assist the surgeons by providing real-time three-dimensional surgical references during the operation.

Evaluation of computer-assisted mandibular reconstruction with vascularized fibular flap compared to conventional surgery.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of computer-assisted mandibular reconstruction with a vascularized fibular flap and compare it with conventional surgery. STUDY DESIGN: In this retrospective study conducted between February 2009 and December 2012, 8 patients underwent computer-assisted mandibular reconstruction, and 14 patients underwent conventional surgery. The accuracy of virtual surgical planning was determined, and the outcomes in the two groups were compared. RESULTS: In the computer-assisted group, the deviation in fibula segment length was 1.34 ± 1.09 mm, the angular deviation was 2.29 ± 1.19°, and the mean 3-D deviation was 0.53 ± 0.06 mm. Mean differences in intercondylar distance, intergonial angle distance, anteroposterior distance, gonial angle, and duration of ischemia were all improved in the computer-assisted group compared with the conventional surgery group. CONCLUSIONS: Computer-assisted surgery, including preoperative virtual surgical planning, intraoperative cutting and reconstructive guides, and postoperative analysis is highly accurate in fibular flap mandibular reconstruction.