Novel V-shaped kiss flap harvest technique for the forearm free flap in soft tissue reconstruction.

INTRODUCTION: Radial forearm flap (RFF) is widely used in oral reconstruction. However, the donor-site defect remains the main limit. In this paper, V-shaped kiss RFF (VRFF) is described as a novel technique to improve aesthetics and function of it. A retrospective study was conducted to introduce VRFF and evaluate its effect and safety. METHODS: A total of 21 patients who underwent VRFF for oral reconstruction, and 23 patients who underwent conventional RFF from February 2016 to April 2018 were included in this study. Direct comparisons were made on patient's subjective evaluation of postoperative hand function and degree of scarring and objective donor-site function assessment including range of wrist movements and grip strength before and after surgery between the two groups. RESULTS: No skin grafts were used in the VRFF group, and 20 of 21 patients achieved primary healing at donor site, while all patients from the RFF group had skin grafts. And 18 of 23 patients achieved primary healing. The postoperative scar score of donor site in the VRFF group was significantly higher than that in the RFF group (3.4 vs 2.8, P = 0.035). There were no significant differences in other subjective evaluation and donor-site morbidity and hand function assessment. CONCLUSION: VRFF is able to provide a new and simple method to close donor-site defect and realize a better healing in donor site.

CTSB+ macrophage repress memory immune hub in the liver metastasis site of colorectal cancer patient revealed by multi-omics analysis.

Colorectal cancer (CRC) is a lethal malignant tumor and 25-30% of CRC patients develop liver metastasis (LM) with a worse prognosis, but the metastasis mechanism is yet elucidated. To identify the potential immune regulatory mechanism of CRC liver metastasis, single-cell sequencing and multiplex immunohistochemistry were applied to identify key cell populations of the tumor microenvironment (TME) in the CRC and LM sites. We found memory CD8+ T cells, B cells, and CTSB + macrophages were enriched in the LM site, forming the memory immune hub, which was important for the anti-tumor response against LM. Therefore, our results revealed that memory immune responses were called in the LM sites and probably meditated by CTSB + macrophages.

Pathogenic variant of DYNC2H1 associated with lingual hamartoma in a Chinese pedigree.

BACKGROUND: Molecular etiology of lingual hamartoma is poorly understood. This study aims to identify potentially deleterious mutations for lingual hamartoma and analyze its molecular profile by a combination of whole-exome sequencing and RNA-sequencing. METHODS: Whole-exome sequencing was conducted on the proband presenting lingual hamartoma and patient's unaffected family members. Potentially pathogenic mutations were identified after filtration. The pathogenicity of the identified variants was predicted by in silico algorithms and conservative analysis. RNA-sequencing was performed to further explore the molecular profile of lingual hamartoma. RESULTS: Whole-exome sequencing of the proband and patients' unaffected brother and parents identified a de novo mutation c.931C>T_p.Pro311Ser in the DYNC2H1 gene (NM_001080463.2). The DYNC2H1 mutation was predicted to be disease-causing for affecting highly conserved amino acid by PolyPhen2 and Mutation Taster. RNA-sequencing analysis showed that the DYNC2H1 gene was significantly down-regulated in lingual hamartoma. Gene set enrichment analysis revealed cilium assembly and Hedgehog signaling pathway were significantly affected. CONCLUSION: The study expanded our knowledge on the clinical and genetic spectrum of lingual hamartoma by identifying causal variants in a Chinese pedigree. DYNC2H1 is likely to participate in tongue development and its pathologic mutation may underlie the etiology of lingual hamartoma.

KLF7 is associated with poor prognosis and regulates migration and adhesion in tongue cancer.

OBJECTIVE: The present study was performed to determine the clinical relevance of KLF7 in tongue squamous cell carcinoma (TSCC) and to characterize its potential function and mechanism of action. MATERIALS AND METHODS: KLF7 expression was measured by RT-qPCR in 21 tongue cancer samples. The clinical relevance of KLF7 was analyzed in another cohort of 127 TSCC samples from a public database. Then, we performed RNA sequencing analysis in KLF7-overexpressing TSCC (SCC9 and CAL27) cells to define significantly altered pathways. The possible changes in migration and adhesion were then analyzed in KLF7-overexpressing and knockdown TSCC cells. RESULTS: Our results showed that KLF7 mRNA expression was upregulated in TSCC and was significantly associated with the T and N stages. Patients with high-KLF7 expression had worse overall survival. RNA sequencing and KEGG enriched pathway analysis showed that altered genes were enriched in extracellular matrix-receptor interactions and focal adhesions in both cell lines. KLF7-overexpressing TSCC cell lines showed enhanced migration capacity and cell adhesion ability, and knockdown of KLF7 expression decreased TSCC migration and adhesion ability. CONCLUSIONS: We concluded that KLF7 was overexpressed in TSCC and has prognostic value. KLF7 promoted TSCC migration and increased cell adhesion.

Identification of a Novel Mutation in the Runt-Related Transcription Factor 2 Gene in a Chinese Family With Cleidocranial Dysplasia.

ABSTRACT: Cleidocranial dysplasia (CCD) is an uncommon autosomal dominant disease, characterized by hypoplasia of clavicles, delayed fontanelle closure, dental anomalies, and short stature. It has been reported in the literature that the pathogenic variants of Runt-related transcription factor 2 (RUNX2) gene are correlated with CCD patients.Here, we report a consanguineous Chinese family with 2 patients suffering from CCD, presenting similar skeleton and dentition malformation. Upon whole-exome sequencing, 52863 variants were detected in the propositus. Based on the genotype phenotype correlation, a frameshift deletion c.1554delG p.(Trp518Cysfs∗61), located in exon 8 of RUNX2, remained after filtration. For Sanger sequencing, all exons of the RUNX2 gene in members of this Chinese family were amplified by polymerase chain reaction. Mutation mentioned above was confirmed in the propositus and his mother, which has not been reported previously and cannot be found in the publicly available databases. The present study expands the pathogenic variant spectrum of RUNX2 gene and contributes to molecular diagnosis.

Enhanced osteogenesis of quasi-three-dimensional hierarchical topography.

Natural extracellular matrices (ECMs) are three-dimensional (3D) and multi-scale hierarchical structure. However, coatings used as ECM-mimicking structures for osteogenesis are typically two-dimensional or single-scaled. Here, we design a distinct quasi-three-dimensional hierarchical topography integrated of density-controlled titania nanodots and nanorods. We find cellular pseudopods preferred to anchor deeply across the distinct 3D topography, dependently of the relative density of nanorods, which promote the osteogenic differentiation of osteoblast but not the viability of fibroblast. The in vivo experimental results further indicate that the new bone formation, the relative bone-implant contact as well as the push-put strength, are significantly enhanced on the 3D hierarchical topography. We also show that the exposures of HFN7.1 and mAb1937 critical functional motifs of fibronectin for cellular anchorage are up-regulated on the 3D hierarchical topography, which might synergistically promote the osteogenesis. Our findings suggest the multi-dimensions and multi-scales as vital characteristic of cell-ECM interactions and as an important design parameter for bone implant coatings.

Medial Sural Artery Perforator Flap Aided by Ultrasonic Perforator Localization for Reconstruction After Oral Carcinoma Resection.

PURPOSE: To evaluate the application of the medial sural artery perforator flap (MSAPF) aided by preoperative ultrasonic perforator localization for postsurgical reconstruction of oral carcinoma. MATERIALS AND METHODS: From November 2013 to August 2014, 25 patients with oral carcinoma underwent postsurgical reconstruction after oral carcinoma resection using MSAPFs. To explore and locate the perforators, preoperative vascular ultrasound localization was used to find the MSAPs. The number and location of the perforators, length of the vascular pedicle, and thickness of the MSAPF were measured. Thirty-eight patients who underwent reconstruction with a radial forearm flap (RFF) and 21 patients who underwent reconstruction with an anterolateral thigh flap (ALTF) were selected for comparison. RESULTS: The number of MSAPs ranged from 1 to 4, and 52 perforators were found accurately using preoperative ultrasonic localization (92.86%). The distance from the perforator to the popliteal crease ranged from 6.2 to 17.1 cm (10.70 ± 2.31 cm); the distance from the perforator to the midline of the back of the calf ranged from 0.1 to 3.5 cm (1.83 ± 0.81 cm); and the pedicle length ranged from 6.8 to 12.5 cm (10.14 ± 1.51 cm). Compared with the RFF, and ALTF, the thickness, postoperative oral sensation, and function of the MSAPF were similar to those of the RFF but better than those of the ALTF. In appearance and function of the donor site, the MSAPF was similar to the ALTF, but better than the RFF. CONCLUSION: The MSAPF is a good alternative for postsurgical reconstruction of oral carcinoma because of its anatomic structural stability, suitable thickness, minimal donor-site scar, and ideal functional recovery after surgery. Preoperative vascular ultrasonic localization is a feasible and advantageous method for preoperative mapping of the MSAP because of its high accuracy.

Duplicated posterior belly of digastric muscle and absence of omohyoid muscle: a case report and review of literature.

PURPOSE: We report a unique case of duplicated posterior belly of digastric muscle and absence of omohyoid muscle, review literatures and discuss its clinical importance. MATERIALS AND METHODS: An abnormal strip of muscle was found during the routine functional neck dissection in a 58-year-old man, who suffered from moderately differentiated squamous cell carcinoma of right tongue. We check the anatomical features and search for similar variations in the past literatures. RESULTS: The abnormal strip of muscle was attached to mastoid process, passed anteroinferiorly into the infrahyoid muscles. The muscle was as long as, but narrower than the posterior belly of the digastric muscle. So far, only one case of this anomaly was reported. Meanwhile, the omohyoid muscle was confirmed to be absent in the right neck of this patient. CONCLUSIONS: To our knowledge, report of variations of both digastric muscle and omohyoid muscle, this variation mostly derives from abnormal development of the mesenchyme in the branchial arches. Attention should be paid to such variations, which might influence surgical procedures.

Metabolomics, Transcriptome and Single-Cell RNA Sequencing Analysis of the Metabolic Heterogeneity between Oral Cancer Stem Cells and Differentiated Cancer Cells.

Understanding the distinct metabolic characteristics of cancer stem cells (CSC) may allow us to better cope with the clinical challenges associated with them. In this study, OSCC cell lines (CAL27 and HSC3) and multicellular tumor spheroid (MCTS) models were used to generate CSC-like cells. Quasi-targeted metabolomics and RNA sequencing were used to explore altered metabolites and metabolism-related genes. Pathview was used to display the metabolites and transcriptome data in a KEGG pathway. The single-cell RNA sequencing data of six patients with oral cancer were analyzed to characterize in vivo CSC metabolism. The results showed that 19 metabolites (phosphoethanolamine, carbamoylphosphate, etc.) were upregulated and 109 metabolites (2-aminooctanoic acid, 7-ketocholesterol, etc.) were downregulated in both MCTS cells. Integration pathway analysis revealed altered activity in energy production (glycolysis, citric cycle, fatty acid oxidation), macromolecular synthesis (purine/pyrimidine metabolism, glycerophospholipids metabolism) and redox control (glutathione metabolism). Single-cell RNA sequencing analysis confirmed altered glycolysis, glutathione and glycerophospholipid metabolism in in vivo CSC. We concluded that CSCs are metabolically inactive compared with differentiated cancer cells. Thus, oral CSCs may resist current metabolic-related drugs. Our result may be helpful in developing better therapeutic strategies against CSC.

Adenovirus-mediated expression of keratinocyte growth factor promotes secondary flap necrotic wound healing in an extended animal model.

BACKGROUND: No effective treatments have been found for flap necrosis. Animal models that focus on the initial flap viability are inappropriate for necrotic wound studies. Keratinocyte growth factor (KGF) promotes keratinocyte proliferation with stronger activity and fewer complications and thus may be useful for necrotic flap wound healing. METHODS: Rats with modified flap necrosis were randomly divided into four groups. An adenoviral vector expressing KGF was injected subdermally in the back of the animals after necrosis began. The expression and effect of KGF was assessed by real-time polymerase chain reaction, enzyme-linked immunoassay, and transwell, and wound healing was monitored. RESULTS: The plasmid and adenovirus were able to express KGF and stimulate epithelial cell growth (p = 0.029). Histology showed that the necrosis healed fastest in the KGF administration group than in the control groups (p < 0.01). The adenovirus-mediated KGF (Ad-KGF) group had the thickest epithelium on days 15 (p = 0.044) and 25 (p = 0.014). The KGF level in the blood serum soared 10 and 15 days postoperatively (p < 0.01) but returned to baseline by day 25 (p = 0.561). The KGF mRNA levels in vivo increased dramatically in the Ad-KGF group (p = 0.037). CONCLUSIONS: The extended flap model is applicable in necrotic wound study. Keratinocyte growth factor can promote secondary necrotic flap wound healing, and administration of KGF can be achieved by an adenoviral vector.

Sternocleidomastoid myocutaneous flap or free flap: Long-term follow-up of soft tissue defect repair in oral cancer.

OBJECTIVE: To evaluate the reliability and long-term efficacy of the sternocleidomastoid (SCM) flap in reconstructing and repairing soft tissue defects after oral cancer surgeries. STUDY DESIGN: A total of 102 patients who underwent soft tissue defect reconstruction with the SCM flap after oral cancer surgery (from 2012 to 2019) were assessed. Relevant clinical indicators were analyzed. They were also grouped according to pathologic cervical lymph node staging. Postoperative recurrence and metastases were compared with radial forearm free flap (RFFF). RESULTS: The flap healing rate was 100% in SCM flap, compared with a success rate of 94% in RFFF. SCM flaps would not increase the risk of dysfunction or paresthesia in the neck dissection area. Prognostically, the rate of cervical lymph node metastasis was similar in patients with pathologic cervical lymph node staging N0 and N1 for both flap types, whereas the rate of cervical lymph node metastasis was significantly higher in patients with SCM flaps compared with RFFF in N2 cases. CONCLUSIONS: The SCM flap is a reliable, cost-effective flap with minimal adverse effects. It is ideal for soft tissue reconstruction of oral cancers if the patients are selected judiciously. N2 cases are not an indication for SCM flaps.

[Clinical application and accuracy analysis of occlusion-guided functional mandibular reconstruction].

OBJECTIVE: To investigate the influence of the design and application of novel surgical template on the accuracy of reconstructed mandibula and implant position in occlusion-guided functional mandibular reconstruction, so as to provide guidance for clinical treatment. METHODS: Between January 2017 and May 2019, 11 patients with segmental mandible defects were treated, including 8 males and 3 females with an average age of 31.8 years (range, 19-45 years). There were 6 cases of ameloblastoma, 3 cases of keratocystic tumor, and 2 cases of ossifying fibroma. According to Urken classification of mandible defects, there were 1 case of CRB, 4 cases of RB, 2 cases of RBS, and 4 cases of SB. According to the occlusion relationship, a novel surgical template with the reconstruction titanium plate screws and implants drill-guided information was designed and manufactured. With the help of the novel surgical template, the "one and a half" fibula reconstruction mode was used for jaw functional reconstruction, and the implant supported denture was finally completed. The postoperative CT at 1 week were collected to analyze the morphology of the preoperative virtual design jaw and postoperative jaw. The coincidence of fibular reconstructed mandible (fibular upper barrel, fibular reconstructed ramus and condyle, and whole mandible) and implant in mandible were calculated. When the coincidence was less than 80%, it was considered that the deviation was obvious. Oral panoramic X-ray film and cone beam CT were examined at 6 months after operation to evaluate the osseointegration before implant repair. RESULTS: None of the 11 flaps had postoperative vascular crisis. One flap occurred necrosis at 1 month after reconstruction combined with 3 implants failed, and had been removed at 6 months after reconstructed surgery; the others had no flap necrosis. One week postoperatively, the coincidence of the fibular upper barrel was 87.55%±3.08%, the whole mandible was 82.68%±5.94%, and the implant in mandible was 88.00%, with significant differences ( t=8.131, P=0.000; t=2.118, P=0.046; Z=4.070, P=0.000) when compared to 80%, respectively. The fibular reconstructed ramus and condyle was 77.82%±3.54%, with no significant difference ( t=-2.042, P=0.068) when compared to 80%. Six months postoperatively, oral panoramic X-ray film and cone beam CT showed that all 22 implants achieved osseointegration and the palatal mucosa transplantation was performed, then finally completed the denture rehabilitation at 6-9 months after operation. All patients were satisfied with their postoperative appearance. CONCLUSION: The novel surgical template can guarantee the accuracy of functional mandible reconstruction guided by occlusal guidance, and ultimately achieve the beautiful contour of jaw and occlusal function reconstruction, and improve the patient's life quality.

isoTarget: A Genetic Method for Analyzing the Functional Diversity of Splicing Isoforms In Vivo.

Protein isoforms generated by alternative splicing contribute to proteome diversity. Because of the lack of effective techniques, the isoform-specific function, expression, localization, and signaling of endogenous proteins are unknown for most genes. Here, we report a genetic method, isoTarget, for multi-purpose studies of targeted isoforms in select cells. Applying isoTarget to two isoforms of Drosophila Dscam, Dscam[TM1] and [TM2], we found that, in neurons, endogenous Dscam[TM1] is in dendrites, whereas Dscam[TM2] is in both dendrites and axons. We demonstrate that the difference in subcellular localization, rather than biochemical properties, leads to the two isoforms' functional differences. Moreover, we show that the subcellular enrichment of functional partners results in a DLK/Wallenda-Dscam[TM2]-Dock signaling cascade in axons. We further apply isoTarget to study two isoforms of a GABA receptor to demonstrate its general applicability. isoTarget is an effective technique for studying how alternative splicing enhances proteome complexity.

Ultraviolet Radiant Energy-Dependent Functionalization Regulates Cellular Behavior on Titanium Dioxide Nanodots.

Titanium dioxide (TiO2) photofunctionalization has been demonstrated as an effective surface modification method for the osseointegration of implants. However, the insufficient understanding of the mechanism underlying photofunctionalization limits its clinical applications. Here, we report an ultraviolet (UV) radiant energy-dependent functionalization on TiO2 nanodots (TN) surfaces. We found the cell adhesion, proliferation, and osteogenic differentiation gradually increased with the accumulation of UV radiant energy (URE). The optimal functionalizing treatment energy was found to be 2000 mJ/cm2, which could regulate cell-specific behaviors on TN surfaces. The enhanced cell behaviors were regulated by the adsorption and functional site exposure of the extracellular matrix (ECM) proteins, which were the result of the surface physicochemical changes induced by the URE. The correlation between the URE and the reconstruction of surface hydroxyl groups was considered as an alternative mechanism of this energy-dependent functionalization. We also demonstrated the synergistic effects of FAK-RHOA and ERK1/2 signaling pathways on mediating the URE-dependent cell behaviors. Overall, this study provides a novel insight into the mechanisms of photofunctionalization, guiding the design of implants and the clinical practice of photofunctionalization.

Utilization of a pre-bent plate-positioning surgical guide system in precise mandibular reconstruction with a free fibula flap.

OBJECTIVES: We evaluated the effects of three-dimensional virtual planning and the use of a plate-embedded surgical guide in mandibular reconstruction with microvascular fibula flaps. MATERIALS AND METHODS: We retrospectively reviewed 35 patients who underwent primary mandibular reconstruction with a free fibula flap. They were divided into three groups according to the therapy they received. In group A, 12 patients underwent reconstruction using the modified surgical guide system, including virtual surgeries, pre-bent titanium plates, screw-predesignated cutting guides for mandibular and fibular osteotomies, and plate-embedded shaping guides. In group B, 14 patients underwent reconstruction using the common surgical guide system, including virtual surgeries, cutting guides and pre-bent plates. In group C, 9 patients underwent reconstruction based on the surgeon's experience. All cases were reviewed for the total operative time, ischemia time of the fibula flaps, accuracy of surgery, and postoperative complications. RESULTS: All of the fibula flaps survived. In group A, the ischemia time was shorter than that of groups B and C (P < .05). The average gonion and condyle shift was lower in group A than in groups B and C (P < .01). CONCLUSIONS: Application of the screw-predesignated and plate-embedded surgical guide system can reduce the ischemia time and operation time in mandibular reconstruction with a fibula flap, and can increase reconstruction accuracy. This method is a precise and highly reliable technique for improving the clinical outcome of mandibular reconstruction.

Pedicled partial thickness clavicular graft for oromandibular reconstruction.

OBJECTIVE: To report our experience on pedicled partial-thickness clavicular graft (PPCG) for oromandibular reconstruction. STUDY DESIGN: PPCG was used for oromandibular reconstruction after tumor resection in 23 patients with early-stage gingival carcinoma but were eager for postoperative dental implant therapy for restoration of good occlusal function. PPCG was harvested during neck dissection. The sternocleidomastoid (SCM) myocutaneous flap was also harvested in 18 cases. Dental implants were placed in the clavicular graft of 19 cases, and the other 4 declined because of financial concerns. Postoperative viability of the flaps and the dental implants were assessed. RESULTS: All the clavicular grafts survived without necrosis and implant-supported dentures of 19 patients provided satisfactory occlusion and masticatory function. Complications, although low in occurrence, included partial skin pedicle loss, nonunion between the clavicular graft and the remaining inferior border of the mandible, and clavicular bone fracture. CONCLUSIONS: PPCG is a simple but reliable procedure for reconstruction of severe alveolar defects. Correct preoperative evaluation and precise surgical technique contribute to higher success rates and lower complication rates. It is a viable reconstructive option for early-stage gingival carcinoma requiring neck dissection without postoperative radiation therapy.

[MEDIAL SURAL ARTERY PERFORATOR FREE FLAP FOR REPAIR OF DEFECT AFTER TONGUE CANCER ABLATION].

OBJECTIVE: To investigate the effectiveness of medial sural artery perforator free flap (MSAP) for repairing defect after tongue cancer ablation. METHODS: Between March 2013 and April 2014, the defects after tongue carcinoma resection were repaired with MSAP in 12 patients, including 8 cases of high or medium differentiated squamous cell carcinoma (SCC) and 4 cases of moderately-poor differentiated SCC. There were 7 males and 5 females with a median age of 55 years (range, 45-68 years). The disease duration ranged from 2.0 to 8.5 months (mean, 4.3 months). The tumor located at the tongue edge in 8 cases and at the tongue abdomen in 4 cases (mouth floor infiltration in 1 case). According to TNM stage, 7 cases were rated as T2N0M0, 2 cases as T2N1M0, 2 cases as T3N1M0, and 1 case as T4N1M0. The size of tumor ranged from 3.0 cm x 2.0 cm to 4.5 cm x 3.0 cm. The size of MSAP varied from 4.0 cm x 3.5 cm to 6.5 cm x 6.0 cm. RESULTS: The time of total operation ranged from 5.5 to 8.3 hours (mean, 6.8 hours), and flap harvesting time ranged from 54 to 85 minutes (mean, 65.6 minutes). The other flaps survived except 1 case of vein crisis. All the patients were followed up 6-18 months (mean, 13.7 months). With time passing, the pronunciation got better, and the skin showed mucosa-like change; the patients were capable of normal language exchange at 6 months after operation. No obvious scar on the leg or limitation of limb motion was observed. CONCLUSION: The MSAP is reliable for repair of defect after tongue cancer ablation, with the advantages of satisfactory recovery of tongue appearance, language function, and less donor site morbidity.

[INITIAL APPLICATION OF COMPUTER ASSISTED NAVIGATION SYSTEM IN RECONSTRUCTION OF MANDIBULAR DEFECTS].

OBJECTIVE: To evaluate the value of computer assisted navigation system (CANS) in the reconstruction of mandibular defects. METHODS: Between April 2012 and September 2014, 8 patients with mandibular defects were included in this study. There were 5 males and 3 females with an age range of 22-50 years (mean, 34.5 years), including 4 cases of ameloblastoma, 3 cases of odontogenic keratocyst, and 1 case of condylar osteoma. According to the CRABS (condyle, ramus, angle, body, symphysis) classification criteria based on the location of mandibular defect, there were 1 case of right CRAB type, 1 case of left RABS type, 1 case of left CR type, 1 case of right RAB type, 1 case of left C type, 1 case of right RABS+left S type, and 2 cases of right AB type. With the biteplate fixing mandible, maxillofacial CT and the donor site CT scan were done. Computer assisted design was made by using Surgicase CMF5.0 software and BrainLab Iplan software, included delineating the osteotomy lines for resection, ascertaining the normal anatomic structures for defect reconstruction, and determining the reconstructive morphology. With guide plates and the guidance of BrainLab navigation system, an en bloc tumor resection and simultaneous defect reconstruction were performed under the precise localization of mandibular angle and condyle. Preoperative and postoperative CT images were superimposed in Geomagic studio12.0 software system, and both were compared by three-dimensional (3D) objects and 2D slices. The complications and signs of recurrence were observed. RESULTS: Under the guidance of navigation, preoperative facial symmetry design, surgery simulation, and simultaneous navigation operation were performed successfully. The postoperative CT and postoperative 3D error analysis showed osteotomy lines and reconstruction contour had good matching with the preoperative planning. The error of important corresponding points (mandibular angle and external pole of condyle) in the reconstruction of mandibular defects were (1.83 ± 0.19) mm and (1.61 ± 0.24) mm. The patients were followed up 2-6 months (mean, 3.5 months). No complication was observed in the other patients except the patients undergoing rib transplantation who had mild limitation of mouth opening. Good facial symmetry was obtained, and no tumor recurrence was found. CONCLUSION: CANS can effectively increase the surgical precision in the reconstruction of mandibular defects and reduce complications, and recover facial symmetry. It is regarded as a valuable technique in this potentially complicated procedure.