Development of a Novel Adjustable Osteotomy Guide for Use in Free Fibula Flap Osteotomies and Comparison With Conventional Methods on 3D-Printed Models

CT DICOM data from 5 representative mandibular reconstruction cases were segmented to generate digital models of the maxilla, mandible, and fibula, and then 3D printed (PLA). The authors developed a reusable adjustable osteotomy guide (AOG) to translate in-house virtual surgical planning (VSP) measurements (segment lengths and osteotomy angles) into controlled free fibula flap osteotomies without patient-specific printed cutting guides. For each case, duplicate 3D-printed models were allocated to a conventional wire-template technique (CT) without VSP and to the AOG technique guided by in-house VSP (3D Slicer). After simulated mandibular resection and fibula shaping, reconstructions were photographed in standardized views. Symmetry was assessed using predefined right-to-left ratios (a1/a2–h1/h2) measured in ImageJ, and procedure duration from resection to completion of reconstruction was recorded. The AOG technique improved symmetry for the angulus-gnathion distance ratio (b1/b2) compared with CT (median 99 [IQR 2] versus 95 [IQR 3], P =0.043) and for the midline-angulus distance ratio (d1/d2) (median 98 [IQR 4] versus 95 [IQR 4], P =0.041). Procedure duration was shorter with AOG (median 14 [IQR 4] versus 20 [IQR 9] min, P =0.042). On 3D-printed models, an adjustable, reusable osteotomy guide informed by in-house VSP improved selected symmetry metrics and reduced shaping time versus conventional wire templating, suggesting a practical pathway to VSP-informed fibula osteotomies with reduced cost and logistical dependence.