Unexpected Modifications to Surgical Plans in Computer-assisted Mandibulectomy With Fibula Free-flap Reconstruction: A Five-case Series

Background/Aim: Computer-assisted surgery (CAS) for segmental mandibulectomy with fibula free-flap reconstruction in gingival cancer has been widely accepted as enabling both precise reconstruction and corrective osteotomy. Because modification of mandibulectomy after a preoperative planning session using computer-assisted osteotomy is considered challenging, high-volume centers have developed in-house CAS systems. Case Report: Herein, we report a five-case series involving modified mandibulectomy with fibula free-flap reconstruction following a preoperative planning session using an out-of-house CAS system. Two of the cases underwent reconstruction without modification of fibula osteotomy, two required modification at the medial site, and one required modification at the lateral site. The cutting guides were intraoperatively modified for four cases. The planned custom plates were used without modification in all five cases. Conclusion: Further development of CAS for accurate mandibular reconstruction requires accumulation of out-of-house cases involving modified segmental mandibulectomy after the planning session.