Mandibular defect reconstruction with the help of mirror imaging coupled with laser stereolithographic modeling technique

With the advent of microsurgery, composite defect in the mandible can be repaired with various forms of osteocutaneous free flaps. However, it is difficult to accurately reconstruct a large defect in the mandible when not enough mandibular reference blueprints remain. This case report describes a large ameloblastoma at the left lower molar region and ascending ramus of the mandible in a 53-year-old male patient. Before surgery, spiral computed tomography scanning of the whole skull of the patient was performed. Using three-dimensional reconstruction and mirror imaging coupled with laser stereolithographic technique, a complete mandibular biomodel with idealized shape was fabricated. A titanium reconstruction plate was made using the biomodel as a guide. The tumor mass together with the left mandible from the second premolar to the condylar head area was resected en bloc. The large mandibular defect was then reconstructed with the precontoured titanium plate and three segments of vascularized fibular bone graft fixed along the plate. The temporomandibular joint was restored with temporalis muscle as an interpositional disc replacement. The complex defect in the mandible was thus repaired with satisfactory functioning and esthetic result. We suggest that with the help of mirror imaging coupled with laser stereolithographic technique, a precontoured titanium plate can be made for the reconstruction of large mandibular defects.