Anatomical Landmark-guided Strategy for Computer-assisted Reconstruction of Infrastructure Maxillary Defects Using Free Fibula Flap.

Background: Computer-assisted surgery in head and neck reconstruction yields predictable and favorable clinical outcomes. However, there is a lack in the optimal arrangement of the fibula bone segments to re-establish the function and aesthetics of the maxilla. Methods: This study proposed a novel anatomical landmark-guided strategy for the virtual surgical planning (VSP) of infrastructure maxilla reconstruction using a free fibula flap. The optimal positioning of fibula segments was validated with a retrospective clinical study. Patients who underwent computer-assisted infrastructure maxillectomy and reconstruction with a free fibula flap from May 2017 to April 2024 were reviewed. Reproducibility of the landmarks and associated clinical parameters was assessed in VSP compared with the preoperative maxilla. Additionally, a structured quantitative approach was adopted for postoperative surgical outcome analysis by comparison of the postoperative maxilla and the VSP. Results: Twenty patients fulfilled the criteria of this study. In 11 cases, we conformed to the proposed reconstruction strategy (group A). In 9 cases, we adopted a modified approach (group B) with deviations in the count of fibula segments and positioning strategy. In group A, the pooled median landmark error was 2.19 mm (interquartile range, 1.63-2.91 mm) in the VSP compared with the preoperative maxilla; in group B, the error was 4.54 mm (interquartile range, 2.05-6.15 mm). The clinical parameters demonstrated satisfactory recapture of the alveolar arch and maxillary width. Conclusions: This anatomical landmark-guided strategy was validated with satisfactory reproducibility of the quantitative metrics in the VSP. The anatomical landmarks and associated clinical parameters provided a structured quantitative approach for postoperative analysis of computer-assisted maxillary reconstruction using FFFs.