Mandible Reconstruction

Our Approach

By deploying PDR’s 17 years of surgical & prosthetic design experience via an online collaboration with a maxillofacial surgeon, we were able to improve the accuracy and speed of this intricate procedure.  Despite being geographically distant, we utilised a concise screen-sharing planning meeting with the surgeon to agree the tumour excision margins – as well as specifying the fibula cutting points and fixation methods from the outset.  By asking the correct questions and gathering sufficient information early, we were able to undertake detailed design work offline – freeing the surgeon to return to his busy schedule.

The Problem

The patient had a mandibular tumour – requiring resection of the mandible and reconstruction using a fibula bone flap accurately harvested from the patient’s leg. 

What We Did

Virtual surgical planning was undertaken to pick excision margins which would be safe and realistic to achieve in the operating theatre – with the margins translated robustly and reliably by custom surgical guides which interfaced with the patient’s jaw. 

Precise cutting points and angles were also rehearsed and finalised for the fibula to achieve an aesthetically pleasing and functionally appropriate contour.  Two separate pieces of fibula were deemed necessary.  Again, custom surgical guides were designed to accurately and reliably translate the planned cuts into surgery.  The raised cylinders dictated where to pilot drill holes into the fibula while still in-situ – to guarantee correct implant placement later on.

Finally, we designed a custom implant – fabricated using Electron Beam Melting (EBM) to match the patient’s anatomy precisely.  Its correct positioning was guaranteed (on the fibula sections) by the holes pilot-drilled earlier.  Correct positioning was guaranteed on the mandible by interfacing with distinctive anatomical features.

The Result

Surgery time was reduced.  The guides fitted precisely and functioned correctly.  The implant provided an exact anatomical match and was fitted quickly.  From receipt of the data, to delivery of the models, guides and implants, the lead time was 1 week.

"PDR provide a rapid, flexible service which allows for a cancer case to be planned and executed well within the 31/62 day NHS targets.  In Sunderland we've found the jigs and implants to be an accurate fit, saving us theatre time and improving outcomes."