Research Summary

CAD/CAM Techniques Reduce Long-Term Complications in Jaw Reconstruction After Cancer Surgery

Anthony Calabro, MA

Key Highlights

  • CAD/CAM-assisted free fibula flap reconstruction reduced operating room time by approximately 1 hour.
  • Patients in the CAD/CAM group had a lower risk of wound dehiscence (7.4% vs 16.5%).
  • Long-term risk of hardware removal was 60% lower in the CAD/CAM group compared with conventional reconstruction.
  • CAD/CAM provides precise anatomical alignment and reduces need for postoperative surgical revisions.

In a retrospective cohort study of 215 patients undergoing mandibular reconstruction, computer-aided design and manufacturing (CAD/CAM) improved key clinical outcomes compared with conventional surgical methods. Most notably, CAD/CAM reduced the risk of long-term complications requiring hardware removal and decreased operating room time.

Free fibula flap reconstruction has become a mainstay for mandibular repair following oncologic resection. The introduction of CAD/CAM has revolutionized this approach by enabling preoperative virtual planning and the creation of patient-specific surgical guides and pre-contoured hardware. Despite its technological promise, comparative data with traditional techniques have been limited until now.

This study included 215 patients who underwent free fibula flap reconstruction of the mandible from 2012 to 2021. Of these, 136 received CAD/CAM-assisted surgery, and 79 underwent conventional reconstruction. The two groups were analyzed for differences in operative efficiency, short-term complications, and long-term surgical outcomes.

Operating room time was significantly shorter in the CAD/CAM group—by approximately 1 hour—though hospital length of stay was comparable. Short-term outcomes such as bleeding, thromboembolic events, and flap loss were similar between the groups. However, incision dehiscence occurred in only 7.4% of patients in the CAD/CAM group compared with 16.5% in the conventional cohort, indicating improved early wound healing with the use of precision-guided planning and hardware.

For long-term outcomes, the study evaluated 195 patients who had no major complications within 30 days of surgery. Patients who underwent CAD/CAM-assisted procedures were less likely to require secondary surgery for hardware removal. After adjusting for potential confounders, the odds of hardware removal were reduced by 60% in the CAD/CAM group, highlighting the durable stability of this approach.

Limitations of the study include its retrospective design and potential for selection bias. Furthermore, while clinical benefits were evident, the study did not perform a formal cost-effectiveness analysis to assess the economic tradeoffs of using CAD/CAM technology.

“Given the added cost with the use of CAD/CAM, future studies focusing on cost-effectiveness of this approach with respect to long-term outcomes and hardware maintenance will be important to justify the clinical significance of our results,” the authors concluded.

Reference
Bengur FB, Humar P, Saadoun R, et al. Computer-aided design and manufacturing in free fibula reconstruction of the mandible: comparison of long-term outcomes. Plast Reconstr Surg. 2025;155(5):910e-920e. doi:10.1097/PRS.0000000000011701