Computer aided design and computer aided manufacturing (CAD-CAM) are an exciting dimension in the functional and accurate reconstruction of the oral cavity. The fibula is commonly used for mandibular reconstruction as a free flap. This straight bone needs to be shaped accurately to the peculiar shape of the mandible and yet remain viable. Add to that the avascular time constraints, so any method that helps to speed up this process accurately is a welcome addition. Patient-specific mandibular reconstruction plates in combination with cutting guides are widely thought to improve outcomes and reduce operating times. This is a prospective study from Italy based on data from 20 consecutive mandibular reconstructions from 2011-2015. A similar number of 20 patients that had the conventional ‘freehand’ reconstruction were used as controls. The mean reconstruction time for the freehand reconstructions was 63.8 (range 45-79) minutes and 30.7 (range 21-41) minutes for the CAD-CAM cases. Interestingly, no microvascular complications occurred in the CAD-CAM cases and in the free hand there was one a complete loss of flap and one of loss of the paddle. Finally, the authors estimate the cost of the CAD-CAM to be Euro 3500. The cost of the regular mandibular reconstruction plate for the free hand group was Euro 500. The money saved from the time gained and theatre cost (estimated as Euro 30 per minute) was Euro 3450. Thus, it was cost neutral. In addition to having better outcomes there were fewer complications and shorter hospital stay. This is a poignant study in difficult economic times and demonstrates the appropriate use of technology and investment will lead to better outcomes and is cost-effective in the longer term.
Money saving using CAD-CAM in mandibular reconstruction
Reviewed by Sunil K Bhatia
Is a computer-assisted design and computer-assisted manufacturing method for mandibular reconstruction economically viable?
