The Use of Customised Surgical Guide for Bilateral Inferior Mandibulectomy in a Case of Monostotic Fibrous Dysplasia

Fibrous dysplasia (FD) is a benign pathological condition of bone in which normal cancellous bone is replaced by immature woven bone and fibrous tissue. Surgical recontouring aims to remove the excess fibrous bone and achieve acceptable symmetry. Conventional surgery which depends on visual exposure and the surgeon’s assessment during the procedure poses a great challenge in obtaining a predictable surgical outcome especially in bilateral presentation. Recent advances in surgical technology may overcome this challenge. Herein, we present a case of 23 years old Chinese lady who underwent bilateral inferior mandibulectomy for monostotic fibrous dysplasia. The aims of this surgery were to recontour the mandible symmetrically via extraoral approach while preserving the inferior alveolar nerves and mental nerves with the aid of a surgical guide. A stereolithography model of the patient’s mandible was produced using the computed tomography (CT) scan data in Digital Imaging and Communications in Medicine (DICOM) format to assist in the surgery. Simulation with SurgiCase software (Materialise, Leuven, Belgium) was utilised in creating the customised surgical guide. The autoclavable surgical guide was manufactured by rapid prototyping technology and used intraoperatively to define the osteotomy line for mandibular recontouring. Virtual surgical planning greatly assists surgeons to deliver a good surgical result.