Reconstruction of a mandibular segmental defect with a customized 3-dimensional-printed titanium prosthesis in a cat with a mandibular osteosarcoma

CASE DESCRIPTION A 12-year-old neutered male domestic shorthair cat had been treated for a mass arising from the lingual aspect of the caudal right mandibular body. Cytoreductive surgery of the mass had been performed twice over a 2-year period, but the mass recurred following both surgeries. The mass was diagnosed as an osteosarcoma, and the cat was referred for further evaluation and treatment. CLINICAL FINDINGS Clinical findings were unremarkable, except for a 2-cm-diameter mass arising from the lingual aspect of the right mandible and mild anemia and lymphopenia. Pre- and postcontrast CT scans of the head, neck, and thorax were performed, revealing that the osteosarcoma was confined to the caudal right mandibular body, with no evidence of lymph node or pulmonary metastasis. TREATMENT AND OUTCOME The stereolithographic files of the CT scan of the head were sent for computer-aided design and manufacture of a customized 3-D-printed titanium prosthesis. Segmental mandibulectomy was performed, and the mandibular defect was reconstructed in a single stage with the 3-D-printed titanium prosthesis. The cat had 1 minor postoperative complication but had no signs of eating difficulties at any point after surgery. The cat was alive and disease free 14 months postoperatively. CLINICAL RELEVANCE Reconstruction of the mandible of a cat following mandibulectomy was possible with computer-aided design and manufacture of a customized 3-D-printed titanium prosthesis. Cats have a high rate of complications following mandibulectomy, and these initial findings suggested that mandibular reconstruction may reduce the risk of these complications and result in a better functional outcome.

[A comparative evaluation of bone tissue formation by tissue scaffold and osteoplastic material «Bio-Oss» transplantation in the maxillary sinus floor]

The effectiveness of bone tissue formation by transplantation of tissue-engineering scaffold and frequently used osteoplastic material «Bio-Oss» combined construction in maxillary sinus floor was evaluated and marked differences in regeneration terms by this treatment mode were found out.

[Application of computer aided design-computer aided manufacture technique in mandible defect reconstruction with individual titanium prosthesis]

OBJECTIVE

To investigate the application of computer aided design-computer aided manufacture (CAD-CAM) technique in the reconstruction of mandible defect with individual titanium prosthesis.

METHODS

Six patients with large mandibular ramus and angle tumor were spiral CT scanned preoperatively, and the CAD-CAM was used to design and make individual titanium prosthesis for reconstructing the mandibular defects after resection of the tumor. The prosthesis were assembled during operation. Postoperative follow-up period was 9 - 38 months.

RESULTS

The design and manufacture of titanium prosthesis by use of CAD-CAM technique was convenient and the prosthesis fitted the defects very well. The outline of the face, the occlusion and function were restored. After 9 - 38 months of follow-up, the mandibular symmetry was good.

CONCLUSIONS

The application of CAD-CAM provided accurate simulation and fast manufacturing process for the titanium prosthesis in the repair of mandibular defect.

[Inferior hemiarthroplasty of the temporo-mandibular joint with articulated condylar prosthesis type Stryker]

The optimal reconstruction of the mandible and of the temporo-mandibular joint after mandibular hemi-resection with disarticulation is still controversial in literature. This paperwork presents our experience on four cases in the reconstruction of the mandible together with the inferior arthroplasty of the temporo-mandibular joint, after the resection of extended benign tumors of the mandible, based on fibular free vascularized grafts having attached a Stryker titanium condylar prosthesis reconstructing the inferior segment of the temporo-mandibular joint. Our results for the this technique were excellent, with a functional rehabilitation very close to normal. After reviewing the various techniques and their arguments in literature, with accent on the TMJ reconstruction, we consider this method to be optimal for the reconstruction of mandibular defects in patients with neoplastic conditions.

[A study on individual mandibular prostheses according to 3D reconstruction of CT images and CNC simulation method]

The new method of manufacturing individual mandibular prostheses, in combination with CT data and CNC technique, can duplicate bone tissues accurately, and can have the individual mandibular prosthesis made to order, and repair the mandibular defect (especially the lager mandibular segmental defect).

The prosthetically guided osteodistraction of the mandible in the microvascular bone reconstruction after cancer surgery

The rehabilitation of the mandible after ablation cancer surgery is a challenge. Furthermore, osteodistraction in the microvascular fibula flap makes it difficult to predict adequate bone lengthening. The aim of this article is to evaluate a protocol used to manufacture templates for measuring osteodistraction, in terms of force vectors and definitive height. An accurate prosthetic wax-up with guide pins measuring the quantity of bone lengthening must be performed to manufacture the template. This device may be used to establish the end of the osteo-distraction in respect to the vertical dimension of the definitive occlusion.

[On the indications for and morbidity of segmental resection of the mandible for squamous cell carcinoma in the lower oral cavity]

BACKGROUND

Segmental resection of the mandibula in oral cancer surgery leads to both functional and aesthetic problems. The decision to preserve or resect the mandible depends on the vicinity of the lesion to the bone. Consequently, based on the rules of safety margins to all planes that are recommended for soft tissues, each lesion that is closer than 10 mm to the mandible needs resection of the bone.

PATIENTS AND METHODS

To establish data-based treatment modalities, a retrospective study was initiated and the results from all preoperative staging investigations of 152 patients with intraoral squamous cell carcinoma who underwent continuity or marginal resection of the mandible were evaluated. The histological outcome of the resected bone was compared to the staging results. Functional rehabilitation and long-term follow-up including survival rates were evaluated. The study reports on typical complications following segmental resection such as fracture of the reconstruction plate and demonstrates experiences with secondary microsurgical reconstructive surgery.

RESULTS

Mainly in cases of stage T1 and T2 carcinomas which are closer than 10 mm to the bone and clinically do not show any infiltration to the mandible, a marginal resection seems to be adequate. The decision about the extension of mandibular resection can be based on intraoperative cross sectional investigation of the periosteum. The survival rate of patients with intraoral carcinomas close to the mandible who underwent marginal mandibulectomy seems to be the same as in cases of continuity resection. A more conservative management of mandibular resection seems to be adequate and a data-based concept to standardize therapy of mandibular resection is presented.

Alternative Management of the Aging Jawline and Neck

The lower third of the face and neck have distinct changes that occur with aging. These changes can be globally and dramatically addressed with a traditional rhytidectomy. However, as the demographics of facial plastic surgery patients evolve, patients seek increasingly less invasive procedures that will result in faster recovery time and less postoperative morbidity. To accommodate this change, today's facial plastic surgeon must include less invasive procedures in the treatment strategies for the lower face and neck. Correct, patient-specific procedure selection and patient education can yield results similar to those of a traditional facelift. This article discusses options available for treatment of the lower face and neck.

Long term results of reconstruction plates in lateral mandibular defects. Revision of nine cases

OBJECTIVE

Although microsurgical bone transplant is still the gold standard, mandibular reconstruction plates (MRP) were for several years considered a fast and safe way to restore mandibular continuity without using a bone graft. New plate designs with locking screws have been recently introduced, and these may overcome some of the complications related to previous designs. We review the results of mandibular reconstruction plates in our institution from 1991 to 1995.

METHODS

The records of nine cancer patients who underwent lateral mandibular resections (with preservation of both condyle and symphysis) followed by reconstruction with a mandibular reconstruction plate, were retrospectively reviewed. Patients were treated between 1991 and 1995 with regular Synthes and Leibinger plates (without locking screws). Immediately after tumour resection, the bone defect was reconstructed with an MRP without bone grafting. Three cases required soft tissue coverage: two flaps and one buccal fat pad flap.

RESULTS

There was immediate orocervical fistula in six cases, one of which required surgical closure; and late complications were common. One patient died due to distant metastasis 13 months after surgery without symptoms related to the plate. The remaining eight patients had their plates removed at between 9 and 52 months after reconstruction, due to screw loosening (four cases), plate exposure (one case), or both (three cases).

CONCLUSION

Lateral mandibular reconstruction with non-locking screws and regular profile plates is no longer recommended. New plates with improved designs are currently available. Their low profile and locking screws are the usual characteristics of these new plates. More clinical experience is necessary before plate reconstruction can be recommended over microvascular bone transfer.

Mandibular reconstruction using the titanium functionally dynamic bridging plate system: a retrospective study of 34 cases

PURPOSE

We sought to examine the use of the Titanium Functionally Dynamic Bridging Plate System (Howmedica Leibinger, Freiburg, Germany) for mandibular reconstruction after oncologic resection in 34 patients.

PATIENTS AND METHODS

A retrospective study of 34 patients who had mandibular reconstruction using the titanium dynamic bridging plate system for mandibular reconstruction after oncologic resection were evaluated. The indications and postoperative outcomes were studied. Our evaluation focuses on the tolerance and aesthetic and functional results of this system.

RESULTS

The follow-up ranged from 1 to 4 years. At the end of the study, 18 of the 34 patients (53%) still had the plate in place. One plate fracture and 1 plate exposure requiring surgical management were found. Surgical results were satisfying, particularly when looking at healing delay or long-term tolerance. Aesthetic (79% rated the results as good or acceptable) and functional results of this reconstruction material were satisfying.

CONCLUSION

This reconstruction system provides a solution for a safe and rapid mandibular reconstruction for patients with a poor prognosis or poor general condition. This method also preserves the possibility of secondary reconstruction.

Use of Kirschner wire in mandible reconstruction: a case report and review of the literature

Reconstruction of massive defects in head the and neck usually requires different tissues such as skin, bone, and muscle in three-dimensional organization. Therefore, reconstruction of mandibular defects in particular include many difficulties for the head and neck, and for reconstructive surgeons. Various techniques and materials are available, and each has some advantages and disadvantages. But no materials or methods have all the reconstructive requirements. The surgeon's choice of techniques should be safe, simple, economic, and effective. We present a patient with a massive facial defect that was reconstructed successfully by using a 2-mm K wire with a free transverse rectus abdominis myocutaneous flap, and we also review the literature about the use of K wires in mandible fixation and reconstruction. We think that K wires should be kept in mind as a readily available, easily applicable, safe, inexpensive, and stable prosthetic material for mandible reconstruction, especially in cases with advanced disease.

[Congenital teratoma of the skull base: case report of an interdisciplinary treatment]

Teratomas of the oropharynx are quite rare congenital tumors. Even more rare than oropharyngeal teratomas are those with additional intracranial extension. Reviewing the literature the prognosis of these cases has been poor. In the majority stillbirth or immediate postpartum death following respiratory obstruction is reported. We present a case of a congenital teratoma of the oral cavity with intracranial extension in a female neonate. After several intraoral tumor resections to establish secure airway in the postpartum period the total tumor resection had to be performed at the age of 6 month via a lateral transmandibular approach to the skull base. By using extraoral distaction devices the operation related microsomia of the mandible could be corrected at the age of 5 years. At 7 years follow-up the girl presented free of recurrence and without any neurological or functional deficits.

[Evolution of tissue structures in the mandible after implantation of plate from polymethylmethacrylate and its compositions with hydroxyapatite]

Tissue reactions to active modified composite material were studied in experiments on Chinchilla rabbits. In the first series of experiments plates from composite material were implanted: polymethylmethacrylate (PMMA) plates were used in group 1, PMMA composition with hydroxyapatite (HAP) in group 2, and PMMA composition with HAP modified by polyacrylic acid in group 3. The content of HAP in each group was 30% by weight. Implantation of plates from pure PMMA induced atrophic processes with formation of connective tissue capsule at the site of implantation. In the second series of experiments the manifestations of inflammatory reactions in the bone and adjacent tissues, caused by HAP release into tissue, were observed, which were paralleled by activation of bone formation, which sometimes acquired the pattern of a hyperproductive reaction. PMMA/HAP composite modified by chemical bond proved to be the most effective: its implantation caused no manifest pathological reactions and inflammatory infiltration; no intraosseous deposition of crystals were detected. Intensive osteogenesis round the implanted plate was observed.

Importance of chin evaluation and treatment to optimizing neck rejuvenation surgery

The chin is the keystone linking the aesthetics of the face and neck but is often neglected in the analysis. Procedures related to the chin play an important role in defining neck anatomy. Alloplastic implants can provide the illusion of a longer jaw line in a patient with retrogenia. Even greater anatomic changes to the neck result when a sliding genioplasty is performed. This effect is primarily due to the digastric attachments from the mentum and mastoid. Advancing the mentum may have a more direct effect of elevating the position of the hyoid, which sharpens the angle between the jaw and neck. Finally, the diagnosis of a witch's chin is also discussed for the patients who present for aging neck surgery.

Mandibular augmentation

Porous polyethylene implants are available that are designed to augment the mandibular ramus and body. They can be used to increase the bigonial distance in patients with normal mandibular anatomy who desire an increase in lower facial width. When used in combination with extended chin implants, they can camouflage the skeletal contour inadequacies associated with class II mandibular deficiency. The implants are placed through intraoral incisions and fixed with titanium screws. In a clinical experience with 11 patients over 6 years, this technique has proven to be safe and effective.

Improving the mandibular reconstruction plate: technical innovation

The mandibular reconstruction plate can be improved by constructing a shaped acrylic spacer secured with self-tapping screws. It is removed to leave space for bone grafting.

Vertical chin augmentation with interpositional porous polyethylene implants: a histologic study in monkeys

The objective of this paper was to evaluate histologically the tissue reaction in the chin after a vertical augmentation using interpositional porous polyethylene (PPE) implants in monkeys. Six monkeys (Cebus apella) underwent an anterior horizontal mandibular osteotomy with implantation of an interpositional PPE implant to increase the vertical height. The animals were sacrificed 5 months postoperatively. Histologic preparations were stained with hematoxylin and eosin. The perimeter of the interface between the implant and the bone, the implant and the trabecular space, and the implant and the fibrous capsule were quantified using the NIH Image Analysis System (Image 1.60/PPC). In addition, the Tukey test was done. The study demonstrated that bone growth takes place within the pores of the implant; a fibrous capsule exists in some animals, where the implant has contact with the periosteum and mentalis muscle with few chronic inflammatory cells; and the 3 different tissues responded in statistically different manners. Perimeter analysis revealed 68.9% implant-bone contact, 22.9% implant-fibrous tissue contact, and 8.2% implant-trabecular space contact.

The bridging lateral mandibular reconstruction plate revisited

BACKGROUND

Lateral oromandibular reconstruction using a soft tissue free flap with a first-generation locking mandibular reconstruction plate (MRP) was rejected in a previous series by the senior author (K.E.B.) owing to a high incidence of delayed plate extrusion through the cheek skin.

OBJECTIVE

To reexamine this method of reconstruction using a second-generation, low-profile MRP.

PATIENTS AND DESIGN

A prospective case series of 27 patients with segmental defects of the lateral mandible after treatment of head and neck cancer.

SETTING

An academic tertiary care referral center.

INTERVENTION

All patients had mandibular continuity restored using the Leibinger Locking System (Stryker Leibinger Inc, Kalamazoo, Mich) MRP. Associated soft tissue defects were repaired using radial forearm (n = 22) or rectus abdominis (n= 5) free flaps.

MAIN OUTCOME MEASURE

Incidence of hardware-related complications.

RESULTS

All microvascular flap transfers were successful. One patient experienced a plate fracture 9 months after reconstruction. Only 1 patient experienced external plate exposure, 6 months after undergoing reconstruction of a through-and-through defect. Reconstruction was successful in 25 (93%) of the cases after a median follow-up period of 19.5 months.

CONCLUSIONS

The high incidence of external plate exposure in patients undergoing lateral oromandibular reconstruction using soft tissue free flaps and first-generation locking MRPs may have resulted from a plate geometry that was prone to result in extrusion. After a similar length of follow-up, the incidence of reconstructive failure was reduced by using a low-profile, rounded-contour MRP. Final assessment of the durability of this technique will require long-term follow-up.

Mersilene mesh chin augmentation. A 14-year experience

During the past 20 years, a variety of alloplastic materials have been introduced for chin augmentation. Mersilene mesh (Ethicon, Sommerville, NJ), introduced in 1950, demonstrates many qualities that make it an ideal implant. This article reviews the senior author's (S.W.P.) successful 14-year experience using Mersilene mesh chin implants. Between 1983 and 1997, 264 patients underwent chin implantation procedures. The results show a low rate of infection (0.8%) and displacement (1.5%). There were 14 temporary paresthesias and no cases of permanent anesthesia. There were no incidences of absorption, rejection, or extrusion. Mersilene provides a soft, natural appearance to the chin, and it continues to be our choice for chin implantation.

A method with combined prosthetic treatment of mandible with lateral resection and exarticulation

A part of the people who need prosthetic treatment in the maxillofacial area are in the stage of after-surgical operation of tumors. One of the most commonly discovered defects in the mandible is the lateral resection with exarticulation. Our goal is to examine the possibilities of achieving optimal prosthetic restoration of the patients with lateral resection and exarticulation of the mandible through clinical application and combination of the modern technology and supportive-retentioned elements.

Osseointegration of dental implants in patients with and without radiotherapy

Between 1987 and 1997, 275 dental implants were inserted in the mandibles of 63 patients with squamous cell carcinoma of the lower oropharyngeal level following a radical surgical procedure. Thirty-five of these patients had been preirradiated with a complete dose of 60 Gy. In a retrospective analysis we have reviewed the data of these patients for age, sex, localization of the implants, irradiation, interval of implantation and interval of the abutment operation. Thus far, the median follow-up time is 65 months. The 5-year success rate for all implants was 97.9%. We found that radiotherapy, age, sex, localization of implantation or the interval between the end of the tumor therapy and the time of implantation did not have any significant influence on osseointegration or loss of osseointegration. Only the time interval between implantation and the abutment operation was recorded to be of any great significance (p = 0.0001). No augmentation in the osteoradionecrosis rate could be recorded after dental implantation (1.6%), which leads us to conclude that radiotherapy (60 Gy) in patients with head and neck cancers should not be regarded as a contraindication for dental implantation.

Volume-length impact of lateral jaw resections on complication rates

OBJECTIVE

To study the relationship between soft tissue volume loss and bone resection length following lateral segmental mandibulectomy with plate reconstruction and complication rates.

DESIGN

Retrospective case review of 31 patients (1989-1996), with average follow-up of 37.2 months, who were treated by lateral composite resection for oral cavity and/or oropharyngeal malignancy with primary reconstruction by defect-bridging plates.

SETTING

Academic tertiary care referral center.

INTERVENTIONS

Thirty patients had stainless steel and 1 patient a vitallium reconstruction plate to restore mandibular continuity. Soft tissue defects were repaired with pectoralis myocutaneous flaps (n = 25), skin grafts (n = 4), a radial forearm free flap (n = 1), or primary closure (n = 1). All patients received preoperative (n = 6) or postoperative (n = 25) radiation therapy.

MAIN OUTCOME MEASURES

Overall and hardware-related complications.

RESULTS

All 31 initial soft tissue repairs were successful. Subsequent complications occurred in 14 patients (45%), which included plate exposure (29%), loosened screws requiring hardware removal (29%), fistula (14%), local wound infection (14%), osteomyelitis (7%), and plate fracture (7%). Average time to complication was 7.7 months. Complication rates were 81% for bone defects greater than 5.0 cm, and 7% for those less than 5.0 cm. Bivariate analysis indicated bone resection lengths greater than 5.0 cm to be a significant predictor of both hardware-related (P = .02) and overall complications (P = .005), whereas soft tissue volume resections greater than 240 cm3 were found only to be marginally significant (P = .04) for overall complications.

CONCLUSION

Extirpative losses involving more than 5 cm of bone, or tissue volume greater than 240 cm3, are associated with unacceptably high complication rates when reconstructed with solid screw stainless steel plates and this warrants consideration of alternative techniques for long-term stability.

Functional reconstruction of the mandible: a modified titanium mesh system

This paper describes a method for mandibular reconstruction utilizing autogenous cancellous bone in a titanium mesh. The mesh is designed preoperatively based on a duplicate of the patient's mandible which is modified to simulate an anatomically correct edentulous segment in the region to be reconstructed. The duplicate mandible is articulated with a maxillary dental cast, and a locating splint is fabricated for intraoperative use to aid the positioning of the mesh in relation to the upper teeth. The method facilitates future rehabilitation with dental implants and results in a symmetric and highly functional reconstruction of the mandible.

Primary reconstruction of mandible in head and neck cancer with silastic implant--a review of 69 cases

Different methods of primary mandibular reconstruction carried out at the Tata Memorial Cancer Hospital range from the pectoralis major myocutaneous or osteomyocutaneous composite flap, which is the most frequently performed procedure, to a free vascularised composite tissue transfer with microvascular anastomosis, including, iliac crest free vascularised bone grafts or radial artery forearm flap free vascularised radius bone grafts, free vascularised fibular bone grafts and silastic mandibular implants. The clinical results of immediate mandibular reconstruction with a silastic mandibular implant (SMI) in 69 patients is presented. Out of the 69 cases, 2 patients died in the early post-operative period. Twenty (30%) SMI were retained for a period of 1 year to 5 years. Forty seven (70%) SMI were retained for a period of less than 1 year. These implants have been used in a variety of cases, with or without major flap reconstruction, where a skeletal support was indicated, especially after mandibular arch resection. The results of this series indicates the importance of these implants as a short term spacer, even in advanced, fungating lesions of head and neck cancer where the risk of infection, haematoma and salivary leak is very high. Bone replacements were undertaken at a later date in suitable cases. The effects of preoperative chemotherapy and radiotherapy on the retention of these implants has also been studied.

Augmentation genioplasty with hard tissue replacement implants

PURPOSE

This study assessed the soft tissue changes produced by the placement of hard tissue replacement (HTR) polymer chin implants for augmentation genioplasty and evaluated the dimensional stability as well as any bony changes associated with the implants.

PATIENTS AND METHODS

The study group consisted of 18 patients (3 males, 15 females) with an average follow-up of 21.5 months (range, 12 to 44 months). All implants were placed through an intraoral incision and stabilized to the symphysis with a single 2.0-mm diameter titanium screw. Preoperative, postoperative, and long-term cephalometric radiographs were analyzed for changes in soft tissue thickness in the chin region, implant stability, and the presence of bone resorption.

RESULTS

The net hard tissue chin augmentation achieved averaged 6.0 mm (range, 4.5 to 9 mm). Average preoperative soft tissue thickness was 12.1 mm (range, 11 to 14.5 mm) and postoperatively it was 10.6 mm (range, 10 to 13.5 mm). The average increase in soft tissue projection was 77.6% (range, 71.4% to 83.3%) of the implant thickness. There was no radiographic evidence of implant migration or bony resorption beneath the implant.

CONCLUSIONS

HTR implants appear to be a predictable means of augmenting the chin, providing the desired aesthetic change, without causing resorption of underlying bone.

Staged sequential reconstruction of a total lower lip, chin, and anterior mandibular defect

The combination of a total lower lip, chin, and anterior mandibular defect following cancer resection is an extremely complex problem that requires a sequence of operations to optimize functional and aesthetic results. One patient is presented in whom the defect was reconstructed with a free fibular flap followed by a series of ancillary procedures using both modern and traditional techniques. At the time of tumor ablation, the through-and-through oromandibular defect was reconstructed with a fibular osteocutaneous flap. The lower lip and gingivolabial sulcus was reconstructed later with a tongue flap. Tissue expansion was subsequently used to replace the fibular skin with expanded submental hair-bearing skin. A polyethylene implant was added later to the fibular bone for chin augmentation. Subsequently the lower lip was supported with a tendinous graft suspended to the anterior masseter bilaterally. Lastly, the vermilion border was elevated by removing a rim of the tongue flap and covering the secondary wound with a full-thickness skin graft. At the end of the reconstructive procedures, lip seal and oral aperture were good with no drooling and excellent speech.

McCune-Albright syndrome progressing with severe fibrous dysplasia

We present the case of an 11-year-old girl with McCune-Albright syndrome associated with severe fibrous dysplasia. In addition to bone lesions, she has apparent manifestations of precocious puberty. In examination, a mass at the mentum spreading to mandibular corpus bilaterally was seen. This mass has affected the mandibular teeth. It was nearly 20 x 20 x 15 cm in size and had local necrotic regions on it. The lower lip was expanded too much by the mass. Another mass filled the left maxillary sinus, expanding the left zygomatic region outwardly and closing the left nasal fossa completely. A rectangular skull shape was related to the involvement of cranial bones. After stainless steel, custom-made mandibular prosthesis was prepared, the patient underwent surgery. A partial mandibulectomy was performed, and resulting mandibular bone defect was reconstructed by steel prosthesis. Craniofacial involvement occurs in 100% of disseminated cases. In the dental literature, mandibular involvement was found in 20% of cases. However, in studied literature, we did not find a dramatic mandibular lesion as severe as that presented here.

Individual prostheses and resection templates for mandibular resection and reconstruction

This new technique uses helical computed tomography data and computer-aided design and manufacturing for preoperative fabrication of individual mandibular prostheses together with corresponding resection templates. Coherent 3D geometries for computer-based models are the basis for the construction of prostheses and provide data for a computerized numerical control fabrication. Fixation plates are fabricated with the titanium prostheses. The identical data of these plates are used for the computer-aided design and manufacturing of resection templates, which guide an oscillating saw in a precisely determined resection plane. This plane again is identical with the prostheses' margins for mandibular body replacement. The use of this technique in four patients is reported on: after temporary insertion of the templates for resection and after resection, the prostheses were stabilized with the same screws in the same screw-holes where the templates had been. Resection and reconstruction were thus highly precise, safe and fast and primarily led to excellent aesthetic and functional results. Wound-healing depends on a safe soft-tissue reconstruction over these large prostheses. Coverage with flaps seems obligatory. In spite of the superior technical aspects, the clinical long-term results of this new technique were poor.