下顎骨因為外傷、癌症等情況下，需要切除部分下顎骨，所造成的缺陷必須接受重建手術，以期恢復臉部外型輪廓和咀嚼功能，目前醫學界常使用腓骨游離皮瓣重建。以腓骨重建下顎骨所面臨的困難之處是如何量測下顎骨的缺損範圍、如何決定並鋸切腓骨的拼接面角度，及如何以分段式的腓骨建構理想下顎骨外型，使手術結果能兼具美觀與功能。
本研究以長方體紙模型與輔助器械協助決定腓骨皮瓣片段長度及鋸切腓骨、並提出腓骨片段數量的決策演算法等。方法是利用建構的下顎骨模型投影至二維平面取得下顎骨輪廓，以此輪廓規劃下顎骨缺損範圍，再應用演算法求得腓骨片段數量與腓骨拼接間所需的切割角度、長度，並據以製作簡易的長方體紙模型，提供輔助機構組合成下顎骨缺損所需的腓骨片段，作為鋸切腓骨的依據，以完成下顎骨重建。
以長方體紙模型協助重建方法已應用在臨床上，共六案例且皆成功。另外結合腓骨片段數量決策演算法與腓骨皮瓣鋸切用輔助器械，用於下顎骨模型的重建實驗中，可準確且迅速測量下顎骨缺損，切割出理想的腓骨接觸切面，並測得腓骨片段的切面貼合間隙於1.1mm範圍內。

For patients with mandibular defects caused by tumor resection or trauma, they usually need to receive mandibular reconstruction to restore facial profile and chewing function. The common approach is to use free fibula flap for filling in mandibular defect. The difficulties of mandibular reconstruction come from the measurement of the defect size, the determination of the bevel surface orientation of each fibula bone segment, and the osteotomy of fibula bone.
In this research, we developed a new method for mandibular reconstruction, which used a rectangular paper model for presurgical planning, an assistive mechanical device for guiding osteotomies, and an decision algorithm for deciding the number of bone segments. The approach is to project a reconstructed 3D mandible model from CT images to obtain a planar outline of the mandible for estimating the mandible defect size. Then use the decision algorithm to determine the number of fibular segments and the angles of beveling surfaces of each fibula segment. Based on the calculated results, a paper model is produced for adjusting the assistive devices to form the required shape and number of fibula bone segments. The assistive devices are then used as the guidance for fibula bone osteotomy.
The paper model method for assisting mandibular reconstruction had been applied to clinical trials. All of the six cases were successful. Furthermore, combining the fibula segment decision-making algorithm and the assistive device for reconstructing the defect of a saw bone mandible model is also successful. The gap between the surfaces of two neighboring fibula bone segments was less than 1.1mm.

[1]. Flemming, A.F., Brough, M.D., Evans, N.D., et. al., “Mandibular reconstruction using vascularised fibula.” British Journal of Plastic Surgery, Vol. 43, pp. 403-409, 1990.
[2]. Hidalgo, D.A., “Aesthetic improvements in free-flap mandible reconstruction.” Plastic and Reconstructive Surgery, Vol. 88, pp. 574-585, 1991.
[3]. Yilmaz, M., Vayvada, H., Menderes, A., et. al., “A comparison of vascularized fibular flap and iliac crest flap for mandibular reconstruction.” The Journal of Craniofacial Surgery, Vol. 19, pp. 227-234, 2008.
[4]. Sylvia, M., and Patrick, C.著, “彩色圖解基礎人體解剖與生理學.”陳金山,徐淑媛譯,合記圖書出版社, pp. 99, 2000.
[5]. Lerrick, A.J., and Zak, M.J., “Oromandibular reconstruction with simultaneous free and pedicled composite flaps.” Operative Techniques In Otolaryngology-Head And Neck Surgery, Vol. 11, pp. 90-101, 2000.
[6]. Chana, J.S., Chang, Y.M., Wei, F.C., et. al., “Segmental mandibulectomy and immediate free fibula osteoseptocutaneous flap reconstruction with endosteal implants: an ideal treatment method for mandibular ameloblastoma.” Plastic & Reconstructive Surgery, Vol. 113, pp. 80-87, 2004.
[7]. Hidalgo, D.A., “Fibula free flap mandibular reconstruction.” Clinics in plastic surgery, Vol. 21, pp. 25-35, 1994.
[8]. Chee, E.K., Sara, T., and Ng, E.S., “Fibula osteocutaneous flap for mandible reconstruction after ameloblastoma resection: amending technique to reduce ischaemic time.” Malaysian Orthopaedic Journal, Vol. 1, pp. 39-41, 2007.
[9]. Yoshimura, M., Shimamura, K., Iwai, Y., et. al., “Free vascularized fibular transplant. A new method for monitoring circulation of the grafted fibula.” The Journal of Bone and Joint Surgery, Vol. 65, pp. 1295-1301, 1983.
[10]. Hallermann, W., Olsen, S., Bardyn, T., et. al., “A new method for computer-aided operation planning for extensive mandibular reconstruction.” Plastic and Reconstructive Surgery, Vol. 117,pp. 2431-2437, 2006.
[11]. Stojadinovic, S., Eufinger, H., Wehmöller, M., et. al., “One-step resection and reconstruction of the mandible using computer-aided techniques-experimental and clinical results.” Mund-, Kiefer- und Gesichtschirurgie, Vol. 3, pp. S151-S153, 1999.
[12]. Yeung, R.K., Samman, N., Cheung, L.K., et. al., “Stereomodel-assisted fibula flap harvest and mandibular reconstruction.” Journal of Oral and Maxillofacial Surgery, Vol. 65, pp. 1128-1134, 2007.
[13]. Marchetti, C., Bianchi, A., Mazzoni, S., et. al., “Oromandibular reconstruction using a fibula osteocutaneous free flap: four different "preplating" techniques.” Plastic and Reconstructive Surgery, Vol. 118, pp. 643-651, 2006.
[14]. Kroll, S.S., and Reece, G.P., “Aesthetically successful mandibular reconstruction with a single reconstruction plate.” Clinics in plastic surgery, Vol. 28, pp. 273-282, 2001.
[15]. Samman, N., Luk, W.K., Chow, T.W., et. al., “Custom-made titanium mandibular reconstruction tray.” Australian dental journal, Vol. 44, pp. 195-199, 1999.
[16]. Serra, J.M., Paloma, V., Mesa, F., et. al., “The vascularized fibula graft in mandibular reconstruction.” Journal of Oral and Maxillofacial Surgery, Vol. 49, pp. 244-250, 1991.
[17]. Valentini, V., Agrillo, A., Battisti, A., et. al., “Surgical planning in reconstruction of mandibular defect with fibula free flap: 15 patients.” The Journal of Craniofacial Surgery, Vol.16, pp. 601-607, 2005.
[18]. Nakayama, B., Kamei, Y., Ikuo, H., et. al., “Free fibula bone wedge technique for mandible reconstruction using fibula osteocutaneous flaps.” Plastic and Reconstructive Surgery, Vol. 117, pp. 1980-1985, 2006.
[19]. Shirani, G., Arshad, M., and Mohammadi, F., “Immediate reconstruction of a large mandibular defect of locally invasive benign lesions (A new method).” Journal of Craniofacial Surgery, Vol. 18, pp.1422-1428, 2007.
[20]. Rohner, D., Jaquiery, C., Kunz, C., et. al., “Maxillofacial reconstruction with prefabricated osseous free flaps: a 3-year experience with 24 patients.” Plastic and Reconstructive Surgery, Vol. 112, pp. 748-757, 2003.
[21]. Kernan, B.T., and Wimsatt, J.A., “Use of a stereolithography model for accurate, preoperative adaptation of a reconstruction plate.” Journal of Oral and Maxillofacial Surgery, Vol. 58, pp. 349-351, 2000.
[22]. Strackee, S.D., Kroon, F.H., Spierings, P.T., et. al., “Development of a modeling and osteotomy jig system for reconstruction of the mandible with a free vascularized fibula flap.” Plastic and Reconstructive Surgery, Vol. 114, pp. 1851-1858, 2004.
[23]. Mehta, R.P., and Deschler, D.G., “Mandibular reconstruction in 2004: an analysis of different techniques.” Current opinion in otolaryngology & head and neck surgery, Vol. 12, pp. 288-293, 2004.
[24]. Strackee, S.D., Kroon, F.H., Jaspers, J.E., et. al., “Modeling a fibula transplant in mandibular reconstructions: evaluation of the effects of a minimal number of osteotomies on the contour of the jaw.” Plastic and reconstructive surgery, Vol. 108, pp. 1915-1921, 2001.