JAW IN A DAY SURGERY WITH CAD-CAM-ASSISTED FIBULA FREE FLAP RECONSTRUCTION: A CASE REPORT

Abstract
Background - Mandibular reconstruction after oncologic resection or severe trauma remains a complex challenge in head and neck surgery. The introduction of computer-aided design and manufacturing (CAD-CAM) technology, combined with fibula free flap reconstruction, has improved surgical precision and predictability. Patient-specific cutting guides and customized plates enable accurate osteotomies, optimal flap shaping, and three-dimensional anatomical restoration. A major advantage of this technique is the possibility of immediate osseo integrated dental implant placement, termed “Jaw in a day” (JIAD) procedure. This single-stage procedureprovides immediate restoration of mandibular form and function, accelerates oral rehabilitation, and improves patient quality of life. Case Report - A 52-year-old patient underwent left marginal mandibulectomy for mandibular osteoradionecrosis in January 2024. Reconstruction was performed with a CAD-CAM–assisted right fibula free flap. Three end osseous implants were placed immediately into the fibula segment using 3D cutting and drilling guides specifically designed on the donor site. Postoperative outcomes showed excellent flap integration, confirmed by orthopantomography. The reconstruction restored an optimal mandibular contour. Implant-supported prostheses were successfully placed in June 2024, allowing early functional rehabilitation. Conclusion - JIAD procedure with CAD-CAM–assisted fibula free flap reconstruction improves aesthetic and functional outcomes while reducing operative time and intraoperative adjustments. Although this approach involves higher initial costs and technical requirements, it represents the current gold standard for mandibular rehabilitation. By combining accuracy, reliability, and the potential for early prosthetic loading, this technique provides long-term clinical success and substantial benefits for both patients and surgical teams.