Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap: A Systematic Review and Meta-Analysis

Abstract

Sir: We would like to congratulate the authors, first for their contribution of the successful compilation entitled “Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap: A Systematic Review and Meta-Analysis”1 to the literature. The study was designed very well, and their evaluation attempted to be as objective as possible. Thus, we appreciate the authors and would like to emphasize a few points. Although comparison between conventional and computer-assisted mandibular reconstruction with free fibula flaps was made in standardized way as much as possible, some factors limit this. In the Patients and Methods section, it was stated that patients with mandibular malignancy, benign lesions, osteomyelitis, and osteonecrosis were included in the study. Thus, assessment of patients with the same diseases in terms of conventional and computer-assisted reconstruction could provide more appropriate and more accurate results statistically. It is clear that reconstructive outcomes of patients with osteomyelitis and results of the reconstruction caused by benign conditions will vary greatly in terms of accuracy, efficiency, and reconstructive outcomes, respectively. Furthermore, parameters such as reconstructive time, ischemic time, and total operative time were evaluated in the study, and computer-assisted mandibular reconstruction was reported to be faster. Reconstructive time was measured in only three of 11 studies, and it was reported that computer-assisted reconstruction had been significantly faster than conventional reconstruction.2–4 The absence of this parameter in the remaining eight studies restricts the comparison. Total operative time was reported in seven studies. There was no significant difference between the two methods in three of these studies,3,5,6 whereas computer-assisted mandibular reconstruction decreased total operative time in the remaining four studies.2,3,5–9 According to these data, the difference between the two methods cannot be defined in terms of total operative time and reconstructive time. Actually, given the methodology of the study, it is not possible to compare the speed of both techniques. Surgical experience and equipment parameters are important for a reconstructive period. The operative time of each surgeon may be different. Moreover, comparing the experiences of different surgeons affects the objectivity of the review. It is not a correct way to find out the aimed-for data by comparing outcome and speed of a surgeon in the conventional reconstruction group to success and speed of another surgeon in the computer-assisted group. However, if the same surgeon uses both techniques, data regarding surgical speed could be obtained. As mentioned above, the comparison of operative and reconstructive periods between the patients operated on for the same pathologic condition could be statistically significant. It is obviously clear that surgery performed because of a benign neoplasm takes less time compared with other cases. We thank the authors for their valuable article and successfully submitting such an extremely complex compilation. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. The research was not sponsored by an outside organization.

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