Feasibility of Low-Cost In-House 3D Printing in Mandibular Reconstruction with Fibula Free Flap: Initial Regional Experience from Northern Thailand

Thanyanan  Panich; Ueaungkun Sitthimongkon

doi:10.64387/tjs.2026.278453

Authors

Thanyanan Panich โรงพยาบาลลำปาง
Ueaungkun Sitthimongkon

DOI:

https://doi.org/10.64387/tjs.2026.278453

Keywords:

Mandibular reconstruction, Fibula free flap, 3D printing, Open-source software, Virtual surgical planning, In-house workflow

Abstract

Background: Computer-assisted mandibular reconstruction with fibula free flap (FFF) improves accuracy but is often limited by high cost and dependency on external engineering support. This study evaluated the feasibility, workflow, and outcomes of a low-cost, in-house 3D printing protocol for mandibular reconstruction in a regional hospital.

Materials and Methods: Eighteen patients who underwent in-house, open-source–based 3D–planned FFF reconstruction between 2020 and 2025 were retrospectively reviewed. We analyzed demographic, operative, and reconstructive parameters, including ischemia time, operative duration, flap survival, and postoperative outcomes.

Results: The mean age was 60.9 years, with an equal sex distribution. Squamous cell carcinoma was the most common diagnosis (61%), and lateral-type defects predominated (78%). All reconstructions used osteocutaneous FFF with a single skin paddle. The mean defect length was 83.8 mm, ischemia time was 101 ± 32 minutes, and total operative time was 613 ± 110 minutes. No patient required routine ICU admission. All 18 flaps survived (100%). Minor complications included two fistulae (11%) and one plate exposure (5.6%). The average 3D printing cost was approximately 100 THB (USD 2.7) per model.

Conclusion: An in-house, surgeon-driven 3D printing workflow using open-source software is feasible, accurate, and cost-effective for mandibular reconstruction. A regional hospital setting can achieve outcomes comparable to high-cost commercial systems, supporting broader access to digital reconstructive technology.

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