Methods: A quantitative serial retrospective radiographic analysis was performed in patients who underwent free fibula flaps for mandibular reconstruction. A matched pair analysis of immediate post-operative scans were compared to longer-term post-operative scans on patients with free fibula flaps. The two radiographic modalities used to measure the dimensions included digital computed tomography (CT) scans and digital orthopantomograms (OPT). Previous studies have been undertaken to analyze the fibular height in 2-D using OPT images. CT scans, on the other hand, provide the ability to view the graft in 3-D and in 2-D from a myriad of vantage points for improved clinical relevance. The CT and OPT data was analyzed using commercially available software (OsiriX, Switzerland). Fifteen patients were included in the final analysis. CT scan data included height and depth measurements while OPT data included only height.
Results: Depth measurements using CT analysis yielded an average of 3.94% bone resorption. Height measurements using CT analysis yielded an average of 1.56% bone resorption and height measurements using OPT images yielded an average of 5.24% bone resorption.
Conclusion: We conclude that both modalities were able to distinguish minute changes in the size of the fibula, both resorption and hypertrophy. The OPT measurements may have over estimated the amount of bone resorption over time but a larger patient pool is needed to confirm. Further studies that have greater patient numbers and patients with both CT and OPT images should be done to verify any discrepancies between CT and OPT analysis of free fibular flap mandibular reconstructions.