Accuracy and reproducibility of virtual cutting guides and 3D-navigation for osteotomies of the mandible and maxilla

Bernstein, Jonathan M; Daly, Michael J.; Chan, Harley; Qiu, Jimmy; Goldstein, David P.; Muhanna, Nidal; Almeida, John R. de; Irish, Jonathan C.

doi:10.1371/journal.pone.0173111

Cited by 27 publications

(25 citation statements)

References 16 publications

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“…In both preclinical (5 cadavers) and clinical (5 patients) experiments, the mean cutting accuracy was less than 2 mm. These accuracy metrics are consistent with previous sawbone experiments performed using the same image‐guidance system in pelvic, extremity, mandible, and maxilla models . As a result, this study provides proof‐of‐principle validation of CBCT‐guided navigation accuracy under clinical conditions.…”

Section: Discussionsupporting

confidence: 87%

“…For future investigation, it is of interest to include a wider cohort of patients, including more complex maxillectomy cuts, to enable direct comparison between guided and unguided approaches. When using a large number of sawbone models in a preclinical setting, image‐guidance offered a statistically significant improvement in accuracy in comparison to unguided approach; however, further investigation is required to validate these results clinically.…”

Section: Discussionmentioning

confidence: 99%

“…Proof‐of‐principle clinical studies have demonstrated the potential for CBCT imaging to aid head and neck procedures involving significant bone resection and/or complex anatomical reconstruction . More recently, our research group has evaluated the combined use of CBCT imaging with surgical saw navigation in preclinical sawbone models (Sawbone, Vashon Island, WA), first for orthopedic oncology applications including pelvic surgery and then for mandible and maxilla resection . Each study showed statistically significant improvements in cutting accuracy in comparison to unguided procedures under laboratory conditions.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative cone‐beam CT‐guided osteotomy navigation in mandible and maxilla surgery

et al. 2019

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Objectives: Surgical navigation systems based on preoperative imaging are now increasingly used for guidance of head and neck resection and reconstruction. The primary aim of this study was to quantify osteotomy cutting accuracy using an image-guidance system for intraoperative cone-beam computed tomography (CBCT) imaging and surgical saw navigation. To enable clinical translation of this CBCT-guided navigation system, a secondary aim of the study was to design and fabricate a patient reference tracker suitable for clinical use on a mobile mandible.Methods: First, a preclinical cadaveric study was performed to quantify navigation accuracy with the use of clinically suitable patient reference trackers. Second, a proof-of-principle patient study was conducted to evaluate this technique under clinical conditions.Results: In both preclinical (5 cadavers) and clinical (5 patients) experiments, the mean cutting accuracy was less than 2 mm. In all preclinical specimens, bilateral mandibulectomies and bilateral maxillectomies were performed, for a total of 20 cut planes for analysis. The mean (standard deviation [SD]) values for distance, pitch, and roll were 1.4 mm (1.1 mm), 4.2 (3.5 ), and 2.9 (2.5 ) mm, respectively. Five mandibulectomies were performed on five patients, for a total of 10 cut planes for analysis. The mean (SD) values for distance, pitch, and roll were 1.7 mm (0.8 mm), 5.4 (1.5 ), and 6.7 (4.6 ) mm, respectively.Conclusions: The overall performance in comparison to alternative approaches warrants further consideration. In terms of accuracy, the results presented here are comparable to recent systematic reviews assessing CAD-CAM cutting guides that cite accuracies of~2 to 2.5 mm.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraoperative cone‐beam CT‐guided osteotomy navigation in mandible and maxilla surgery

et al. 2019

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“…Previous studies from our research group have demonstrated that real-time, 3D guidance of osteotomies in the maxillofacial skeleton is accurate and applicable to the surgical setting [20,48]. In a recent study from Hasan et al, intraoperative CBCT was acquired to provide on-thetable images for navigation reflecting changes in patient anatomy (e.g., mandible mobility) [27,48].…”

Section: Osteotomiesmentioning

confidence: 99%

“…However, the potential for navigation to maximize precision and avoid major complications during the ablation was considered when this technology was first described for head and neck surgical oncology [17][18][19]. Navigation has clearly demonstrated improved accuracy and reproducibility of craniomaxillofacial osteotomies [20], thus translating clinically into improved outcomes [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

et al. 2019

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To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. Materials and methods: Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using realtime tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. Results: The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). Conclusion: This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting-with rigorous assessment of oncological outcomeswould be the proposed next step.

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Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery

Sabiq,

Cherukupalli,

Khalil

et al. 2024

Head & Neck

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ObjectivesVirtual surgical planning (VSP) has gained acceptance because of its benefits in obtaining adequate resection, achieving cephalometric accuracy, and reducing operative time. The aim of this study is to compare the rate of union between VSP and free‐hand surgery (FHS), identify predictors of non‐union and evaluate the difference in operative time.MethodsPost‐operative CT were retrospectively reviewed for 123 patients who underwent maxillary or mandibular reconstruction between 2014 and 2021 using either VSP or FHS. Each apposition was graded as complete, partial or non‐union. The rate of union, risk difference and inter‐rater reliability were calculated. The difference in operative time was assessed. Predictors of non‐union were identified using logistic regression.ResultsA total of 326 appositions were graded (VSP n = 150; FHS n = 176). The rates of complete and partial union were higher with VSP than FHS (74.7% vs. 65.3%; 18% vs. 15.9%, respectively, p = 0.01). Non‐union was found at a higher rate with FHS than with VSP (18.7% vs. 7.3%). The non‐union risk difference was 11.4. FHS, major complications and apposition at the native bone were predictors of non‐union (OR 2.9, p = 0.02; OR 3.4, p = 0.01; OR 2.5, p = 0.05, respectively). The mean surgical time was shorter with VSP than with FHS (265.3 vs. 381.5 min, p < 0.001). The inter‐rater agreement was high (k = 0.85; ICC = 0.86).ConclusionVSP demonstrated significantly higher bony union rates and shorter operative time. FHS, development of major complications and apposition with native bone correlated with non‐union.

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Accuracy and reproducibility of virtual cutting guides and 3D-navigation for osteotomies of the mandible and maxilla

Cited by 27 publications

References 16 publications

Intraoperative cone‐beam CT‐guided osteotomy navigation in mandible and maxilla surgery

Intraoperative cone‐beam CT‐guided osteotomy navigation in mandible and maxilla surgery

Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery

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