In house virtual surgery and 3D complex head and neck reconstruction

Abstract

Background3-Dimensional (3D) printing can be applied to virtual planning and creation of surgical guides for mandibular reconstruction. Such systems are becoming increasingly prevalent in head and neck reconstruction. However, third party access to this technology is costly and removes the opportunity to design, create, and modify the bony reconstructions, as third party technology is a black box. This series is a pilot study to document the feasibility of an in-house software tool. The objectives of this study are to describe the design of an automated in house system and assess the accuracy of this in house automated software tool for mandibular reconstruction in a simulated environment.MethodsSoftware was written to automate the preoperative planning and surgical guide creation process. In a simulation lab, Otolaryngology residents were tasked with resecting and reconstructing a simulated mandible using the 3D-printed cutting guides. A control group of residents performed resection and reconstruction using the traditional method without cutting guides. T-test analysis was performed to compare specific aspects of the final reconstructions including: change from native mandibular width and projection, segment gap distance, and reconstruction time.ResultsMandibular reconstruction was successful in all participants using the 3D printed system.The guided group performed significantly better on the measurement of change in Mandibular overlap, projection, segment gap volume. There was a non-significant trend towards better mandibular width and operative time for the guided group.ConclusionsThis study confirms functionality and feasibility of using an in house automated software for planning and creating surgical guides.

Clinical evaluation of an automated virtual surgical planning platform for mandibular reconstruction

“…More specifically, in the current workflow, the contour of the resected portion of the outer cortex is simplified to an optimal set of linear lines representing respective fibula segments, based on a welldocumented mathematical algorithm. 15,27 Recently, the authors have published applying this algorithm to determine optimal mandibular reconstruction. 16 This computational approach contrasts with other VSP solutions where the virtual reconstruction is guided by heuristics or by mandibular simplification models reported in the literature.…”

“…By simplifying the geometry of the mandible and fibula, the algorithm used an optimization algorithm to mathematically position the reconstruction segments. 15 The algorithm was constrained such that the minimum individual segment length was 1.5 cm, and the surgeon could specify a maximum number of segments. The VSP software created models of the planned reconstruction, fibula cutting guide, and mandible cutting guide.…”

“…The authors of this paper have developed a custom, in-house semi-automated VSP platform for planning and executing mandibular reconstructions and have previously reported on an ex vivo validation of the program. 15 More recently, the authors described the application of an automated optimization algorithm that, for any given mandibular defect, computes an optimal reconstruction based on mathematical principles. 16 The goal of this study is 3-fold: To evaluate an in-house VSP that mathematically computes an optimal reconstruction in a prospective case series of 25 mandibular reconstructions, to compare complication rates, operative times, and length of stay to 25 prior non-VSP reconstructions, and to develop and apply a standardized approach to measure VSP outcomes.…”

Predicting the Number of Fibular Segments to Reconstruct Mandibular Defects

“…The authors have developed an in-house custom virtual surgical planning software based on the RDP method and have previously published on an ex vivo proof of concept analysis. 15 The disadvantage of such an approach compared to current classification and template methods is that a 3D model of the mandible must be generated based on the patient's preoperative CT scan. In cases where pathology distorts the outer cortex of the mandible, techniques to recreate the premorbid mandible are required.…”

Full-Digital Workflow for Fabricating a Custom-Made Direct Metal Laser Sintering (DMLS) Mandibular Implant: A Case Report

“…Novel, three-dimensional, surgical simulation software has rendered reconstructive surgery much more reliable than it was before [17]. During the surgery, we were able to easily insert the mandibular prosthesis due to careful presurgical planning.…”