Point-of-care computer-assisted design and manufacturing technology and its utility in post-traumatic mandibular reconstruction: An Australian public hospital experience

Abstract

Application of load-bearing osteosynthesis plates is the current gold-standard management for complex mandibular fractures. Traditionally, this has required a transcutaneous submandibular approach, carrying with it the risk of damage to the facial nerve and obvious extraoral scarring. The existing literature describes the use of computer-assisted design and manufacturing technology through external vendors to aid transoral mandibular reconstruction. However, the reliance on third-party manufacturers comes with significant drawbacks, notably increased financial costs and manufacturing delays. We describe our experience in using point-of-care three-dimensional-printed surgical models to aid with the application of mandibular reconstruction plates. Utilising a virtual three-dimensional reconstruction of the patient’s preoperative computed tomography facial bones, we fabricate a custom model of the patient’s mandible with the department’s in-house three-dimensional printer. Stock plates are subsequently pre-bent and adapted to the three-dimensional model, with plate and screw position marked and screw lengths measured with callipers. By using a custom three-dimensional-printed surgical model to pre-contour the plates, we are able to position stock reconstruction plates via a transoral approach. Moreover, our unit’s utilisation of in-house computer-assisted design and manufacturing software and hardware allows us deliver a same-day turnaround for both surgical planning and performing the operation. Patient-specific surgical planning guides can facilitate the safe and efficient transoral application of mandibular reconstruction plates. Moreover, the use of point-of-care computer-assisted design and manufacturing technology ensures timely and cost-effective manufacturing of the necessary biomodel.

Three-Dimensional Finite Element Analysis on Mandibular Biomechanics Simulation under Normal and Traumatic Conditions

“…Given the fact that mandible fractures occur due to stress in different areas, their treatment involves performing intermaxillary fixation by using different approaches such as semi-rigid internal fixation or osteosynthesis [25]. The current gold-standard treatment for complex mandibular fractures is the placement of osteosynthesis plates, mandibular reconstruction plates can be patient-specific and have a computer-assisted design and manufacturing technology [26]. Titanium plates are used for treating subcondylar fractures [27].…”