Three-Dimensionally Printed Patient-Specific Surgical Plates Increase Accuracy of Oncologic Head and Neck Reconstruction Versus Conventional Surgical Plates: A Comparative Study

Abstract

Background Surgeons are pursuing accurate head and neck reconstruction to enhance aesthetic and functional outcomes after oncologic resection. This study aimed to investigate whether accuracy of head and neck reconstruction is improved with the use of three-dimensionally (3D)-printed patient-specific surgical plates compared with conventional plates. Methods In this comparative study, patients were prospectively recruited into the study group (3DJP16) with 3D-printed patient-specific surgical plates. The patients in control group with conventional surgical plates were from a historic cohort in the same unit. The primary end point of the study was the accuracy of head and neck reconstruction. The secondary end points were accuracy of osteotomy, intraoperative blood loss, total operative time, and length of hospital stay. Results The study recruited of 33 patients, including 17 in the study group and 16 in the control group. The patients’ baseline characteristics were similar between the two groups. The absolute distance deviation of the maxilla or mandible was 1.5 ± 0.5 mm in the study group and 2.1 ± 0.7 mm in the control group [mean difference, − 0.7 mm; 95% confidence interval (CI) − 1.1 to − 0.3; p = 0.003], showing superior accuracy of reconstruction for the patients with 3D-printed patient-specific surgical plates. Improved accuracy of reconstruction also was detected in terms of bilateral mandibular angles and bone grafts. Concerning the secondary end points, the accuracy of the osteotomy was similar in the two groups. No difference was found regarding intraoperative blood loss, total operative time, or length of hospital stay. Conclusions This is the first study to prove that compared with conventional plates, 3D-printed patient-specific surgical plates improve the accuracy of oncologic head and neck reconstruction.

Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

“…More recently, the advent of 3D-printed patientspecific surgical plates has further enhanced the precise alignment and fixation of bone grafts 14,15 . In previous studies conducted by the present authors, patient-specific surgical plates have been demonstrated to enhance the overall accuracy of oncological mandibular reconstruction 14,[16][17][18][19] . However, spatial deviations of the TMJ are rarely evaluated, and whether CAS and patientspecific surgical plates contribute to the normal fossa-condyle relationship remains to be elucidated.…”

“…CAS was performed on all patients, including preoperative virtual surgery, real surgery, and postoperative accuracy analysis 16,17,19 . In the preoperative virtual surgery, the oncological mandibular resection and reconstruction were conducted in ProPlan CMF 3.0 (Materialise, Leuven, Belgium).…”

“…3D-printed patient-specific surgical plates were designed and applied in a novel 'surgeon-dominated' approach, which has been detailed in previous articles 16,17 . The study group has been registered at ClinicalTrials.gov (3DJP16, NCT03057223) 14,19 . Patients in the control group underwent CAS performed by the same chief surgeon in the same unit.…”

“…Superimposition of the CAS postoperative skull with the preoperative model facilitates the evaluation of the spatial deviations of the TMJ 6,19,20 . Conventionally, the algorithm for superimposition is based on the non-operated side of the mandible [19][20][21] ; this has been adopted in many previous studies assessing the accuracy of CAS. The algorithm deposits reconstruction discrepancy on the operated side for assessing spatial accuracy; therefore, this was termed 'absolute deviation'.…”

“Three‐in‐one” patient‐specific surgical guides for simultaneous dental implants in fibula flap jaw reconstruction: A prospective case series

“…Previously, we have designed and fabricated novel patient‐specific surgical plates by metal three‐dimensional (3D) printing technology for jaw reconstruction, which led to precise reconstructive outcomes 8,9 . Further, we explored the workflow and technical procedures, and then proposed a novel “surgeon‐dominated” approach to the design of 3D printed patient‐specific surgical plates 10 .…”