Virtual Planning and 3D printing modeling for mandibular reconstruction with fibula free flap

Abstract

BackgroundThis study was to evaluate the use of virtual planning and 3D printing modeling in mandibular reconstruction and compare the operation time and surgical outcome of this technique with conventional method.Material and MethodsBetween 2014 and 2017, 15 patients underwent vascularized fibula flap mandibular reconstruction using virtual planning and 3D printing modeling. Titanium plates were pre-bent using the models and cutting guides were used for osteotomies. 15 patients who underwent mandibular reconstruction using fibula flap without aid of virtual planning and 3D printing models were selected as control group. The operation time was recorded and compared in two groups. Accuracy of reconstruction was measured by superimposing the preoperative image onto the postoperative image of mandible. The selected bony landmark, distance and angle were measured.ResultsThe mean total operation time and reconstruction time were 1.60±0.37 and 5.54±0.50 hours in computer-assisted group, respectively; These were 2.58±0.45 and 6.54±0.70 hours in conventional group, respectively. Both operation time and reconstruction time were shorter in computer-assisted group. The difference between the preoperative and postoperative intercondylar distances, intergonial angle distances, anteroposterior distances and gonial angles were 2.92±1.15 and 4.48±1.41mm, 2.93±1.19 and 4.79±1.48mm, 4.31±1.24 and 5.61±1.41mm, 3.85±1.68° and 5.88±2.12° in the computer-assisted and conventional group, respectively. The differences between the preoperative and postoperative mandible is smaller in the computer-assisted group.ConclusionsVirtual planning and 3D printing modeling have the potential to increase mandibular reconstruction accuracy and reduce operation time. we believe that this technology for mandibular reconstruction in selected patients will become a used method and improve the quality of reconstruction. Key words:Mandibular reconstruction, fibula flap, virtual planning, computer-assisted design, 3D printing.

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

“…3,8,12 VSP has been shown to reduce operating and ischemia time, [4][5][6]13 and in some cases shown to improve the accuracy of reconstructions compared to the standard freehand approach. 4,5,14 The drawback of commercial options is that they are expensive, on This work has not been published or presented anywhere. It has been accepted for podium presentation at the AHNS 10th international conference on Head and Neck Cancer.…”

“…Generally, VSP can be divided into three modes: external planning through a commercial planning service in which the surgeon has a virtual meeting with the third party, 7,9,11 in‐house planning using commercial dedicated planning software, 4,5,10 and, less commonly, in‐house planning using a custom software workflow 3,8,12 . VSP has been shown to reduce operating and ischemia time, 4‐6,13 and in some cases shown to improve the accuracy of reconstructions compared to the standard freehand approach 4,5,14 . The drawback of commercial options is that they are expensive, on the order of thousands of dollars extra per case, 4,6,8,12 and are often black box solutions lacking a geometric analysis guiding the particular solution.…”

Virtual planning and navigational technology in reconstructive surgery

“…Further technological innovation has spawned the advent of 3D printing. Stereolithographic models have been particularly useful in delineating anatomy, planning resections, and devising osteotomy guides …”

The Use of Customised Surgical Guide for Bilateral Inferior Mandibulectomy in a Case of Monostotic Fibrous Dysplasia

“…The surgical guide should be stable, well fitting, easy to fix, and not interfering with the surgical site (Ren et al, 2018).…”