Virtual Surgical Planning Using Stereolithographic Models for Segmental Mandibular Resection with Limited Extraoral Skin Incision versus Traditional Surgical Protocols

Abstract

Purpose: To evaluate, both clinically and radiographically the usage of stereolithographic model with limited extraoral skin incision versus the traditional method using dry mandibles in preoperative adaptation of locking reconstruction plate for lateral mandibular continuity defects in delayed type mandibular reconstruction. Materials and methods: Sixteen patients were randomly classified into two equal groups; in which group I was the control (traditional method) and group II was the study group (new method). Group (I): 8 patients with mandibular lesions indicated for segmental mandibular resections via intraoral approach and a wide extraoral incision assisted with preoperative adaptation of the reconstruction plate on dry mandible and refined intraoperatively with the use of a plastic template. Group (II): 8 patients with mandibular lesions indicated for segmental mandibular resections via intraoral approach and with very limited extraoral incision assisted with preoperative adaptation of the reconstruction plate on the patient`s stereolithographic model. Results: The operation time, plate bending and adaptation time, the intraoperative blood loss, scar visibility, TMJ dysfunction, facial asymmetry, accurate plate adaptation, proper plate angulation, and plate over-extension especially in the proximal segment beyond the sigmoid notch, all were with statistically significant differences between both groups with better results always found in group II patients. However, no cases of tumor recurrence, plate exposure, or abnormal condylar position were recorded at the last follow up visit (6 months) in both groups. Conclusion: The use of the patient`s 3-D steriolithographic model for virtual surgical planning for segmental mandibular resection with limited skin incision has several advantages over the traditionally used method. It improves reconstruction of form and function, decreases operating room time and complications and enhances the capability to perform more accurate surgical procedures.