Background: Virtual surgical planning (VSP), via commercial services or developed in-house, has been applied to facilitate head and neck reconstruction. We evaluate a custom, automated planning software. Methods: Prospectively, VSP of 25 consecutive patients undergoing segmental mandibular reconstruction was performed. Postoperative CT was used to assess structural accuracy of VSP. Operative time, length of stay, and complication rate of the prospective cohort were compared with those of 25 consecutive retrospective historical cases. Results: The deviations between the plan and execution in mandibular width, projection, and volumetric overlap were 2.32 ± 3.91, 2.39 ± 1.72, and 0.59 ± 0.51 mm respectively. Compared with historical data, there was a significant reduction in operative time and length of stay, and no significant difference in complication rates. Conclusion: This is the largest prospective series evaluating an in-house VSP workflow for mandibular reconstruction and the first clinical evaluation of an automated planning platform.

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Background This study virtually compares patient‐specific fibular and scapular reconstructions for maxillectomies. Methods Nine maxillectomy defects were created on 10 maxillas and virtually reconstructed with patient‐specific fibulas and scapulas. Reconstructions were compared for restoring midface cephalometrics, dental implantability, and pedicle length. Results Of 90 maxillectomy defects, the vertically oriented scapula provided improved orbital floor and maxillary height reconstructions (p < 0.001), albeit at the cost of dental implantability compared to the fibula (p < 0.001). In two defects crossing the midline, the fibula, allowing for more osteotomies, provided improved maxillary projection. In the remaining three defects crossing the midline, the horizontally oriented scapula was comparable to the fibula. Fibular and scapular reconstructions were amenable for dental implantation and had similar pedicle lengths, although favoring scapula in extensive defects. Conclusion Fibular and scapular reconstructions of maxillectomy defects provide unique strengths. This virtual analysis can guide a goal‐oriented reconstruction based on defect type and patient‐specific goals.

Objectives/Hypothesis Virtual surgical planning (VSP) for reconstructions of advanced mandibular neoplasms that have distorted the contour of the mandible is challenging, as the premorbid shape of the mandible is unknown. We introduce a novel modeling technique, based on a statistical shape model (SSM), that has learned the shape of a normal mandible from a set of 84 mandibles, such that given a diseased mandible, the model can determine its premorbid shape. Methods Eighty‐four control mandibles were used to generate an SSM. Various mandibular defects were created, and the SSM was applied to predict the shape of the original mandible. The predicted and original shape of the defect were compared for accuracy using volumetric overlap and Hausdorff distance. All mandibular VSP cases in the past 2 years were reviewed to identify those that required virtual preprocessing due to significantly distorted mandibular contours. The SSM was compared to those cases requiring preprocessing and highlighted in one prospective VSP. Results The average volumetric overlap and Hausdorff distance between the defect replacement and the defect are 73.9% ± 13.3% and 4.51 mm ± 2.65 mm, respectively. The SSM is more accurate for smaller defects, and those not including the condyle. Ten out of 40 VSP cases required preprocessing using four different techniques. Qualitatively, the SSM outperformed those preprocessing techniques applied in the retrospective cases. Conclusions The SSM can accurately predict the premorbid shape of a distorted mandible and is superior to current preprocessing techniques. The SSM was successfully applied to a retrospective series and one prospective index case. Level of Evidence 4 Laryngoscope, 131:E781–E786, 2021

Background The study's objective is to assess the feasibility and utility of VSP for maxillary reconstruction with the scapular free flap. Methods An open‐source VSP platform was used to create the reconstruction models and simple guides. Clinical, operative, and postoperative data were collected. Results Ten patients in the VSP cohort and 18 in the non‐VSP control cohort were included in the study. There was a significant reduction in operative time (256.0 ± 69.4 vs. 448.1 ± 108.2 min, p < 0.01), tracheotomy rate (20% vs. 72%, p < 0.01), increased two‐team utilization rate (80% vs. 0%, p < 0.01) and better reconstructive accuracy (7.5 ± 3.4 vs. 11.7 ± 7.6 mm, p = 0.048) for the VSP cohort. Conclusions Maxillary reconstruction planned with an in‐house open‐source VSP platform and accompanied simple guides can facilitate a two‐team approach, reduce operative time, and improve structural accuracy. This open‐source technology has great potential to be readily applied in other institutions to improve efficiency and outcomes.