Clinical application and accuracy analysis of 3D printing guide plate based on polylactic acid in mandible reconstruction with fibula flap

Abstract

Background: Due to the special anatomy morphology and physiological function of the mandible, it has always become a challenge to accurately reconstruct the mandibular defect in maxillofacial surgery. Digital three dimensions (3D) printing surgical guide, as the effective method for individual and accurate surgery, is a hotspot of clinical research at present. In this study, 3D printing PLA surgical guide plate was applied to reconstruct the mandibular defect with fibula flap, its clinical effect and accuracy were evaluated, which aimed to improve the accurate reconstruction of mandibular defects.Methods: After sterilization, the dimension deformation of the PLA standard specimen were measured. Eighteen patients diagnose with mandibular tumor were collected as observation objects. Then partial mandible resection and simultaneous mandible reconstruction with fibula graft were implemented according to the computer-aided design plan. The clinical effects of 3D printing PLA guide plates application were evaluated by facial contours, occlusal stability and chewing function. Through registering the postoperative computed images reconstruction with preoperative designed shape, the reconstruction accuracy was evaluated by detecting the maximum difference including the distance between lateral convex point of the condyles, the distance between medial convex point of the condyles and the horizontal contained angle between long axis of the condyles.Results: After high temperature steam sterilization, the curvature of the PLA specimen with 100% filling rate and 4.8 mm thickness were the smallest and their dimension deformation had no statistical significance (P>0.05). The minimally deformed 3D printing PLA guide plate were smoothly placed in the right place during the operation. After surgery, the face was symmetrical, the occlusal relationship was restored well and no deviation of the mandibular movement were found. The spiral computed tomography (SCT) scanning showed that the distance between lateral/medial convex points of the condyle and the horizontal contained angle were 128.34±8.68 mm, 88.69±6.75 mm and 145.87°±12.01°. Compared with preoperative design, the maximum deviation of the actual postoperative registration was 1.67±0.63, and the difference was not statistically significant (P>0.05). Conclusions:The application of 3D printing PLA guide plate in the segmental section and reconstruction of the mandible can effectively simplify the operation, and better reconstruct the continuity of the mandible.The surgical accuracy can fully meet clinical needs with relatively low prices.

3D printing personalized guide plate in the management of recurrent intramuscular venous malformations: A single center experience

“…In recent year, 3D printing guide plate has been widely applied in reconstructive surgery for its improvement of personalization, accuracy, and safety of the operation. 28,29 Wu et al 30 reported the use of percutaneous needle guide plate can perform safe and individualized tumor biopsy of acetabulum. It was also used in tumor resection and reconstruction in the field of thoracic surgery, which promoted surgeons' understanding of thoracic wall tumor location, morphology, and invasion range.…”

The Role of 3D Printing in Planning Complex Medical Procedures and Training of Medical Professionals—Cross-Sectional Multispecialty Review

“…In addition to operative and ischemic time gains attributable to CAD/CAM, CAMR has enabled more complex surgeries [ 95 ] with a high degree of accuracy in mandibular reconstruction compared to preoperative virtual models [ 93 , 96 ], with a mean error as low as 1 mm (range 0.4–2.46 mm) reported by Tarsitano et al [ 97 ]. A systematic review of subjective cosmetic (e.g., facial appearance, aesthetic/social activity satisfaction) and functional (e.g., regular diet, intelligible speech) outcomes by Powecharoen et al likewise favors CAMR over CFMR [ 94 ].…”

Redefining precision and efficiency in orthognathic surgery through virtual surgical planning and 3D printing: a narrative review

“…The choice of material is crucial in 3D printing for medical applications. Commonly used materials include the following: Polylactic acid (PLA): Biodegradable and safe for human contact, often used for temporary implants or surgical guides [ 25 ]. Resins: Used in SLA printing, these offer high detail but are generally less durable than other materials [ 26 ].…”