Using 3D computer planning for complex reconstruction of mandibular defects

Abstract

For complex reconstruction of osseous defects of the head and neck, three-dimensional (3D) computer planning has been available for over 20 years. However, despite its availability and recent refinements, it is a technology that has not been widely adopted. While 3D computer planning has been proposed to improve surgical precision, reduce operating time and enhance functional outcomes, the objective evidence supporting these claims is limited. Here we review the recent literature that supports the use of 3D computer planning for complex osseous defects of the mandible. We highlight a case example where 3D modeling played a critical role, particularly during the virtual surgical planning stage. Finally, we propose that routine post-operative 3D analysis become an essential element in determining operative success. Critical evaluation of outcomes will better define its use in complex reconstruction of osseous defects.

Procedure Increasing the Accuracy of Modelling and the Manufacturing of Surgical Templates with the Use of 3D Printing Techniques, Applied in Planning the Procedures of Reconstruction of the Mandible

“…Despite the additional costs of the applied technology, thanks to the above-mentioned advantages, reductions in the total cost of treatment have been shown. Even though in the course of the research on 14 patients no detailed statistical studies were carried out on, among other things, shortening the time of surgery and blood loss, the observations made themselves are consistent with those presented in the publications [ 82 , 83 , 84 ]. Other advantages of the procedure include: the reduction of operator stress, and improved communication between members of the tumour resection team and doctors responsible for reconstruction.…”

“…So far, when supplementing the restored fragment of the mandibular bone with the fibula, the surgeon during the procedure, on the basis of his experience and spatial imagination, decided where and at what angle to carry out the cut of the fibula so that the bone fragment could be used to obtain a shape similar to the mandible. By carrying out these stages before the procedure on the basis of printed models, the accuracy of adherence of bone fragments during the surgical procedure was increased, and thus, more favourable conditions for their fusion were ensured [ 82 ]. The aesthetic effects of the reconstruction were also improved.…”

“…Time is an important factor in the process of virtual planning, template modelling, and printing. Based on the literature data, it is estimated that the average time needed to apply the technology is approximately 14 days, which is not without significance in the case of malignant neoplasms, as the total treatment time should not be more than 100 days [ 82 ]. Moreover, it is necessary to purchase software and hardware, spend a certain amount of time learning how to use them, and implement procedures (bearing the costs of the material and labour of the printer operator).…”

Virtual planning for mandible resection and reconstruction

“…CT angiography of lower extremities or the scapular region can be obtained as well to simulate the vascular status. High-resolution CT scans with slice increments less than 1.0 mm of the craniomaxillofacial skeleton should be preferred to guarantee proper accuracy [ 14 ]. Generic virtual 3D models of the planned donor site may be an acceptable alternative [ 15 ].…”

Assessment of the Learning Curve for Virtual Surgical Planning in Orbital Fractures

“…However, engineer costs, prolonged planning time, and diminished surgeon input are limitations in this model. [4][5][6] The industry-based model has gained a strong foothold, however as planning software becomes more user friendly, it is likely that surgeon-based workflows will become more common and gain greater acceptance. 6 The aim of this study is to evaluate the learning curve for novice VSP software users.…”