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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
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Accuracy of virtually 3D planned resection templates in mandibular reconstruction
Willem L J Weijs1, Casper Coppen1, Ruud Schreurs2
1Department of Oral and Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands.
Summary
Prefabricated surgical resection templates show reasonable accuracy for mandibular segmental resections. Further improvements in template accuracy are needed to enhance the precision of head and neck reconstructions.
Area of Science:
- Oral and Maxillofacial Surgery
- Head and Neck Surgery
- Medical Device Technology
Background:
- Reconstructing composite defects in the head and neck is challenging.
- Surgical aids are crucial for improving outcomes in complex head and neck procedures.
- Mandibular segmental resections require precise planning and execution.
Purpose of the Study:
- To evaluate the accuracy of prefabricated surgical resection templates.
- To compare template accuracy against virtual surgical plans for mandibular resections.
- To assess the utility of surgical aids in head and neck reconstruction.
Main Methods:
- Prospective study of 11 patients with advanced oral squamous cell carcinoma or mandibular osteoradionecrosis.
- Preoperative cone-beam computed tomography (CBCT) for virtual template design.
- Intraoperative placement of patient-specific resection templates secured with screws.
- Postoperative CBCT to evaluate template positioning and resection plane accuracy.
- Interobserver reliability testing for measurement methods.
Main Results:
- Mean proximal template shift of 3.76 mm (SD 3.10 mm).
- Mean distal template shift of 3.06 mm (SD 1.57 mm).
- Mean proximal resection angle deviation of 8.5° (SD 5.3°).
- Mean distal resection angle deviation of 10.4° (SD 5.0°).
- High interobserver reliability (ICC = 0.99 for positioning, ICC = 0.98 for angles).
Conclusions:
- Prefabricated surgical resection templates demonstrate reasonable accuracy in mandibular segmental resections.
- Virtual surgical planning aids enhance mandibular reconstruction with microvascular free flaps.
- Further refinement of resection template accuracy is essential for optimizing reconstruction outcomes.
