Low-cost, self-made CAD/CAM-guiding system for mandibular reconstruction

Area of Science:

• Oral and Maxillofacial Surgery
• Biomedical Engineering
• Reconstructive Surgery

Background:

• Mandibular reconstruction presents challenges in achieving facial symmetry and function.
• Computer-aided surgery (CAS) and CAD/CAM technologies improve reconstruction but are costly and time-consuming.
• Malignant neoplasms necessitate prompt treatment, making expensive prototyping a limitation.

Purpose of the Study:

• To evaluate the reliability and efficiency of a "homemade" protocol for producing surgical cutting guides.
• To assess a cost-effective alternative to commercial CAD/CAM systems for mandibular reconstruction.

Main Methods:

• A protocol using free open-source software for digital planning and a 3D deposition printer was developed.
• Four patients with oral squamous cell carcinoma underwent segmental mandibulectomy and free fibula flap reconstruction.
• 3D volume overlay analysis was used to compare pre- and postoperative mesh points.

Main Results:

• The homemade protocol resulted in an average mean distance of 1.631 mm (SD 5.496 mm) between 3D preoperative and postoperative mesh points.
• Prototyping time was significantly shorter compared to commercial systems.
• Estimated cost per case was approximately 3 Euros.

Conclusions:

• The developed in-house technique offers a reliable and efficient method for creating surgical guides for mandibular reconstruction.
• This approach has the potential to reduce operative time and costs in reconstructive surgery.
• Further studies with larger patient cohorts are needed to validate these findings for routine surgical practice.