A new concept for mandible reconstruction after oncological resection: Multisegment virtual surgical planning

Area of Science:

• Maxillofacial Surgery
• Oncological Surgery
• 3D Reconstruction

Background:

• Virtual surgical planning (VSP) aids 3D reconstructions in maxillofacial surgery.
• Preoperative uncertainty regarding resection margins can complicate VSP.
• Adverse intraoperative conditions necessitate adaptable surgical plans.

Purpose of the Study:

• To elaborate on VSP for ideal reconstruction.
• To prepare for adverse surgical conditions.
• To enable step-by-step oncological resections using defined planes (A, B, C).

Main Methods:

• Study included four patients with primary mandible malignancies undergoing multisegment VSP.
• Initial resection margin was defined as plan A.
• Plans B and C were prepared based on intraoperative frozen section results.

Main Results:

• Resection margins were extended to plan B in two patients and plan C in one patient, guided by frozen section outcomes.
• Osteotomy and implant positions showed a mean difference of -0.55 mm (SD 1.76 mm) with 95% confidence.
• Staged resection prevented removal of tumor-free bone and teeth.

Conclusions:

• Multisegment VSP facilitates optimal reconstruction in mandible malignancies.
• Staged resection, guided by intraoperative feedback, enhances surgical precision.
• This VSP approach minimizes the removal of healthy tissue, improving patient outcomes.