Intraoperative Real-Time Image-Guided Fibular Harvest and Mandibular Reconstruction: A Feasibility Study on Cadaveric...

Area of Science:

• Oral and Maxillofacial Surgery
• Surgical Navigation
• Reconstructive Surgery

Background:

• Mandible reconstruction presents challenges in achieving accurate anatomical restoration.
• Real-time surgical navigation offers potential for improved precision in complex reconstructive procedures.

Purpose of the Study:

• To assess the feasibility and accuracy of an image-guided surgical (IGS) system for planning and executing mandible reconstruction.
• To evaluate the cephalometric accuracy of IGS-assisted fibular flap reconstruction in cadaveric models.

Main Methods:

• Development of a custom IGS system with specialized fixation devices and software.
• Performance of mandibular and fibular segmental osteotomies using the IGS system on five cadaveric specimens.
• Recording of procedural time and cephalometric measurements for accuracy assessment.

Main Results:

• Successful completion of five real-time IGS-assisted mandibulectomy and fibular reconstructions.
• Mean Dice score of 0.8 ± 0.08 and Hausdorff-95 distance of 7.29 ± 4.81 mm between planned and actual reconstructions.
• Minimal differences in intercoronoid width (1.15 ± 1.17 mm), interangle width (0.9 ± 0.56 mm), and mandible projection (1.47 ± 1.62 mm).

Conclusions:

• This study provides the first comprehensive demonstration of an IGS workflow for mandibulectomy and fibular flap reconstruction.
• The developed IGS system achieved adequate cephalometric accuracy, indicating its potential for clinical application.
• Real-time navigation enhances precision in complex mandible reconstruction procedures.