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Evaluating Osteotomy Accuracy in Mandibular Reconstruction: A Preliminary Study Using Custom Cutting Guides and

Claudia Borbon1, Andrea Novaresio1, Oreste Iocca1

  • 1Division of Maxillofacial Surgery, Città della Salute e della Scienza University Hospital, 10126 Torino, Italy.

Diseases (Basel, Switzerland)
|March 26, 2025
PubMed
Summary

In-house cutting guides, combined with virtual surgical planning (VSP), accurately reconstruct mandibles using fibula free flaps (FFF). This advanced approach enhances surgical precision and patient outcomes in maxillofacial surgery.

Keywords:
VRVSPfibula free flapmaxillofacial surgeryvirtual realityvirtual surgical planning

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Area of Science:

  • Maxillofacial Surgery
  • Biomedical Engineering
  • Surgical Technology

Background:

  • Mandibular reconstruction has advanced significantly since the early 1900s.
  • The fibula free flap (FFF) is the gold standard for extensive mandibular and maxillary reconstructions.
  • Extended Reality (XR) and virtual surgical planning (VSP) are transforming maxillofacial surgery.

Purpose of the Study:

  • To evaluate the accuracy of in-house cutting guides for mandibular reconstruction with FFF using VSP.
  • To compare planned versus intraoperative osteotomies using postoperative CT scans.
  • To analyze deviations and classify precision of mandibular osteotomies.

Main Methods:

  • Compared planned and intraoperative osteotomies in 17 patients using postoperative CT scans.
  • Measured deviation angles, thickness at the center of gravity, and maximum deviation volume.
  • Developed a 12-configuration coding system to analyze osteotomy precision and identify systematic errors.
  • Utilized an interactive VR environment (VieweR) for surgical planning and outcome analysis.

Main Results:

  • Customized cutting guides are effective for mandibular reconstruction.
  • Advanced technologies like CAD/CAM and VR are crucial in modern maxillofacial surgery.
  • A novel 12-configuration coding system was developed to classify and analyze mandibular osteotomy precision based on cutting blade position, intersection axis, and rotation.

Conclusions:

  • In-house cutting guides are accurate and reliable for FFF-supported mandibular reconstruction with VSP.
  • Minimal deviations were observed between planned and intraoperative osteotomies, confirming precision.
  • CAD/CAM and XR technologies are vital for improving surgical precision and patient outcomes in maxillofacial surgery.