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

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.