Smaller safe surgical margin for resecting mandibular ameloblastomas in digitally assisted surgery

Area of Science:

• Oral and Maxillofacial Surgery
• Oncology
• Digital Surgical Planning

Background:

• Clinical adoption of digital surgical guides for ameloblastoma resection is limited.
• Determining safe surgical margins for complete tumor removal requires further investigation.

Purpose of the Study:

• Evaluate the precision of digital surgical guides in mandibular ameloblastoma resection.
• Determine the minimum safe bone margin distance for radical tumor removal based on histopathology.

Main Methods:

• Analyzed 23 patients undergoing digitally guided segmental mandibulectomy.
• Utilized 3D virtual surgical planning to define osteotomy margins.
• Compared planned vs. actual margins and assessed histopathological margin status in two cohorts with different target margin sizes (5-10mm and 6mm).

Main Results:

• Digital guidance showed millimeter-level precision with a mean deviation of 1.05 mm between planned and actual margins (Cohort 1).
• All margins were histopathologically negative in Cohort 1.
• A 4.0% positive margin rate was observed in Cohort 2 with a 6mm planned margin, with one anterior margin positive for conventional ameloblastoma.

Conclusions:

• Digital surgical guidance provides high precision for mandibular ameloblastoma resection.
• A 6mm bone margin may be a practical minimum for balancing oncological safety and function.
• A 4.0% risk of positive margins exists even with a 6mm planned distance, necessitating careful consideration.