The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results.

摘要: Purpose The concept of virtual surgery uses surgical simulation rather than relying exclusively on intraoperative manual approximation facial reconstruction. purpose this study was to evaluate the degree which outcomes in free fibula mandibular reconstructions planned with and carried out prefabricated plate templates cutting guides correlated plan a series 11 patients. Materials Methods This retrospective evaluated consecutive patients (6 males 5 females) an average age 50.73 years (range, 23-72 years) who required reconstruction for aggressive benign or malignant disease osseomyocutaneous flap at Emory University Hospital (Atlanta, GA) between January 1, 2009 December 31, 2009. In each case, high-resolution helical computed tomography (CT) scan maxillofacial region mandible obtained prior surgery. CT data sent CD modeling company (Medical Modeling Inc, Golden, CO). scans were then converted into 3-dimensional models skeleton utilizing both automatic segmentation techniques SurgiCase CMF software (Materialise NV, Leuven, Belgium). A planning session held via Web meeting surgeons company, resection planes mandible, positioning plate, lengths/osteotomy angles established. using bending template. postoperative patient within first 7 days same scanner. Three-dimensional computer final comparison preoperative plan. To make desired comparisons, objects representing outcome superimposed onto alignment techniques. These compared by 1-to-1 magnification measurements fibular bone volume, location osteotomies, contour, position fibula, mandible. Comparison made plates regard contour through superimposition overlays that are registered coordinate system. Results total 19 osteotomies out. mean distance actual osteotomy when 2.00 ± 1.12 mm. volume determined program fibulas 13,669.45 3,874.15 mm 3 9,568 22,860 ), 12,361.09 4,161.80 7,142 22,294 ). percentage volumes 90.93 18.03%. 22 segments involved created 44 separate osteotomies. 1.30 0.59 overlap 58.73% 8.96%. Conclusions Virtual appears have positive impact major defects provision accuracy difficult achieve placement graft, even hands experienced surgeons. Although reasonably high level achieved use guides, limited ability correctly hand replicate template is reflected our findings.