Abstract
Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon’s hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.
Highlights
Craniomaxillofacial surgery is difficult due to the dangerous structures in the compact and deeply hidden region [1]
The resection curve was performed between the third molar posteriorly in the right mandible to the canine anteriorly in the left mandible for full excision of the tumor on a virtual 3-D model, and an accurate match between the operative anatomy and the computed tomography (CT) images was achieved within 1.0 mm
The surgical simulation with the virtual 3-D model and surgical navigation provided safe and precise mandibular reconstruction. Both facial contour recovery (Figure 4(a) and Figure 4(b)) and occlusal rehabilitation (Figure 4(c) and Figure 4(d)) were achived, showing excellent new bone formation of the mandible radiologically (Figure 4(e)). This is the first report describing how computer planning and intraoperative navigation are used for reconstruction of the mandible with a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM)
Summary
Craniomaxillofacial surgery is difficult due to the dangerous structures in the compact and deeply hidden region [1]. In recent years, advanced engineering technology including medical image processing, computer-aided design and computer-aided manufacturing (CAD/CAM), rapid prototyping (RP) known as 3-D printing, and surgical navigation have been widely used in the fields of neuro- [2], orthopedic- [3], and otolaryngological surgery [4]. Of these advanced techniques, virtual surgical simulation before the actual surgery progressing from 2-D images to sophisticated 3-D images and surgical navigation providing real-time feedback to the surgeons dramatically improve the quality and efficiency of the actual surgery. Preoperative computer design, including prebending reconstruction materials combined with intraoperative navigation, provides a more accurate, safer, and less time-consuming method for reconstruction of the mandible compared with conventional methods of flap insertion
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