Does the Use of a 'Wrap' in 3D Surgical Planning Influence the Bony Margin Status of Neoplasms of the Oral, Head and Neck Region?

Abstract

PurposeThree-dimensional surgical planning (3-DSP) is becoming commonplace in the management of benign and malignant disease for oral and maxillofacial surgery practice within the last decade.1 Surgeons utilize a virtual “wrap” to preoperatively delineate and define maxillofacial tumor resection margins. The investigators hypothesized that the use of a wrap is a predictable method to obtain negative bony margins. MethodsThe investigators implemented a retrospective chart review. The sample was composed of patients over the age of 18 treated at John Peter Smith Health Network and Parkland/UT Southwestern Medical Center who obtained 3-DSP for pathology of the head and neck, involving bone, with a virtual wrap utilized for bony margins. The proportion of cases was calculated, descriptive statistics reported, and binomial exact calculation was performed for confidence intervals. The primary variable analyzed was bony margin status on final histopathology, involved or uninvolved, based on the pathology report. ResultsThe sample was composed of 39 cases, 1 of which was excluded due to aborting the preplanned 3-DSP. Of the 38 included cases, 1 had involved bony margin on final histopathology (2.6%; 95% confidence limits: 0.1%, 13.8%). There were 16 malignant cases (42%) and 22 benign cases (58%). When stratified by pathology, 1 out of the 16 malignant cases (6.3%; 95% confidence interval: 0.2%, 30%) and 0 out of the 22 benign cases (95% confidence interval: 0 %, 15.4%) had an involved bony margin on final histopathology. ConclusionThe results of this preliminary study suggest 3D surgical planning with wrap margins is a predictable method to obtain negative bony margins in benign and malignant disease of the maxillofacial complex. Further studies will focus on compiling prospective data to solidify the accuracy and predictability of using a wrap to obtain negative bony margins.