In-house manufactured 3D guides for the localization and treatment of mandibular lesions. Workflow and case series

Abstract

The anatomical location of certain lesions can be a difficulty when locating them intraoperatively. The use of surgical navigation allows anatomical structures to be located with great precision. However, there are technical difficulties with its use in mandibular surgery. Three-dimensional (3D) printing has established itself as a definitive tool in the generation of biomodels for diagnosis and treatment as well as implantable devices. Some applications, little explored today, have to do with the use of 3D-printed devices for the localization of hard-to-reach lesions. To determine the position of mandibular bone lesions, we propose using 3D printed localization guides manufactured “in-house,” using freely licensed design programs (software) to design them, and made of biocompatible resins. This improves surgical precision and reduces morbidity from the intervention. 3D planning models are shown and segmented using open-source software (3D Slicer) using imported conventional computed tomography data. Digital component modification is possible with free software (Autodesk Meshmixer) to arrange precise osteotomy cuts for lesion localization. With the help of customized cutting guides, intraoperative placement is precise. These are created utilizing a fused filament manufacturing 3D printer and polylactic acid. Three localization guides were successfully completed, resulting in improved surgical accuracy and reduced surgical morbidity. The use of 3D surgical guides in cases of mandibular lesions in difficult or delicate locations saves the need for navigation, requires less surgical time, does not require splints or reference stars.