The role of surgical navigation in computer-assisted mandibular reconstruction: is it necessary?

Abstract

Accurate mandibular reconstruction following tumor ablation is important yet challenging. While computer-assisted surgery and surgical navigation have been applied widely in maxillofacial reconstruction, the accuracy and the efficacy remain debatable due to the native mobile nature. This study aimed to evaluate the surgical outcomes and accuracy of mandibular reconstruction aided by different types of adjunctive computer-assisted techniques with or without intraoperative navigation. Patients with anterior and/or lateral mandibular defects who underwent microvascular mandibular reconstruction aided by adjunct computer-assisted techniques, with or without intraoperative navigation were assessed. The deviations in spatial alignment of the bony segments between the pre-operative and post-operative datasets were measured to evaluate the overall surgical outcomes and accuracy. Independent t-test was performed and p-value less than 0.05 was statistically significant. A total of 93 patients with L/LC or LCL defects who underwent microvascular mandibular reconstruction aided by adjunct computer-assisted techniques with or without surgical navigation were assessed. No significant difference was observed when comparing the mean differences between the preoperative and postoperative intercondylar and intergonial distance in both navigation-assisted and computer-aided design/computer-aided manufacturing (CAD/CAM) groups. There were also no significant differences noted among the different mandibular defects, osteosynthesis plates and types of free flap. Accurate mandibular reconstruction following tumor resection can be achieved by incorporating intraoperative navigation and adjunctive methods such as computer-assisted techniques and our innovative device, mandibular fixation device.