Viability of computer-aided design/computer-aided manufacturing surgery in mandibular reconstruction

Abstract

Background: Computer-aided design/computer-aided manufacturing (CAD-CAM) has created many new opportunities for the planning and implementation of mandibular reconstruction. Although this surgical method seems to be accurate, the question of the additional cost should be discussed. Objectives: To evaluate the cost generated by CAD-CAM surgery, we performed a comparative study assessing a total of 45 patients treated for mandibular neoplasms. The sample size was divided into two groups: (1) test group: 25 patients undergoing CAD-CAM mandibular reconstruction; and (2) control group: 20 patients undergoing a ‘traditional’ freehand mandibular reconstruction. Methods: Data concerning operation time, complications, and days of hospitalisation were used to evaluate costs related to the management of both groups of patients. Findings and Conclusion: The mean operating time for the CAD-CAM group was 440 min, whereas that for the freehand group was 550.5 min. The total difference in terms of average time gain was 110.5 min. No microvascular complication occurred in the CAD-CAM group; two complications, related to the reconstructive plates (8%) were observed in patients undergoing freehand reconstructions. The mean overall lengths of hospital stay were 14 days for the CAD-CAM group and 17 days for the freehand group. Finally, considering that the institutional cost per minute of theatre time is €30, the money saved as a result of the time gained for the CAD-CAM group, was €3400. This cost corresponds approximately to the total price of the CAD-CAM surgery. We believe that costs for CAD-CAM surgery will be covered by gains in terms of surgical time, quality of reconstruction, and reduced complications.