Evaluating the accuracy of resection planes in mandibular surgery using a preoperative, intraoperative, and postoperative approach

In mandibular surgery, three-dimensionally printed patient-specific cutting guides are used to translate the preoperative virtually planned resection planes to the operating room. This study was performed to determine whether cutting guides are positioned according to the virtual plan and to compare...

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Bibliographic Details
Published in:International journal of oral and maxillofacial surgery Vol. 50; no. 3; pp. 287 - 293
Main Authors: Brouwer de Koning, S.G., ter Braak, T.P., Geldof, F., van Veen, R.L.P., van Alphen, M.J.A., Karssemakers, L.H.E., Schreuder, W.H., Karakullukcu, M.B.
Format: Journal Article
Language:English
Published: Denmark Elsevier Inc 01-03-2021
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Summary:In mandibular surgery, three-dimensionally printed patient-specific cutting guides are used to translate the preoperative virtually planned resection planes to the operating room. This study was performed to determine whether cutting guides are positioned according to the virtual plan and to compare the intraoperative position of the cutting guide with the resection performed. Nine patients were included. The exact positions of the resection planes were planned virtually and a patient-specific cutting guide was designed and printed. After surgical placement of the cutting guide, intraoperative cone beam computed tomography (CBCT) was performed. Postoperative CT was used to obtain the final resection planes. Distances and yaw and pitch angles between the preoperative, intraoperative, and postoperative resection planes were calculated. Cutting guides were positioned on the mandible with millimetre accuracy. Anterior osteotomies were performed more accurately than posterior osteotomies (intraoperatively positioned and final resection planes differed by 1.2±1.0mm, 4.9±6.6°, and 1.8±1.5°, respectively, and by 2.2±0.9mm, 9.3±9°, and 8.3±6.5° respectively). Differences between intraoperatively planned and final resection planes imply a directional freedom of the saw through the saw slots. Since cutting guides are positioned with millimetre accuracy compared to the virtual plan, the design of the saw slots in the cutting guides needs improvement to allow more accurate resections.
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ISSN:0901-5027
1399-0020
DOI:10.1016/j.ijom.2020.06.013