China Journal of Oral and Maxillofacial Surgery ›› 2021, Vol. 19 ›› Issue (5): 469-473.doi: 10.19438/j.cjoms.2021.05.016

• Clinical Reports • Previous Articles     Next Articles

Application of virtual surgical planning in transoral mandibulectomy and accurate mandible reconstruction: report of 9 consecutive cases

YANG Xin, LYU Ming-ming, LI Jun, SUN Jian   

  1. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine;; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology. Shanghai 200011, China
  • Received:2021-02-20 Revised:2021-05-11 Online:2021-09-20 Published:2021-10-20

Abstract: PURPOSE: This study was aimed to introduce the experience of mandibulectomy and vascularized bone reconstruction via intraoral approach assisted by virtual surgical plan and evaluate the effect of postoperative reconstruction. METHODS: Nine patients with benign tumor in the mandible underwent preoperative virtual surgical planning, then screw-predesignated osteotomy guide plate suitable for intraoral operation was designed and manufactured. Mandibulectomy was performed with cutting guide plate, prebent titanium plate and vascularized bone flap were implanted and fixed via intraoral approach. Intraoperative real-time navigation was used to confirm and correct the spatial location of the neo-mandible. The postoperative appearance and function of the patients were evaluated by clinical and imaging examination, and the accuracy of mandibular reconstruction was evaluated by superimposing postoperative CT on preoperative STL model after six months. SPSS 15.0 software package was used for statistical analysis. RESULTS: Aided with the virtual surgical plan, all patients in this series successfully underwent mandibulectomy and reconstruction with vascularized bone flap via intraoral approach. Intraoperative navigation confirmed the correct location of the reconstructed mandible. All patients showed facial symmetry, no facial paralysis and mouth opening limitation at 6-month postoperative visit were noted. All patients were satisfied with the results of the operation. Image fitting showed that the osteotomy line position was accurate with an error of less than 1 mm [(0.72±0.15)mm], and the reconstructed position of the mandible was highly consistent with preoperative design with an error of (1.76±1.99)mm. CONCLUSIONS: Under the guide of virtual surgical planning, intraoral mandibulectomy and vascularized bone reconstruction could be successfully performed by using screw-predesignated guide plate and prebent titanium plate, avoiding extraoral incision and significantly improving the accuracy of mandibular reconstruction.

Key words: Transoral approach, Cutting guide, Virtual surgical planning, Microvascular anastomosis, Mandibular reconstruction

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