Borbon Claudia, Novaresio Andrea, Iocca Oreste, Nonis Francesca, Moos Sandro, Vezzetti Enrico, Ramieri Guglielmo, Zavattero Emanuele
Division of Maxillofacial Surgery, Città della Salute e della Scienza University Hospital, 10126 Torino, Italy.
Department of Management and Production Engineering, Politecnico di Torino, 10129 Torino, Italy.
Diseases. 2025 Mar 13;13(3):81. doi: 10.3390/diseases13030081.
Mandibular reconstruction has evolved significantly since its inception in the early 1900s. Currently, the fibula free flap (FFF) is considered the gold standard for mandibular and maxillary reconstructions, particularly for extensive defects, and the introduction of Extended Reality (XR) and virtual surgical planning (VSP) is revolutionizing maxillofacial surgery.
This study focuses on evaluating the accuracy of using in-house cutting guides for mandibular reconstruction with FFF supported by virtual surgical planning (VSP). Planned and intraoperative osteotomies obtained from postoperative CT scans were compared in 17 patients who met the inclusion criteria. The proposed analysis included measurements of deviation angles, thickness at the centre of gravity, and the maximum thickness of the deviation volume. Additionally, a mandibular resection coding including 12 configurations was defined to classify and analyze the precision of mandibular osteotomies and investigate systematic errors. Preoperative, planned, and postoperative models have been inserted in an interactive VR environment, VieweR, to enhance surgical planning and outcome analysis.
The results proved the efficiency of adopting customized cutting guides and highlighted the critical role of advanced technologies such as CAD/CAM and VR in modern maxillofacial surgery. A novel coding system including 12 possible configurations was developed to classify and analyze the precision of mandibular osteotomies. This system considers (1) the position of the cutting blade relative to the cutting plane of the mandibular guide; (2) the position of the intersection axis between the planned and intraoperative osteotomy relative to the mandible; (3) the direction of rotation of the intraoperative osteotomy plane around the intersection axis from the upper view of the model.
This study demonstrates the accuracy and reliability of in-house cutting guides for mandibular reconstruction using fibula free flaps (FFF) supported by virtual surgical planning (VSP). The comparison between planned and intraoperative osteotomies confirmed the precision of this approach, with minimal deviations observed. These findings highlight the critical role of CAD/CAM and XR technologies in modern maxillofacial surgery, offering improved surgical precision and optimizing patient outcomes.
自20世纪初下颌骨重建技术诞生以来，其已取得显著进展。目前，游离腓骨瓣（FFF）被视为下颌骨和上颌骨重建的金标准，尤其适用于广泛缺损，而扩展现实（XR）和虚拟手术规划（VSP）的引入正在彻底改变颌面外科手术。
本研究聚焦于评估在虚拟手术规划（VSP）支持下，使用内部切割导板进行游离腓骨瓣下颌骨重建的准确性。对17名符合纳入标准的患者术后CT扫描获得的计划截骨和术中截骨进行比较。拟进行的分析包括测量偏差角度、重心处厚度以及偏差体积的最大厚度。此外，定义了一个包含12种构型的下颌骨切除编码，以分类和分析下颌骨截骨的精度并调查系统误差。术前、计划和术后模型已被插入交互式虚拟现实环境VieweR中，以加强手术规划和结果分析。
结果证明了采用定制切割导板的有效性，并突出了CAD/CAM和VR等先进技术在现代颌面外科手术中的关键作用。开发了一种包含12种可能构型的新型编码系统，以分类和分析下颌骨截骨的精度。该系统考虑：（1）切割刀片相对于下颌导板切割平面的位置；（2）计划截骨与术中截骨之间的相交轴相对于下颌骨的位置；（3）从模型上视图看术中截骨平面围绕相交轴的旋转方向。
本研究证明了在虚拟手术规划（VSP）支持下，使用游离腓骨瓣（FFF）进行下颌骨重建的内部切割导板的准确性和可靠性。计划截骨与术中截骨的比较证实了该方法的精度，观察到的偏差极小。这些发现突出了CAD/CAM和XR技术在现代颌面外科手术中的关键作用，提高了手术精度并优化了患者预后。
