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Does the use of a “wrap” in three-dimensional surgical planning influence the bony margin status of benign and malignant neoplasms of the oral, head, and neck region? An initial investigation

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Abstract 

Purpose

Three-dimensional surgical planning (3-DSP) is becoming commonplace in the management of benign and malignant disease for oral and maxillofacial surgery practice within the last decade. Surgeons utilize a virtual “wrap” to preoperatively delineate and define maxillofacial tumor resection margins. The investigators hypothesized that the use of a wrap is a predictable method to obtain negative bony margins.

Methods

The investigators implemented a retrospective chart review. The sample was composed of patients over the age of 18 treated at John Peter Smith Health Network and Parkland/UT Southwestern Medical Center who obtained 3-DSP for the pathology of the head and neck, involving the bone, with a virtual wrap utilized for bony margins. The proportion of cases was calculated, descriptive statistics were reported, and binomial exact calculation was performed for confidence intervals. The primary variable analyzed was bony margin status on final histopathology, involved or uninvolved, based on the pathology report.

Results

The sample was composed of 39 cases, one of which was excluded due to aborting the preplanned 3-DSP. Of the 38 included cases, one had involved bony margin on final histopathology (2.6%; 95% confidence limits, 0.1%, 13.8%). There were 16 malignant cases (42%) and 22 benign cases (58%). When stratified by pathology, 1 out of the 16 malignant cases (6.3%; 95% confidence interval, 0.2%, 30%) and 0 out of the 22 benign cases (95% confidence interval, 0%, 15.4%) had an involved bony margin on final histopathology.

Conclusion

The results of this preliminary study suggest three-dimensional surgical planning with wrap margins is a predictable method to obtain negative bony margins in benign and malignant disease of the maxillofacial complex. Further studies will focus on compiling prospective data to solidify the accuracy and predictability of using a wrap to obtain negative bony margins.

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Authors and Affiliations

  1. Division of Oral and Maxillofacial Surgery, Department of Surgery, Parkland/UT Southwestern Medical Center, Dallas, TX, USA

    Omar Kholaki & Thomas Schlieve

  2. Division of Oral and Maxillofacial Surgery, Denver Health Medical Center, Denver, CO, USA

    Brandon J. Saxe

  3. Office of Clinical Research, John Peter Smith Health Network, Fort Worth, TX, USA

    Kari Teigen

  4. Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, TX, USA

    Fayette C. Williams & Roderick Y. Kim

Authors
  1. Omar Kholaki
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  2. Brandon J. Saxe
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  3. Kari Teigen
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  4. Fayette C. Williams
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  5. Thomas Schlieve
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  6. Roderick Y. Kim
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Contributions

Authors Omar Kholaki and Brandon J. Saxe wrote the manuscript. Author Kari Teigen provided the statistical analysis. Authors Fayette C. Williams, Thomas Schlieve, and Roderick Y. Kim were involved in the edits, review, and preparation of the manuscript. Authors Omar Kholaki and Thomas Schlieve finalized the manuscript.

Corresponding author

Correspondence to Roderick Y. Kim.

Ethics declarations

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of John Peter Smith and University of Texas Southwestern approved this study.

Consent to participate

Informed consent regarding the procedure was obtained from all individual participants included in the study prior to rendering intervention.

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Patients signed informed consent regarding the potential use of their data for publication.

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The authors declare no competing interests.

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Kholaki, O., Saxe, B.J., Teigen, K. et al. Does the use of a “wrap” in three-dimensional surgical planning influence the bony margin status of benign and malignant neoplasms of the oral, head, and neck region? An initial investigation. Oral Maxillofac Surg 28, 163–167 (2024). https://doi.org/10.1007/s10006-022-01123-5

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  • DOI: https://doi.org/10.1007/s10006-022-01123-5

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