Design Workflow for Mandibular Reconstruction. Opportunities and Limitations of In-house Virtual Surgical Planning

Abstract

Purpose

Cranio-maxillofacial surgery boosted the development of medical 3D printing due to intensive use of patient-specific medical devices. The aim of this paper is to describe and assess a hospital-based design method for a mandibular reconstruction and to give an overview on in-house virtual surgical planning (VSP).

Methods

Design was demonstrated on a case of mandibular osteonecrosis fracture using a dedicated software in a step-by-step manner. Evaluation was done by model surgery followed by a dimensional accuracy evaluation of the experimental model surgery result in comparison with the virtually planned reconstruction. Model scanning and dedicated software were used to assess deviations, including potential printing errors. Based on the obtained results and previous published data, items related to opportunities and limitations of the promoted method were discussed focusing on accuracy, time, costs and regulations.

Results

The in-house protocol led to a two-day production period for all the patient-specific surgical gear, with an 11.7 EUR cost of printing material and an estimated initial investment of over 24,000 EUR. Accuracy evaluation by comparing the 3D scanned result with the virtual planned reconstruction suggested most deviations between ± 1.2 mm with most concentrated deviations around + 0.20 mm. Limited exceptions were recorded out of ± 2.2 mm range.

Conclusion

Based on the analyzed data, we consider our method a viable alternative solution to outsourced VSP because the surgeon can independently implement the workflow in the hospital, ensuring immediate availability of patient-specific medical devices. However, further clinical, cost-effectiveness and device safety evaluations need to be performed.

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Acknowledgements

The authors would like to thank Daniel Jamgossian from Eurocom Invest SRL, Cluj-Napoca, Romania for the support in providing the infrastructure and assistance necessary for scanning the study models.

Funding

This paper was partially supported by the Human Capital Operational Programme agreement POCU/380/6/13/123927 financed from the European Social Fund (contract no. 56437/24.07.2019.)

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Authors

Contributions

All authors contributed to the study conception and design. Conceptualization: DO, HR. Methodology: DO, MH, HR. Formal analysis and investigation: DO, CC. Writing—original draft preparation: DO. Writing—review and editing: MH, RR, MC, CC, HR. Funding acquisition: CC. Resources: HR, RR. Supervision: HR, MH.

Corresponding author

Correspondence to Calin Rares Roman.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data.

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Cite this article

Ostas, D., Hedesiu, M., Roman, C.R. et al. Design Workflow for Mandibular Reconstruction. Opportunities and Limitations of In-house Virtual Surgical Planning. J. Med. Biol. Eng. (2021). https://doi.org/10.1007/s40846-021-00633-z

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Keywords

  • Three-dimensional printing
  • In-house
  • Virtual surgical planning
  • Cutting guides
  • Mandibular reconstruction

JEL classification

  • 10—General