Accuracy and reproducibility of virtual cutting guides and 3D-navigation for osteotomies of the mandible and maxilla

Jonathan M Bernstein; Michael J Daly; Harley Chan; Jimmy Qiu; David Goldstein; Nidal Muhanna; John R de Almeida; Jonathan C Irish

doi:10.1371/journal.pone.0173111

Accuracy and reproducibility of virtual cutting guides and 3D-navigation for osteotomies of the mandible and maxilla

PLoS One. 2017 Mar 1;12(3):e0173111. doi: 10.1371/journal.pone.0173111. eCollection 2017.

Authors

Jonathan M Bernstein^{1

2}, Michael J Daly¹, Harley Chan¹, Jimmy Qiu¹, David Goldstein¹, Nidal Muhanna^{1

2}, John R de Almeida², Jonathan C Irish^{1

2}

Affiliations

¹ Guided Therapeutics (GTx) Program, TECHNA Institute, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
² Department of Otolaryngology - Head & Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.

Abstract

Background: We set out to determine the accuracy of 3D-navigated mandibular and maxillary osteotomies with the ultimate aim to integrate virtual cutting guides and 3D-navigation into ablative and reconstructive head and neck surgery.

Methods: Four surgeons (two attending, two clinical fellows) completed 224 unnavigated and 224 3D-navigated osteotomies on anatomical models according to preoperative 3D plans. The osteotomized bones were scanned and analyzed.

Results: Median distance from the virtual plan was 2.1 mm unnavigated (IQR 2.6 mm, ≥3 mm in 33%) and 1.2 mm 3D-navigated (IQR 1.1 mm, ≥3 mm in 6%) (P<0.0001); median pitch was 4.5° unnavigated (IQR 7.1°) and 3.5° 3D-navigated (IQR 4.0°) (P<0.0001); median roll was 7.4° unnavigated (IQR 8.5°) and 2.6° 3D-navigated (IQR 3.8°) (P<0.0001).

Conclusion: 3D-rendering enables osteotomy navigation. 3 mm is an appropriate planning distance. The next steps are translating virtual cutting guides to free bone flap reconstruction and clinical use.

Publication types

Evaluation Study

MeSH terms

Humans
Imaging, Three-Dimensional / methods*
Mandible / surgery*
Maxilla / surgery*
Osteotomy / methods*
Plastic Surgery Procedures / methods*
Surgery, Computer-Assisted / methods*

Grants and funding

The Guided Therapeutics Program (GTx) is funded by the Strobele Family GTx Research Fund, Kevin and Sandra Sullivan Chair in Surgical Oncology, Hatch Engineering Fellowship Fund, RACH Fund and the Princess Margaret Cancer Centre Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.