Three-dimensional biomodeling in complex mandibular reconstruction and surgical simulation: prospective trial
Dziegielewski, P.T.; Zhu, J.; King, B.; Grosvenor, A.; Dobrovolsky, W.; Singh, P.; Ansari, K.; Al-Qahtani, K.H.; Harris, J.R.; Seikaly, H.
Journal of Otolaryngology - Head and Neck Surgery 40(Suppl 1): S70-S81
2011
ISSN/ISBN: 1916-0216 PMID: 21453665 Document Number: 655138
Mandibular reconstruction is challenging for experienced and resident surgeons. Three-dimensional (3D) biomodeling creates accurate physical models of patients' craniofacial skeletons, which can potentially assist reconstruction. However, this capacity has not been objectively examined. The purpose of this study was to assess 3D biomodels in performing and learning mandibular reconstruction through surgical simulation. Prospective cohort study. Tertiary care academic referral centre. Ten experienced and 10 naive resident surgeons were asked to bend and fixate a titanium reconstruction plate, for a standardized anterior hemimandibular defect, on a 3D biomodel by freehand or 3D biomodel-assisted means. Participants were randomized to which technique was performed first. Twenty-four to 48 hours later, participants performed the opposite technique. Accuracy was measured by anterior mental projection and intercondylar and interangular splay. The results per technique were compared to a complete (control) mandible. The time of reconstruction and usability of each technique, as per an International Standards Organization-based questionnaire, were also determined. Three-dimensional biomodel-assisted reconstruction led to plates with statistically indifferent projection and splay compared to the control (p < .05) for both groups. Conversely, freehand constructs significantly deviated in projection and splay for either group (p < .05). No difference in reconstruction time by technique was found (p < .05). Usability favoured 3D biomodel-assisted bending, with significantly higher ratings in either group (p < .05). Three-dimensional biomodels provide a usable and accurate means of mandibular reconstruction for experienced surgeons. Moreover, when used in surgical simulation, they provide an effective tool for teaching residents.