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

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.