ABSTRACT
Background:
Virtual surgical planning (VSG), also known as computer-assisted reconstruction, has started to become the norm for more complex patients in many centers in recent times.
Aim:
This study was conducted to evaluate the VSG in maxillofacial reconstruction surgery.
Methods and Materials:
This study included 20 patients who underwent surgery for maxillofacial reconstruction. The study participants were divided into two main categories: Category 1: Conventional surgical planning (CSG). Category 2: VSG. The surgical planning in both categories, including the evaluation of volume of defect, length, width, and height of graft, to be placed.
Results:
The gap between defect to be reconstructed and graft placed was greater in CSG as compared to VSG. The distance of graft from actual location was lesser in VSG as compared to CSG. The findings were significant statistically. Frequency of success was 93.21% and 97.47%, respectively. The frequency of success was greater in VSG as compared to CSG.
Conclusion:
Virtual surgical planning is more effective in maxillofacial reconstruction surgery.
KEYWORDS: Maxillofacial reconstructions, stereolithographic models, virtual surgical planning
INTRODUCTION
The process of bone modeling is one of the essential elements of mandibulomaxillary reconstruction. This directly affects the proper dental occlusion. Facial contour and bone-to-bone contact.[1,2,3] Precise positioning and precise angles of osteotomies might be difficult to achieve using traditional procedures. To reduce human error, a number of techniques have been implemented, such as prebending a reconstruction plate before bony excision.[4,5,6]
However, this is not suitable for situations where the bone is significantly deficient or deteriorated, or for huge exophytic lesions that the plate is unable to be fitted around. Intraoperative templates and stereolithographic models that can be shaped to replicate normal anatomy are two options to make up for this. Virtual surgical planning (VSG), also known as computer-assisted reconstruction, has started to become the norm for more complex patients in many centers in recent times.[7,8] VSP combines the creation of personalized models and cutting instructions with three-dimensional (3D) computer-assisted planning. Although there are many benefits to VSP, routine implementation has been hindered by the high cost and time required to create the models and guides.[3,4,5,6] This study was conducted to evaluate the VSG in maxillofacial reconstruction surgery.
METHODS AND MATERIALS
This study included 20 patients who underwent surgery for maxillofacial reconstruction (IEC-NHDC and RI/2023/FAC/OMDR.21/SS-14-ECC)
The study participants were divided into two main categories:
Category 1: Conventional surgical planning (CSG).
Category 2: VSG
The VSG was carried out with the help of 3D imaging (cone beam computed tomography, computed tomography) while the CSG was carried out with the help of conventional imaging techniques like panoramic radiographs. The surgical planning in both categories, including the evaluation of volume of defect, length, width, and height of graft, to be placed. Once the surgery was carried out then there was evaluation of different parameters after 1 year of follow-up.
Time of surgery (min)
Deviation in length of graft from actual length desired (mm)
Deviation in width of graft from actual width desired (mm)
Deviation in height of graft from actual height desired (mm)
Gap between defect to be reconstructed and graft placed (mm3)
Distance of graft from actual location (mm)
Frequency of success (%)
Statistical analysis
The data was recorded and placed in MS Excel. Statistical Package for Social Sciences version 21 was used for statistical analysis. The Chi-square test was used for statistical analysis. P ≤ 0.05 was considered statistically significant.
RESULTS
The time of surgery in CSG was 24.26 ± 2.27 min while it was 18.14 ± 1.17 min in VSG. The time of surgery was lesser in VSG as compared to CSG. Deviation in length of graft from actual length desired in CSG was 0.98 ± 0.02 mm while it was 0.43 ± 0.06 mm in VSG. It was observed that deviation in length of graft was lesser in VSG as compared to CSG. The findings were significant statistically (P = 0.001). Deviation in width of graft from actual width desired was 0.57 ± 0.03 mm and 0.35 ± 0.01 mm, respectively. Overall deviation in width of graft was lesser in VSG as compared with CSG. The findings were significant statistically (P = 0.001). Deviation in height of graft from actual height desired in CSG was 0.76 ± 0.02 mm while it was 0.67 ± 0.08 mm in VSG. The deviation in height of graft from actual height desired was greater in CSG as compared to VSG. The findings were significant statistically (P = 0.001). Gap between defect to be reconstructed and graft placed was 0.241 ± 0.002 mm3 and 0.187 ± 0.003 mm3, respectively. The gap between defect to be reconstructed and graft placed was greater in CSG as compared to VSG. The difference was significant statistically (P = 0.001). Distance of graft from actual location was 0.89 ± 0.01 mm and 0.37 ± 0.05 mm, respectively. The distance of graft from actual location was lesser in VSG as compared to CSG. The findings were significant statistically. Frequency of success was 93.21% and 97.47%, respectively. The frequency of success was greater in VSG as compared to CSG (P = 0.001) [Table 1].
Table 1.
Comparison between parameters between conventional surgical planning and virtual surgical planning
| Conventional surgical planning (mean±SD) | Virtual surgical planning (mean±SD) | |
|---|---|---|
| Time of surgery (min) | 24.26±2.27 | 18.14±1.17 |
| Deviation in length of graft from actual length desired (mm) | 0.98±0.02 | 0.43±0.06 |
| Deviation in width of graft from actual width desired (mm) | 0.57±0.03 | 0.35±0.01 |
| Deviation in height of graft from actual height desired (mm) | 0.76±0.02 | 0.67±0.08 |
| Gap between defect to be reconstructed and graft placed (mm3) | 0.241±0.002 | 0.187±0.003 |
| Distance of graft from actual location (mm) | 0.89±0.01 | 0.37±0.05 |
| Frequency of success (%) | 93.21 | 97.47 |
| P | 0.001 |
DISCUSSION
This study was conducted to evaluate the VSG in maxillofacial reconstruction surgery. It was found that the time of surgery was lesser in VSG as compared to CSG. It was observed that deviation in length of graft was lesser in VSG as compared to CSG. Deviation in width of graft from actual width desired was 0.57 ± 0.03 mm and 0.35 ± 0.01 mm, respectively. Overall deviation in width of graft was lesser in VSG as compared with CSG. Deviation in height of graft from actual height desired in CSG was 0.76 ± 0.02 mm while it was 0.67 ± 0.08 mm in VSG. The deviation in height of graft from actual height desired was greater in CSG as compared to VSG.
Computer-assisted reconstruction, or virtual surgery planning, has started to become the standard for more complicated patients in many facilities in recent years. VSP combines 3D computer-assisted planning with the fabrication of customized models and cutting instructions.[1,2,3] This is usually used in conjunction with a patient-specific plate (PSP), which, when utilized properly, removes most intraoperative “guesswork.” Despite the fact that VSP offers many advantages, the expense and time involved in creating the models and guidelines have made routine deployment difficult.[4,5,6,7,8,9]
The gap between defect to be reconstructed and graft placed was greater in CSG as compared to VSG. The distance of graft from actual location was lesser in VSG as compared to CSG. The findings were significant statistically. Frequency of success was 93.21% and 97.47%, respectively. The frequency of success was greater in VSG as compared to CSG.
CONCLUSION
VSG is more effective in maxillofacial reconstruction surgery.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
We would like to acknowledge Deanship of Scientific Research, Prince Sattam Bin Abdul Aziz University, Alkharj KSA, for supporting this research and all the study participants for helping to provide information and sparing their time.
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