title: Three-dimensional biomodeling in complex mandibular reconstruction and surgical simulation: prospective trial.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  The purpose of this study was to assess 3D biomodels in performing and learning mandibular reconstruction through surgical simulation.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary care academic referral centre.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, Edmonton, AB.
authors: Peter T
authors: PT
authors: Dziegielewski
authors: Jay
authors: J
authors: Zhu
authors: Ben
authors: B
authors: King
authors: Andrew
authors: A
authors: Grosvenor
authors: Walter
authors: W
authors: Dobrovolsky
authors: Prabhjyot
authors: P
authors: Singh
authors: Kal
authors: K
authors: Ansari
authors: Khalid H
authors: KH
authors: Al-Qahtani
authors: Jeffrey R
authors: JR
authors: Harris
authors: Hadi
authors: H
authors: Seikaly
mesh_terms: D000328:Adult; D003198:Computer Simulation; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007396:Internship and Residency; D008297:Male; D008334:Mandible / Q000033:anatomy & histology*; D008875:Middle Aged; D008954:Models, Biological; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000193:education* / Q000379:methods; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*