title: Three-dimensional virtual surgery accuracy for free fibula mandibular reconstruction: planned versus actual results.
abstract: OBJECTIVE
  Virtual surgical planning (VSP) can promote efficiency, but the ability to transfer the proposed plan to the actual result has not been adequately studied. The purpose of this study was to morphometrically compare the virtually preplanned scenario with the postoperative 3-dimensional (3D) anatomic result.
  
  
  METHODS
  A retrospective review of 10 patients who underwent mandibular reconstruction using a free fibula flap and VSP were evaluated. Pre- and postoperative Digital Imaging and Communications in Medicine files were imported into Mimics 10.01 software (Materialise, Leuven, Belgium) for surgical planning. Preoperative VSP and 1-week postoperative computed tomographic (CT) scans were evaluated to assess surgical accuracy using VSP. The pre- and postoperative morphometric measurements were compared using the Student t test.
  
  
  RESULTS
  Twenty CT scans from 10 patients (mean age, 56.9±20.2 yr) who underwent partial mandibular resection were analyzed. The dimensions of the fibula segments after osteotomy showed no difference from the preoperative VSP (mean difference in fibula height, 1.2 mm; mean difference in width, 0.9 mm; mean difference in length, 1.3 mm). The postoperative anterior and posterior mandibular angles differed from the VSP by 12.4° and -12.5°, respectively. The condylar distance and inclination showed a discrepancy of only 1.7 mm and 4.6°, respectively, between VSP and postoperative CT scans.
  
  
  CONCLUSIONS
  VSP confers reproducible precision and accuracy for free fibular mandibular reconstruction. The benefit was most striking for large reconstructions requiring multiple fibular segments. Future directions include assessing the use of external registration devices to enhance surgical accuracy and to follow patients longitudinally to monitor the long-term benefit of VSP.
authors.affiliation: Craniofacial Fellow, Yale Plastic Surgery, Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Philipp
authors.initials: P
authors.lastname: Metzler
authors.affiliation: Medical Student, Yale University School of Medicine, Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Geiger
authors.affiliation: Medical Student, Yale University School of Medicine, Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Andre
authors.initials: A
authors.lastname: Alcon
authors.affiliation: Visiting Research Fellow, Yale School of Medicine, Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Xioayang
authors.initials: X
authors.lastname: Ma
authors.affiliation: Associate Professor Plastic Surgery; Director Craniomaxillofacial Surgery, Yale School of Medicine, Yale University School of Medicine, New Haven, CT; Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT. Electronic address: derek.steinbacher@yale.edu.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Steinbacher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013515:Surgery, Oral; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface