title: Accuracy and reproducibility of virtual cutting guides and 3D-navigation for osteotomies of the mandible and maxilla.
abstract: BACKGROUND
  We set out to determine the accuracy of 3D-navigated mandibular and maxillary osteotomies with the ultimate aim to integrate virtual cutting guides and 3D-navigation into ablative and reconstructive head and neck surgery.
  
  
  METHODS
  Four surgeons (two attending, two clinical fellows) completed 224 unnavigated and 224 3D-navigated osteotomies on anatomical models according to preoperative 3D plans. The osteotomized bones were scanned and analyzed.
  
  
  RESULTS
  Median distance from the virtual plan was 2.1 mm unnavigated (IQR 2.6 mm, ≥3 mm in 33%) and 1.2 mm 3D-navigated (IQR 1.1 mm, ≥3 mm in 6%) (P<0.0001); median pitch was 4.5° unnavigated (IQR 7.1°) and 3.5° 3D-navigated (IQR 4.0°) (P<0.0001); median roll was 7.4° unnavigated (IQR 8.5°) and 2.6° 3D-navigated (IQR 3.8°) (P<0.0001).
  
  
  CONCLUSIONS
  3D-rendering enables osteotomy navigation. 3 mm is an appropriate planning distance. The next steps are translating virtual cutting guides to free bone flap reconstruction and clinical use.
authors.affiliation: Guided Therapeutics (GTx) Program, TECHNA Institute, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.|Department of Otolaryngology - Head & Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Bernstein
authors.affiliation: Guided Therapeutics (GTx) Program, TECHNA Institute, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Daly
authors.affiliation: Guided Therapeutics (GTx) Program, TECHNA Institute, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Harley
authors.initials: H
authors.lastname: Chan
authors.affiliation: Guided Therapeutics (GTx) Program, TECHNA Institute, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Qiu
authors.affiliation: Guided Therapeutics (GTx) Program, TECHNA Institute, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.affiliation: Guided Therapeutics (GTx) Program, TECHNA Institute, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.|Department of Otolaryngology - Head & Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Nidal
authors.initials: N
authors.lastname: Muhanna
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
authors.affiliation: Guided Therapeutics (GTx) Program, TECHNA Institute, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.|Department of Otolaryngology - Head & Neck Surgery / Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
mesh_terms: D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008334:Mandible / Q000601:surgery*; D008437:Maxilla / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*