A surgical navigated cutting guide for mandibular osteotomies: accuracy and reproducibility of an image-guided mandibula
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ORIGINAL ARTICLE
A surgical navigated cutting guide for mandibular osteotomies: accuracy and reproducibility of an image‑guided mandibular osteotomy Timon Peter ter Braak1,2 · Susan Gijsbertje Brouwer de Koning2 · Maarten Jan Antony van Alphen2 · Ferdinand van der Heijden1,2 · Willem Hans Schreuder2 · Robert Leonardus Petrus van Veen2 · Munir Baris Karakullukcu2 Received: 16 April 2020 / Accepted: 14 July 2020 © CARS 2020
Abstract Purpose 3D-printed cutting guides are the current standard to translate the virtual surgery plan to the intraoperative setting. The production of these patient-specific cutting guides is time-consuming and costly, and therefore, alternative approaches are currently subject of research. The aim of this study was to assess the accuracy and reproducibility of using a novel electromagnetic (EM) navigated surgical cutting guide to perform virtually planned osteotomies in mandible models. Methods A novel 3D navigated cutting guide (dubbed Bladerunner) was designed and evaluated with a total of 20 osteotomies, performed on plaster mandibular models according to preoperative planning using EM navigation. The pre- and postoperative scans were registered, and the difference between the preoperatively planned osteotomy and the performed osteotomy was expressed as the distance between the planned and performed cutting planes, and the yaw and roll angles between the planes. Results The mean difference in distance between the planned osteotomy and performed osteotomy was 1.1 mm (STD 0.6 mm), the mean yaw was 1.8° (STD 1.4°), and mean roll was 1.6° (STD 1.3°). Conclusion The proposed EM navigated cutting guide for mandibular osteotomies demonstrated accurate positioning of the cutting plane according to the preoperative virtual surgical plan with respect to distance, yaw and roll angles. This novel approach has the potential to make the use of 3D-printed cutting guides obsolete, thereby decreasing the interval between diagnosis and surgery, reduce cost and allow for adaptation of the virtual plan in case of rapid tumor proliferation or unanticipated in situ deviations from the preoperative CT/MR imaging. Keywords Surgical navigation · Electromagnetic · Oral and maxillofacial surgery · Computer-assisted surgery · Intraoperative navigation · Presurgical virtual planning · Cutting guide
Introduction Computer-assisted surgery has become a common tool in head and neck surgery. With the use of 3D planning software in combination with rapid prototyping, a patient-specific * Munir Baris Karakullukcu [email protected] 1
School of Technical Medicine, University of Twente, Enschede, The Netherlands
Department of Head and Neck Surgery, Verwelius 3D Lab, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
2
cutting guide can be created to improve precision and reduce the duration of bone reconstruction during head and neck surgery [1–3]. In addition, this approach allows for less experienced surgeons to conduct this type of surgery successfully. Virtual surgical planning has made the
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