In-house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time-efficient than commercial procedures.

Abstract

To compare an in-house and a commercially available surgical planning solution for mandibular reconstruction in terms of postoperative reconstruction accuracy and economic benefit. Twenty-nine consecutive patients with advanced oral squamous cell carcinoma (OSCC) requiring segmental mandibular reconstruction were enrolled. Fifteen patients underwent in-house surgical planning and 14 patients underwent a commercially available planning solution. A morphometric comparison of preoperative and postoperative computed tomography (CT) data sets and a cost-benefit comparison were performed. Volumes of planned and reconstructed bone segments differed significantly for both in-house planning (p = 0.0431) and commercial planning (p < 0.0001). Significant differences in osteotomy angles were demonstrated for in-house planning (p = 0.0391). Commercial planning was superior to in-house planning for total mandibular deviation (p = 0.0217), intersegmental space volumes (p = 0.0035), and lengths (p = 0.0007). No significant difference was found between the two planning solutions in terms of intersegmental ossification and the incidence of wound healing disorders. In-house planning took less time than commercial planning (p < 0.0001). Component manufacturing costs (p < 0.0001) and total cumulative costs (p < 0.0001) were significantly lower for in-house planning. In-house surgical planning is less accurate but has a cost advantage and could be performed in less time.