Utility of Computed-Tomography Based Navigation to Guide Fibula Mandible Reconstruction Surgery

  • Author / Creator
    Johansson, Rinde
  • Fibula free flap mandibular reconstruction is often performed to correct a mandibular defect. When a tumour is found on the mandible (lower jaw); the cancerous tissue is surgically removed and bone segment(s) from the fibula and soft tissue from the patient’s calf are used to reconstruct the mandible. Fibula bones segments must closely match the removed sections of the mandible. This is a complicated surgical procedure that has to be performed with a high degree of accuracy in order to restore the patient to an optimal functional outcome following surgery. In current practice, additive-manufactured surgical guides are used to ensure a surgical plan is accurately followed in the operating room (OR). However, designing, fabricating and sterilizing additive-manufactured models and surgical guides for mandible reconstruction surgery can be time consuming. Once fabricated, the additive-manufactured surgical guides cannot be modified or adjusted, therefore, necessary changes to the surgical plan may not be accommodated due to time, material and equipment constraints. In such cases, traditional freehand techniques may be used to complete the mandible resection and reconstruction. Digital navigation guides present an alternative to additive-manufactured surgical guides and traditional freehand reconstructions. Digital navigation guides can be used in surgery to guide surgeons during fibula mandible reconstruction by providing the surgical team with visual guides to follow based on medical CT imaging data and a preoperative surgical plan. The resulting CT navigation based surgical guidance can be used by surgeons during fibula mandible reconstruction to ensure the mandible resection and reconstruction is completed according to the preoperative surgical plan. The feasibility of using navigation was tested experimentally on additive-manufactured anatomical models.In this study we explored the possibility of using CT navigation based surgical guidance techniques to perform fibula mandible reconstruction surgery. The utility of CT navigation guidance techniques was evaluated and compared with freehand, and additive-manufactured template surgical guidance techniques in a benchtop scenario. Seven head and neck surgeons performed three fibula mandible reconstructions on additive-manufactured mandible and fibula models using three different surgical guidance techniques (freehand, navigation, and template). The mandible reconstructions completed by the participants were analyzed to determine how closely they matched the planned mandible reconstruction.To a gain a better understanding of the implications of using CT navigation to guide fibula mandible reconstruction surgery, semi-structured convergent interviews were conducted with the surgeon participants following the final benchtop session. The purpose of conducting convergent interviews was to determine the feasibility of using navigation to guide fibula mandible reconstructions, and to identify potential barrier’s to clinical adoption, as well as benefits and limitations of CT navigation as a method of guiding fibula mandible reconstruction surgery. As the intended users, it was important to conduct interviews with participating surgeons to gain a better understanding of their perception of CT navigation as a method of guiding fibula mandible reconstruction surgery.The benchtop study revealed that preoperative surgical planning and surgical guidance positively impacts fibula mandible reconstructions. additive-manufactured template guided surgery seems to produce the most accurate and consistent fibula mandible reconstructions, while freehand surgery produced the least accurate and consistent mandible reconstructions as compared to a planned control model. Computed-tomography surgical navigation guidance resulted in more accurate and consistent fibula mandible reconstructions than freehand surgery but were less accurate and consistent than additive-manufactured templated guided fibula mandible reconstructions. The convergent interviews were an effective method to ascertain head and neck surgeons’ views of the three surgical guidance methods used in the benchtop study. The convergent interviews revealed that surgeon participants prefer additive-manufactured template guided fibula mandible reconstruction but see potential value in computed tomography navigation surgical guidance.

  • Subjects / Keywords
  • Graduation date
    Fall 2019
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
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