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Surgical guides – a tailored solution

Precise positioning of bone grafts in facial skeleton, their stabilisation, good vascularisation of surrounding soft and bone tissues are compounds of the success of the reconstruction surgeries which base on a bone autograft. Pre-operating, virtual planning of the surgery with use of 3D-printing allows to increase the precision of the reconstruction. It results in aesthetic and functional effects.

According to Journal of Oral and Maxillofacial Surgery, Medicine and Pathology [1] subjects that dominate in scientific articles about personalized solutions dedicated to maxillofacial surgery are surgical guides (46%). Why they are so popular among surgeons? What are benefits of their use?

Necessity is the mother of invention

Surgical guides are often named templates or guides and are used for precise leading of surgical instruments in the right place and under the right angle. They are unique and suite only to one patient. Three types of surgical guides can be distinguished: to resect tumour, to prepare grafts and to position them to surrounding bone tissues. This personalised solution is a result of preoperating planning.

Designing of guides always takes place with surgeons involvement- in our case there is a possibility to use an online system which is available from anywhere in the world (psPortal platform). Thanks to this solution the surgeon has an opportunity to define the margin of tumour resection and to verify if the guide meets its requirements. Surgical guides allow to transfer the virtual preoperating plan to the real dimension.

One-time use surgical instruments in a form of guides are useful in many cases of resection and reconstructing surgeries [2]. The most important advantage of surgical guides is an increase of precision of the surgical procedure. In addition, their use shorten the time of surgery, which minimise the risk of consequences such as: damage of trigeminal nerve (12%), infection (3.4%) and postoperative pain of temporomandibular joints (2.1%) [5]. Confirmed precision of surgical guides [3] allows to decrease the possibility of any complications mentioned above and to perform revision surgeries.

Time is money

Research carried out by Chinese scientists [8] proves that use of personalise solution, such as surgical guides, shorten the time of surgery in 15% compared to standard procedures, which usually base only on experience of the surgeon. The average time of the surgery using virtual planning takes 5 hours 54 minutes compared to standard procedure – 6 hours 54 minutes. The time in the case of maxillofacial reconstruction with use of autograft is very important, because the time of ischemia of bone tissue, also of the autograft, should be less than 5 hours [2]. No less important are costs of such complicated and long hours lasting surgeries. According to Annals of Medicine and Surgery [9] the cost of the minute of surgery goes to 25£!

Summarising: patient-specific surgical guides designed based on preoperative planning in guideline of the surgeon provides greater security of procedure. Benefits of their use are not only referring to patient but also to surgeon and to managers of the hospital.

Our surgical guides are made from biocompatible acrylic resin which allows 24 hours contact with living tissues. It’s recommended to sterilize the guide in a pre-vacuum autoclave before use. The time of guides’ manufacturing is limited to 5 working days, starting from sending CT scan to ready reconstructing set with the guide. The short manufacturing time allows to use them also in emergency cases.

We encourage to familiarize with the case of grafts used during the mandibular reconstruction with use of autograft from the fibula.

[1] A.Louvrier, P. Marty, A. Barrabé, E. Euvrard, B. Chatelain, E. Webera, C. Meyer, How useful is 3D printing in maxillofacial surgery, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 2017
[2] Fernando Iglesias-Martín, Luis-Guillermo Oliveros-López, Ana Fernández-Olavarría, María-Ángeles Serrera-Figallo, Aída Gutiérrez-Corrales, Daniel Torres-Lagares and José-Luis Gutiérrez-Pérez. Advantages of surgical simulation in the surgical reconstruction of oncological patients. Med Oral Patol Oral Cir Bucal. 2018
[3]George R.Deeb, MD Riley K.Allen V. PatrickHall DanielWhitley Daniel M.Laskin, SompopBencharit, How Accurate Are Implant Surgical Guides Produced With Desktop Stereolithographic 3-Dimentional Printers? Journal of Oral and Maxillofacial Surgery 2017
[4] TingweiBao, JianfengChangyangYu, WenquanZhao, YiLin, HuimingWang, JianhuaLiu,HuiyongZhu. Utilization of a pre-bent plate-positioning surgical guide system in precise mandibular reconstruction with a free fibula flap, Oral Oncology 2017
[5] Cristina Silva Sousa, Ruth Natalia Teresa Turrini, Complications in orthognathic surgery. A comprehensive review, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 2012[6] A. TARSITANO, L. CIOCCA, R. CIPRIANI, R. SCOTTI, and C. MARCHETTI. Mandibular reconstruction using fibula free flap harvested using a customised cutting guide: how we do it, Acta Otorhinolaryngologica Italica 2015
[7] Tarsitano A, Mazzoni S, Cipriani R, Scotti R, Marchetti C, Ciocca L. The CAD-CAM technique for mandibular reconstruction: an 18 patients oncological case-series. Journal of Cranio-Maxillofacial Surgery 2014
[8] Wenhao Ren, Ling Gao, Shaoming Li, Cheng Chen, Fan Li, Qibo Wang, Yuan Zhi, Jianzhong Song, Zhichao Dou, Lingfa Xue, Keqian Zhi, Virtual Planning and 3D printing modeling for mandibular reconstruction with fibula free flap, Med Oral Patol Oral Cir Bucal. 2018
[9]W.W. Ang, The cost of trauma operating theatre inefficiency, Ann Med Surg(Lond). 2016