Custom titanium guides in mandibular 3D sculpting

Author(s) Markose G.; Corsar K.; Graham R.M.
Source British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)
With advances in CT scanning and 3D printing facilities the use of surgical models / stents in maxillofacial surgical planning for implants and oncological work is fairly routine. We present a case where the use of custom cutting guides aided 3D sculpting of a rather overgrown mandible in a young girl with a central giant cell granuloma. En bloc resection can be challenging due to the variable size and location of the tumours and their proximity to surrounding vital tissues. To overcome the challenge of precise resection, computer-aided models were used to assess vital structures, the extent of the affected area and plan surgery.

​The models were able to accurately identify the course of the mandibular canal. A mirror image of the normal side of the mandible was superimposed on the overgrown mandible and patient-specific guiding templates for resection were fabricated which allowed significant recontouring of the mandible with relative ease. The guiding templates provide significant advantages by guiding surgery, leading to more precise resection of the bone with less blood loss, shorter operation time and avoiding damage to the inferior alveolar nerve. We discuss the pre-operative and operative steps in the surgery and review the results.Copyright © 2019