Standardized Protocol for Visual Surgical Plan and Three Dimensional Surgical Templates Assisted Single Stage Mandible Contour Surgery

Background: Mandible contour surgery (reduction gonioplasty and/or genioplasty) has become increasingly popular. However, it can be challenging even for experienced surgeons due to limited visualization and difficulty in identifying the osteotomy line, and hence, often needs secondary revisions. With the development of three-dimensional (3D) technology, accurately planned single stage mandible contour surgery with minimum complication rates is possible with visual surgical plan (VSP) and 3D surgical templates. This study is to establish a standardized protocol for VSP and 3D surgical templates-assisted mandible contour surgery and evaluate the accuracy of the protocol.

Methods: In this study, we enrolled 20 patients for mandible contour surgery. Visual surgical plans were performed based on 3D CT data. Surgical templates were 3D-printed based on preoperative visual surgical plan. Templates included a pair of mandibular angle bi-cortical curved osteotomy templates, mandibular cortex thinning or splitting template, and an osteotomy and fixation template for genioplasty. The accuracy of the method was analyzed by the comparison of VSP and post-op results.

Result: All patients had symmetric, natural osteotomy lines, and satisfactory facial ratios in a single-stage operation. The discrepancy of VSP and post-op result was minimum (< 1 mm). Both patients and surgeons were satisfied with the results. Surgeons were very satisfied with the use of surgical templates to facilitate the operation.

Conclusion: Our protocol of VSP and 3D printed surgical templates result in accurate, safe, and predictable single-stage mandible contour surgery.  While further studies are warranted we believe that the impact of 3D technology for virtual surgery and pre-operative planning as well as fabrication of surgical templates can improved patient outcomes and reduce reoperation.