Point-of-care computer-assisted design and manufacturing technology and its utility in post-traumatic mandibular reconstruction: An Australian public hospital experience

Abstract

Application of load-bearing osteosynthesis plates is the current gold-standard management for complex mandibular fractures. Traditionally, this has required a transcutaneous submandibular approach, carrying with it the risk of damage to the facial nerve and obvious extraoral scarring. The existing literature describes the use of computer-assisted design and manufacturing technology through external vendors to aid transoral mandibular reconstruction. However, the reliance on third-party manufacturers comes with significant drawbacks, notably increased financial costs and manufacturing delays. We describe our experience in using point-of-care three-dimensional-printed surgical models to aid with the application of mandibular reconstruction plates. Utilising a virtual three-dimensional reconstruction of the patient’s preoperative computed tomography facial bones, we fabricate a custom model of the patient’s mandible with the department’s in-house three-dimensional printer. Stock plates are subsequently pre-bent and adapted to the three-dimensional model, with plate and screw position marked and screw lengths measured with callipers. By using a custom three-dimensional-printed surgical model to pre-contour the plates, we are able to position stock reconstruction plates via a transoral approach. Moreover, our unit’s utilisation of in-house computer-assisted design and manufacturing software and hardware allows us deliver a same-day turnaround for both surgical planning and performing the operation. Patient-specific surgical planning guides can facilitate the safe and efficient transoral application of mandibular reconstruction plates. Moreover, the use of point-of-care computer-assisted design and manufacturing technology ensures timely and cost-effective manufacturing of the necessary biomodel.