Point-of-care virtual surgical planning for jaw reconstruction: An update on the experience with 50 patients at a tertiary referral center.
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BACKGROUND: Virtual surgical planning (VSP) has revolutionized the field of maxillofacial reconstruction. Traditionally, VSP is outsourced to an external company, which can incur considerable costs and delay surgery. Our institution has previously reported on the feasibility of point-of-care VSP (POC-VSP). Here, we present an update on the technical refinements made to our POC-VSP process, and provide an expanded series with specific endpoints including time from planning to product release, operative time, implant survival, and post-operative complications. METHODS: A retrospective cohort study of all maxillomandibular reconstructions performed with POC-VSP from August 2016 to February 2024 was conducted. Data were extracted from the prospectively maintained Integrated Prosthetics & Reconstruction database. Outcomes including the time from the VSP planning session to product release for cases performed within the last 12 months, operative time, dental implant survival, and post-operative complications were evaluated. RESULTS: Fifty patients underwent maxillofacial reconstruction with POC-VSP. The median number of cases performed per annum was 4.5 (range, 2-15). The most common indications were oral squamous cell carcinoma (n=23) and ameloblastoma (n=11). The fibula (n=39) was the most common donor site. The median time from the VSP session to product release was 15.5 days (range, 9-27 days). The mean operative time was 565 min (range, 366-972 min). The implant success rate was 95%. Seven patients experienced a Clavien-Dindo grade III or IV post-operative complication necessitating a return to theater. CONCLUSIONS: POC-VSP is a feasible process which provides acceptable operative time parameters and implant success rates. Optical scans of pre-bent plates can be incorporated into POC-VSP to guide plate fixation. Further research is required to quantify the cost benefit of POC-VSP.