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. 2019 Apr;39(2):117-121.
doi: 10.14639/0392-100X-2408.

Use of a CAD-CAM inferior alveolar nerve salvage template during mandibular resection for benign lesions

F Ricotta  1 , S Battaglia  2 , A Sandi  3 , A Pizzigallo  2 , C Marchetti  2 , A Tarsitano  2
Affiliations

Use of a CAD-CAM inferior alveolar nerve salvage template during mandibular resection for benign lesions

F Ricotta et al. Acta Otorhinolaryngol Ital. 2019 Apr.

Abstract

Utilizzo di una guida CAD-CAM per la preservazione del nervo alveolare inferiore durante le resezioni mandibolari nelle lesioni benigne.

Riassunto: Durante le procedure chirurgiche di resezione mandibolare, la preservazione del nervo alveolare inferiore (NAI) è auspicabile nella patologia benigna. In questo studio pilota prospettico, riportiamo la nostra esperienza nell’uso di una dima di taglio customizzata per la rapida preservazione del nervo alveolare inferiore (RICS). La pianificazione chirurgica virtuale della guida di taglio è basata sul modello 3D ottenuto dall’elaborazione dei file DICOM della TC pre-operatoria. Sono stati inclusi nel nostro studio 5 pazienti affetti da patologia mandibolare benigna. Sono stati esteriorizzati in totale 7 NAI. Il tempo medio di esteriorizzazione è stato 23 minuti. Tutte le esteriorizzazioni sono state eseguite con successo e non è avvenuto alcun danneggiamento del fascio neuro-vascolare. Tutti i pazienti hanno mostrato il recupero completo della sensibilità del NAI entro 7 settimane dall’intervento chirurgico. In conclusione, la dima di esteriorizzazione RICS sembrerebbe permettere una più rapida e sicura preservazione del NAI.

Keywords: Computer-assisted surgery; Inferior alveolar nerve; Mandibular resection; Nerve exteriorisation.

Plain language summary

During surgical procedures involving the mandible, preserving the inferior alveolar nerve (IAN) may be preferable for benign tumours. In this prospective pilot study, we report our experience on the use of a Rapid Inferior Alveolar nerve Customised Salvage (RICS) template. Virtual surgical planning (VSP) of the template is based on a 3D model obtained from the elaboration of DICOM files of the preoperative CT scan. Five patients affected by benign mandibular pathology were included. A total of 7 IANs were exteriorised. The average time of exteriorisation was 23 minutes. All exteriorisations were performed successfully and no damage to the neuro-vascular bundle occurred. All patients showed complete recovery of sensitivity of the IAN within 7 weeks after surgical procedure. In conclusion, RICS template seems to allow faster and safer exteriorisation of the IAN.

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Figures

Fig. 1.
Fig. 1.
Virtual planning of the RICS template for exteriorisation of the IAN. A: Appropriate thresholding to visualise the path of the IAN. B: Outlining of the IAN on the outer cortex of the mandibular canal. C: Design of the RICS template.
Fig. 2.
Fig. 2.
Intra-operative positioning of the RICS template.
Fig. 3.
Fig. 3.
The outer cortex of the mandible is removed. Complete visualisation and exteriorisation of the IAN.
Fig. 4.
Fig. 4.
The mandibular resection is performed with preservation of the IAN (yellow loop), as preoperatively planned.
See this image and copyright information in PMC

References

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