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. 2024 Dec;17(4):NP31-NP35.
doi: 10.1177/19433875241236322. Epub 2024 Mar 14.

Repair of Inferior Alveolar Nerve in Orthognathic Surgery Simulator (RIANOS): A Novel, Open-Source, Combined 3D Printed, and Ex-Vivo Chicken Sciatic Nerve Training Model

Alfonso Navia  1   2 , Sebastian Tapia  3 , Maria Fernanda Rojas  1 , Francisco Rojas  3 , Alex Vargas  3 , Claudio Guerra  1 , Alvaro Cuadra  1 , Susana Searle  1 , Hernan Ramírez  3   2 , Cristian Teuber  3
Affiliations

Repair of Inferior Alveolar Nerve in Orthognathic Surgery Simulator (RIANOS): A Novel, Open-Source, Combined 3D Printed, and Ex-Vivo Chicken Sciatic Nerve Training Model

Alfonso Navia et al. Craniomaxillofac Trauma Reconstr. 2024 Dec.

Abstract

Study design: Face and content validation of a surgical simulation model.

Objective: Accidental transection of the inferior alveolar nerve (IAN) during bilateral sagittal split osteotomies (BSSO) has a reported incidence of up to 7%, determining important sensory disturbances in patients. Proper repair demands the need of microsurgical anastomosis skills. No previous training models have been described to simulate this. Therefore, we present a validated simulation model for intraoral repair of transected IAN.

Methods: A CT scan of an orthognathic surgery patient was modified and a 3D model of a mandible with BSSO was printed. Chicken thigh anatomy was reviewed, and 2.5 mm sciatic nerves were dissected and mounted in the model. In order to simulate intraoral work depth, it was put inside a dental phantom or medical glove box. The model was tested by a group of experts (n = 12), simulating a transected IAN repair inside the mouth with both loupes and a double visor surgical training microscope. A survey was conducted to assess Face and Content validity.

Results: The model was named RIANOS after Repair of Inferior Alveolar Nerve in Orthognathic Surgery Simulator. The printing cost of each model was approximately US$3 and the design file is open-source and available for download. All experts "Strongly Agreed" that the model was useful for training inferior alveolar nerve microsurgical repair and would consider implementing it with their residents.

Conclusions: We developed a low cost, reproducible, open-source simulator for IAN injury repair training during BSSO. Face and Content validity was achieved through evaluation by a group of experts.

Keywords: inferior alveolar nerve; microsurgery; nerve repair; orthognathic surgery; training simulator.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Postero-medial view of a dissected chicken thigh showing the sciatic nerve anatomy (A: Artery, V; Vein).
Figure 2.
Figure 2.
RIANOS model printed and mounted with a sciatic nerve at the right sagittal osteotomy.
Figure 3.
Figure 3.
RIANOS model mounted inside a glove box.
Figure 4.
Figure 4.
RIANOS model mounted inside a dental phantom.
See this image and copyright information in PMC

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