Interactive pipeline for mandible reconstruction surgery planning using fibula free flap

Abstract

Purpose: Mandible reconstruction surgery using fibula free flap is a long and expensive process requiring extensive surgical experience. Indeed, the planning stage, mandible shaping, and therefore osteotomy positioning on the fibula are tedious, often done by hand, and can take months. This delay is unacceptable when mandible deterioration is caused by a time-sensitive disease such as cancer. In this paper, we propose an interactive pipeline for an easy-to-use and time-efficient surgical planning tool tailored to be used directly by the surgeon.

Methods: From CT scans of patient's mandible and fibula, we propose to register a cutting structure to the mandible and to segment and mesh the fibula; then, respecting anatomical constraints (mandible curvature, flap size, vessel preservation, etc.), we generate a surgery plan. Next, in a 3D interactive environment, the surgeon can intuitively shape the mandible by cutting, moving, and modifying bone fragments nondestructively. This stage allows surgeons to express their expertise, and the resulting cutting plane positions are then sent to a robot serving as a cutting guide for the surgery.

Results: We demonstrate the efficiency of our method through patient-specific surgery planning for two different pathologic cases. We show our results are comparable to a commercial solution away from cutting guides design.

Conclusion: Our proposed pipeline allows for a patient-specific precise planning and to cut down the preoperative planning phase of the mandible reconstruction surgery from days to minutes.

Keywords: 3D modeling; Computed tomography segmentation; Fibula free flap; Interactive system; Interactive volume rendering; Mandible reconstruction.