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Development of a 3D navigated surgical cutting guide

Braak, T.P. ter (2019) Development of a 3D navigated surgical cutting guide.

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Abstract:Background: The gold standard treatment for tumour invading the mandibular bone, is surgical resection of the bone and reconstruction with autogenous bone flaps. Currently, the mandibular osteotomies are performed using patient-specific three-dimensional (3D) printed cutting guides. These guides allow the location and orientation of the planned osteotomies to be replicated accurately during surgery, however they still have shortcomings. These guides do not allow for alterations of the preoperative planning and have a lengthy time interval between planning and surgery due to design and production. Both the inability to allow alterations and the lengthy time interval negatively influence the surgical result. In this study, a navigated cutting guide is proposed along with an improved registration method for mandibular osteotomies. Registration: The current registration method using intraoperative cone beam computed tomography takes surgery time and has a low resolution, limiting the registration accuracy. Five different registration methods utilising splints, screws or combinations are evaluated. A dental and edentate phantom model of a mandible were created and scanned according to the regular preoperative computed tomography protocol, together with the splint/screws for the registration. Surgical navigation was performed with the NDI Aurora planar field generator. A point-match procedure was performed for the registration, thereafter the target registration error was determined along the surface on a total of 45 points for the dental and 35 points for the edentate model. The dental splint with incorporated registration fiducials performed best, with a root mean square error of 0.89 mm, which is a clear improvement on the 2.1 mm of the current registration method. Navigated cutting guide: A navigated cutting guide has been developed, consisting of three elements which allow for fixation to the mandible while still enabling adjustments in position and orientation. A total of twenty osteotomies have been performed on ten plaster mandibles, and evaluated on accuracy in position and orientation. The median deviation in position was 1.0 mm and in orientation 1.6° for the yaw and 1.1° for the roll. The results were compared with preliminary clinical data of the 3D printed cutting guides and a navigated saw study found in literature. There was no significant difference in the deviation of the position (p = 0.640), but there were significant differences in both the yaw and the roll. In the yaw, there were statistically significant differences between the navigated cutting guide with the navigated saw (p < 0.001) and with the 3D printed cutting guide (p = 0.035). In the roll, there were statistically significant differences between the navigated cutting guide with the navigated saw (p = 0.018) and with the 3D printed cutting guide (p = 0.043). In conclusion, despite the initial stages of the research, encouraging results were obtained.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/79334
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