Resection in the head and neck region leads to complex defects with significant impairment in function. Reconstruction is even more difficult and to improve the accuracy of both resection and reconstruction a number of aids are used. With the improved and universal presence of the three-dimensional planning software, virtual planning is becoming more common. The resection template is of critical importance, this allows for a planned defect with planned angulations of the defect margins. This is a prospective study from the Netherlands. Eleven consecutive patients with either a T4 squamous cell carcinoma or an osteoradionecrosis of the mandible, between March 2012 and July 2013 were selected. Preoperative cone beam computed tomography was used to make a virtual head model. Virtual resection and reconstruction was carried out. A resection template that had four fixation boreholes was designed to rigidly fix onto the mandible. The bore holes of the resection templates correspond exactly to similar holes in the reconstruction template. The study concluded the resection templates were reasonably accurate. This is another study that confirms the need for accurate templates to aid in both resection and reconstruction. One must bear in mind the clinical picture is liable to change especially if there is a delay between the scans and surgery. Virtual planning is done on scans and the clinical picture may progress. If then the surgeon sticks to the use of these templates resection margin might well be compromised. All in all, this is a good look at the use of virtual planning and a paper worth reading.
Another paper advocating resection templates
Reviewed by Sunil K Bhatia
Accuracy of virtually 3D planned resection templates in mandibular reconstruction.
