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BoneReconstructionPlanner

A 3D Slicer extension for virtual surgical planning of mandibular reconstruction with vascularized fibula free flap and generation of patient-specific surgical guides.

Initial development as final project: Mauro I. Dominguez,

Supervision: PhD. Andras Lasso

Clinical advice: Dr. Manjula Herath

Maintenance and Improvements: Mauro I. Dominguez

Corresponding paper: ScienceDirect

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Bend reconstruction plate according to

resected mandible

Cut the rectangular paper ruler to pieces

that match the reconstruction plate

Align the paper pieces along the grafted

fibula and mark the closing-wedge

osteotomies

EYEBALLING, THE TRADITIONAL PAPER-RULER METHOD

Source: Video tutorial of surgery

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VIRTUAL SURGICAL PLANNING, THE DIGITAL WAY

Segmentation of mandible and cranium

Lateral view of the segmentations

Bottom view of segmentations

Tumour resection is done virtually.

Lateral view post-resection

Placement of mandibular cutting planes and reconstruction.

Lateral view post-reconstruction

Bottom view post-reconstruction

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FIBULA CUTTING GUIDE GENERATION

Fibula bone segmentation with

automatic placement of fibula planes

Fibula cutting guide in STL format.

3D printed reconstructed mandible.

Generation of fibula cutting guide.

3D printed fibula cutting

guide using PLA materials.

3D printer

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INTRA OPERATIVE PHOTOS

Preparing pedicle and fibula graft

to place the cutting guide.

Osteotomy cuts made. The fibula bone is cut into 3 segments.

The main tumour was resected

Fitting of fibula cutting guide at the antero-lateral aspect of the fibula.

Miniplates were fixed onto the fibula segments. Pedicles are still attached at this moment.

Fibula segments were fixed onto the native mandible to form the neo-mandible

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CLINICAL PHOTOS

Pre-operative facial appearance

1-month post-operative facial �appearance.

Pre-operative orthopantomogram

1-month post-operative orthopantomogram

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VIDEO DEMO

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VIRTUAL SURGICAL PLANNING,

THE DIGITAL WAY

Benefits

  • less operation time
  • less ischemic time
  • less hospital stay after surgery
  • better osteotomies accuracy
  • better neomandible contour, more aesthetic

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VIRTUAL SURGICAL PLANNING,

THE DIGITAL WAY

Cons

  • Software: ~$15K/year for commercial licenses (Free with BoneReconstructionPlanner)
  • 3D Printing: Requires printer, biocompatible material, and sterilization (in-house or outsourced).
  • Regulatory: Needs IRB or FDA approval.
  • Planning Time: ~30 min pre-op planning; still saves net OR time.
  • Training: Learning curve; may need biomedical engineer or trained technician.

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AROUND 100 SURGERIES

INFORMALLY DOCUMENTED

Review more examples (link)

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BONERECONSTRUCTIONPLANNER

SOFTWARE ARCHITECTURE

Used features currently available on Slicer:

  • Markups (lines, curves, planes, points)
  • Segmentations (created from the segment editor)
  • 3D models
  • 3D operations (algorithms, filters)
  • Registrations (transforms)

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In top of that:

  • Virtual osteotomies and virtual reconstruction
  • Generation of personalized surgical guides

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Developer: Mauro Dominguez

Linkedin: https://www.linkedin.com/in/engineerdominguez/

GitHub: https://github.com/mauigna06

Project: https://github.com/SlicerIGT/SlicerBoneReconstructionPlanner/

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CONTACT