Yesterday we did the first case of mandibular reconstruction with fibula free flap using 3D Slicer extension, bone reconstruction planner in Sri Lanka at the department of oral and maxillofacial surgery, faculty of the dental sciences university of Peradeniya. Perhaps this is the first time 3D Slicer was used in Sri Lanka for any surgery. Usually, the fibula surgical cutting guide alone costs around 1000 USDs, and both the resection and cutting guide is around 2000 USD including shipping, which we were getting down from Hong Kong. With this extension now it was developed within premises at fraction of the cost. The surgery was a success and we are hoping to continue the development. Thank you @mau_igna_06 for his enthusiasm and amazing coding abilities and Prof @lassoan for his continued effort in improving this extension.
Hi Manjula. I think our team is great. Thank you logging these results.
I have a few suggestions:
change the title of this post to “Mandibular reconstruction surgery made with Slicer’s BoneReconstructionPlanner extension” (or something you like) to make it easier to discover for other surgeons
add a picture of the Virtual Surgical Planning (the reconstructed mandible) and a picture of each surgicalGuide on the Slicer’s 3D-view
@manjula will post a videotutorial of use of this extension soon. He’ll add a link here when it’s ready.
A branch adding a feature to plan inmediate dental implants and design custom titanium plates to fix the reconstruction is currently on development. When this is achieved we’ll have the stardard of care on mandibular reconstruction for free on opensource software.
Thank you for sharing these with us. We’re truly luckty to have this functionality open-source available for free. If you don’t mind, I had a few follow-up questions.
I am currently working with a few surgeons to look into the possibility of creating a similar software, or add to this software’s feature - the functionality of planning a scapula free-flap mandible reconstruction surgery (instead of fibula).
Do you think this is possible (on slicer OR 3d materialise/ProPlan)? How would you tackle this?
Your insight would mean a lot!
Thank you for your message and very happy to know that BRP is useful for you and the team.
It is certainly possible to use the Scapula instead of the fibula with BRP.
As it is I think you can do this even now even though I have not tried to do that personally. I think i remember @mau_igna_06 saying something about trying this with Scapula or the iliac.
The challenges I see are that,
As it is right with the BRP now is that the cutting will go through the entire width of the scapula uncontrollably. So maybe a way to limit the cut to a certain depth?
Generating the cutting guide because of the shape of the scapula could be a challenge except in the lateral border-only segments.
This script by Mauro could be very useful in your workflow.
Thank you Dear Manjula for your guidance
as well as Maruo for offering your help I am curious whether you were able to achieve the results with scapula as well? (considering the potential difficulties that Manjula has highlighted).
I will try look into this on my own meanwhile - please let me know when you’d be available
I have made a bit of progress with the Scapula software - so far I’ve been able to add the planes to the scapula with the script you’ve shared with me @manjula (many thanks). I think that because scapula recon is more complex, I think adding plane modification feature to the scapula would be quite useful.
My plans now include allowing live updates to the mandible planes upon changes to the scapula planes, as well as adding a 3rd plane to put a limit to the depth of the cut as previously discussed (~20mm max. cut)
Before I progress further, would you guys have any other advice or guidance for me?
Thanks a lot
I am curious whether you were able to achieve the results with scapula as well? (considering the potential difficulties that Manjula has highlighted).
