A novel simulation module for segmental mandibulectomy and mandible reconstruction using 3D models

Aarti Agarwal; Lauren Schlegel; Michele Fiorella; Jared M Goldfarb; Swar Vimawala; Dominick J Gadaleta; Robert S Pugliese; Bon Ku; James Kearney; Joseph M Curry; Richard A Goldman

doi:10.1016/j.amjoto.2023.103963

A novel simulation module for segmental mandibulectomy and mandible reconstruction using 3D models

Am J Otolaryngol. 2023 Nov-Dec;44(6):103963. doi: 10.1016/j.amjoto.2023.103963. Epub 2023 Jun 22.

Affiliations

¹ Thomas Jefferson University Hospital, Department of Otolaryngology- Head & Neck Surgery, Philadelphia, PA, USA. Electronic address: aarti.agarwal@jefferson.edu.
² Thomas Jefferson University Hospital, Health Design Lab, USA.
³ Thomas Jefferson University Hospital, Department of Otolaryngology- Head & Neck Surgery, Philadelphia, PA, USA.
⁴ Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.

PMID: 37406412
DOI: 10.1016/j.amjoto.2023.103963

Abstract

Introduction: Mandibular resection and reconstruction are common but complex procedures in head and neck surgery. Resection with adequate margins is critical to the success of the procedure but technical training is restricted to real case experience. Here we describe our experience in the development and evaluation of a mandibular resection and reconstruction simulation module.

Methods: 3D printed (3DP) models of a mandible with a pathologic lesion were developed from imaging data from a patient with an ameloblastoma. During an educational conference, otolaryngology trainees participated in a simulation in which they reviewed a CT scan of the pathologic mandible and then planned their osteotomies before and after handling a 3DP model demonstrating the lesion. The adequacy of the osteotomy margins was assessed and components of the simulation were rated by participants with pre- and post-training surveys.

Results: 52 participants met criteria. After reviewing the CT scan, 34 participants (65.3 %) proposed osteotomies clear of the lesion. This proportion improved to 48 (92.3 %, p = 0.001) after handling the 3D model. Among those with initially adequate margins (n = 33), 45.5 % decreased their margins closer to the ideal, 27.2 % made no revision, 21.2 % widened their margins. 92 % of participants found the simulation beneficial for surgical planning and technical training. After the exercise, the majority of participants had increased confidence in conceptualizing the boundaries of the lesion (69.2 %) and their abilities to ablate (76.5 %).

Conclusions: The structured mandibulectomy simulation using 3DP models was useful in the development of trainee experience in segmental mandible resection.

Lay summary: This study presents the first mandibulectomy simulation module for trainees with the use of 3DP models. The use of a 3DP model was also shown to improve the quality of surgical training.

Keywords: 3D printing; Mandibulectomy; Medical education; Otolaryngology; Surgical education.

MeSH terms

Humans
Mandible / diagnostic imaging
Mandible / surgery
Mandibular Osteotomy
Mandibular Reconstruction*
Osteotomy / methods
Plastic Surgery Procedures*