ABSTRACT Background: Two-dimensional surgical planning does not adequately show the 3D aspect, which is important to assess in the planning of orthognathic surgery (OGS). In the last decade, 3D virtual surgical planning (VSP) has become an advantageous method and may replace conventional planning. Aim: To determine if the experience and implementation of VSP in OGS among professionals in oral and maxillofacial surgery in northern Sweden differs from the literature on the subject. Methods: A questionnaire was created for evaluation of the experience and implementation of VSP and a literature search was conducted through PubMed. Results: Fourteen of 17 respondents answered. Only fifty percent used VSP, even though all respondents were familiar with it. A bigger proportion of respondents would use VSP, but availability and lack of training prevented use. A sample of 33 articles were collected and described 1107 patients undergoing OGS, of which 1083 patients had undergone OGS with incorporation of VSP. Sixty-eight percent underwent bimaxillary surgery, 17 % maxillary surgery and 15 % mandibular surgery. Additionally, 169 patients were treated with genioplasty as well. Conclusion: The experience and implementation of VSP in northern Sweden are both in accordance and discordance with the literature. VSP has the advantage of accurate hard tissue prediction, but the literature describes the need of improvement concerning soft tissue imaging and postoperative assessment in VSP. More studies evaluating the accuracy and reliability of VSP software are needed. Disadvantages of VSP need to be resolved before VSP can replace conventional planning.

Osteoid osteomas are common, painful, osteoblast tumors that frequently present in adolescents and young adults. Surgical management is indicated for cases with associated symptoms, such as headaches, dizziness, diplopia, proptosis, sinusitis, and facial deformity. The authors report a case of a 15-year-old male with an enlarging frontal sinus osteoma. Virtual surgical planning was utilized to design a KLS Martin Resorbable plate for the graft site, as well as a cutting guide for the graft procedure. A split-calvarial bone graft was used to reconstruct the central bony defect in the anterior table of the frontal sinus. Virtual surgical planning sessions were initiated with KLS Martin biomedical engineers to design a graft. Design cutting guides were created for frontal craniotomy, and an interlocking cutting guide was created for the split calvarial bone graft. The graft was harvested from the non-dominant right parietal hemisphere to best match the curvature of the frontal bone. Post-operatively, the patient has not had any complications to date. This procedure proves to be a valuable consideration for the surgical treatment of pediatric osteomas.

Background: Sophisticated guided surgery has not been implemented into total joint replacement-surgery (TJR) of the temporomandibular joint (TMJ) so far. Design and in-house manufacturing of a new advanced drilling guide with vector and length control for a typical TJR fossa component are described in this in vitro study, and its accuracy/utilization was evaluated and compared with those of intraoperative real-time navigation and already available standard drilling guides. Methods: Skull base segmentations of five CT-datasets from different patients were used to design drilling guides with vector and length control according to virtual surgical planning (VSP) for the TJR of the TMJ. Stereolithographic models of the skull bases were printed three times for each case. Three groups were formed to compare our newly designed advanced drilling guide with a standard drilling guide and drill-tracking by real-time navigation. The deviation of screw head position, screw length and vector in the lateral skull base have been evaluated (n = 72). Results: There was no difference in the screw head position between all three groups. The deviation of vector and length was significantly lower with the use of the advanced drilling guide compared with standard guide and navigation. However, no benefit in terms of accuracy on the lateral skull base by the use of real-time navigation could be observed. Conclusion: Since guided surgery is standard in implant dentistry and other CMF reconstructions, this new approach can be introduced into clinical practice soon, in order to increase accuracy and patient safety.