(1) Background: A decrease in operative time can not only improve patient outcomes through a reduction in the risk of developing complications but can also result in cost savings. The aim of this study is to determine whether there an intraoperative time gain can be achieved by using the preoperative virtual planning of mandibular reconstruction using a free fibula flap compared with freehand plate bending and osteotomies. (2) Methods: A retrospective comparative study was carried out in the Oral and Maxillofacial Department of La Paz University Hospital, Madrid, Spain. The study compared 18 patients in the CAD/CAM group with 19 patients in the conventional freehand group. A comparison was made between the total surgical time, the comorbidities, and the hospital stay. The resource consumption was estimated using a cost analysis. (3) Results: Although CAD/CAM was a statistically more expensive procedure in the perioperative phase, no significant differences were observed in total health care costs between the two groups. There was a non-significant trend towards an increase in complications with conventional reconstruction plates compared to patient-specific plates (PSI). (4) Conclusions: CAD/CAM technology and a 3D printed cutting guide offer a significantly shorter surgical time, which is associated with a reduction in hospital days, PACU days, and complications. The cost of CAD/CAM technology is comparable to that of the conventional freehand technique.

(1) Background: In recent years, three-dimensional (3D) templates have replaced traditional two-dimensional (2D) templates as visual guides during intra-operative carving of the autogenous cartilage framework in microtia reconstruction. This study aims to introduce a protocol of the fabrication of patient-specific, 3D printed and sterilizable auricular models for autogenous auricular reconstruction. (2) Methods: The patient’s unaffected ear was captured with a high-resolution surface 3D scan (Artec Eva) and post-processed in order to obtain a clean surface model (STL format). In the next step, the ear was digitally mirrored, segmented and separated into its component auricle parts for reconstruction. It was disassembled into helix, antihelix, tragus and base and a physical model was 3D printed for each part. Following this segmentation, the cartilage was carved in the operating room, based on the models. (3) Results: This segmentation technique facilitates the modeling and carving of the scaffold, with adequate height, depth, width and thickness. This reduces both the surgical time and the amount of costal cartilage used. (4) Conclusions: This segmentation technique uses surface scanning and 3D printing to produce sterilizable and patient-specific 3D templates.

The anatomical location of certain lesions can be a difficulty when locating them intraoperatively. The use of surgical navigation allows anatomical structures to be located with great precision. However, there are technical difficulties with its use in mandibular surgery. Three-dimensional (3D) printing has established itself as a definitive tool in the generation of biomodels for diagnosis and treatment as well as implantable devices. Some applications, little explored today, have to do with the use of 3D-printed devices for the localization of hard-to-reach lesions. To determine the position of mandibular bone lesions, we propose using 3D printed localization guides manufactured “in-house,” using freely licensed design programs (software) to design them, and made of biocompatible resins. This improves surgical precision and reduces morbidity from the intervention. 3D planning models are shown and segmented using open-source software (3D Slicer) using imported conventional computed tomography data. Digital component modification is possible with free software (Autodesk Meshmixer) to arrange precise osteotomy cuts for lesion localization. With the help of customized cutting guides, intraoperative placement is precise. These are created utilizing a fused filament manufacturing 3D printer and polylactic acid. Three localization guides were successfully completed, resulting in improved surgical accuracy and reduced surgical morbidity. The use of 3D surgical guides in cases of mandibular lesions in difficult or delicate locations saves the need for navigation, requires less surgical time, does not require splints or reference stars.

Physicians are used to having complementary studies that help us in all phases of our work. In the maxillofacial surgery field the most commonly used tests are radiological tests (CT and NMR) and digital clinical photographs. In recent years, the concept of 3D surgery has been developed and consists of the use of 3D technology applied to surgery. 3D surgery allows us to move from on-site planning of the surgery to pre-surgical planning, with a simulation and preview of the result at the bone and soft tissue level. Radiological studies are of very limited use in soft tissue planning and digital photography is two-dimensional and dependent on patient positioning. The use of the surface scanner solves these limitations as it computes the spatial coordinates of the patient's anatomical surface in order to create a 3D digital model.

Background: Gardner’s syndrome (GS) is an autosomal dominant inherited disease that predisposes individuals to a high risk of developing colonic polyposis, colorectal cancers, and multiple maxillofacial hard and soft tissue tumors. Odontogenic myxoma (OM) is classified as a benign locally invasive tumor of the jaws. It is estimated as the third most frequent odontogenic tumor, between 2% and 5% of cases. In the present study, we report and discuss a case of odontogenic myxoma in a 13-month-old patient diagnosed with GS. Case Presentation: A 13-month-old patient was referred to our department with a fast-growing tumor located in the left nasomaxillary region and a family history of GS. Computed tomography imaging of the face with contrast was performed, showing a well-defined, insufflating osteolytic lesion located in the left nasomaxillary region, extending up to the inferior orbital wall. The tumor was biopsied, and he was diagnosed with OM. Radical resection was performed and the anterior maxilla wall was reconstructed with PDS. Subsequently, germline mutation in APC gene was found in the patient. Follow up was carried out up to seven years after the intervention, an excellent cosmetic outcome and no signs of recurrence were observed in the area. Conclusion: Oral and maxillofacial surgeons must be aware of the different lesions which may be associated with systemic syndromes. OM may be first manifestation related to early diagnosis of GS and, lastly, colon cancer. OM could be an indication of referring to genetic counselling to determine the presence of the mutation in patients with or without familiar history.