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Utilizzo di una guida CAD-CAM per la preservazione del nervo alveolare inferiore durante le resezioni mandibolari nelle lesioni benigne.Durante le procedure chirurgiche di resezione mandibolare, la preservazione del nervo alveolare inferiore (NAI) è auspicabile nella patologia benigna. In questo studio pilota prospettico, riportiamo la nostra esperienza nell’uso di una dima di taglio customizzata per la rapida preservazione del nervo alveolare inferiore (RICS). La pianificazione chirurgica virtuale della guida di taglio è basata sul modello 3D ottenuto dall’elaborazione dei file DICOM della TC pre-operatoria. Sono stati inclusi nel nostro studio 5 pazienti affetti da patologia mandibolare benigna. Sono stati esteriorizzati in totale 7 NAI. Il tempo medio di esteriorizzazione è stato 23 minuti. Tutte le esteriorizzazioni sono state eseguite con successo e non è avvenuto alcun danneggiamento del fascio neuro-vascolare. Tutti i pazienti hanno mostrato il recupero completo della sensibilità del NAI entro 7 settimane dall’intervento chirurgico. In conclusione, la dima di esteriorizzazione RICS sembrerebbe permettere una più rapida e sicura preservazione del NAI.During surgical procedures involving the mandible, preserving the inferior alveolar nerve (IAN) may be preferable for benign tumours. In this prospective pilot study, we report our experience on the use of a Rapid Inferior Alveolar nerve Customised Salvage (RICS) template. Virtual surgical planning (VSP) of the template is based on a 3D model obtained from the elaboration of DICOM files of the preoperative CT scan. Five patients affected by benign mandibular pathology were included. A total of 7 IANs were exteriorised. The average time of exteriorisation was 23 minutes. All exteriorisations were performed successfully and no damage to the neuro-vascular bundle occurred. All patients showed complete recovery of sensitivity of the IAN within 7 weeks after surgical procedure. In conclusion, RICS template seems to allow faster and safer exteriorisation of the IAN.

Introduction In the present study, our aim was to confirm the role of navigation-guided surgery in reducing the percentage of positive margins in advanced malignant pathologies of the mid-face, by introducing a new volumetric virtual planning method for resection. Materials and methods Twenty-eight patients were included in this study. Eighteen patients requiring surgery to treat malignant midface tumors were prospectively selected and stratified into two different study groups. Patients enrolled in the Reference Points Resection group (RPR – 10 patients) underwent resection planning using the anatomical landmarks on CT scan; patients enrolled in the Volume Resection group (VR – 8 patients) underwent resection using the new volumetric virtual planning method. The remaining 10 patients (Control group) were treated without the use of a navigation system. Results In total, 127 margins were pathologically assessed in the RPR group, 75 in the VR group, and 85 in the control group. In the control group, 16% of the margins were positive, while in the RPR group the value was 9%, and in the VR group 1%. Conclusions The volumetric tumor resection planning associated to the navigation-guide resection appeared to be an improvement in terms of control of surgical margins in advanced tumors involving the mid-face.