Does the Use of a Wrap in Three-Dimensional Surgical Planning Influence the Bony Margin Status of Benign and Malignant Neoplasms of the Oral, Head and Neck Region? An Initial Investigation

Purpose Three-dimensional surgical planning (3-DSP) is becoming commonplace in the management of benign and malignant disease for oral and maxillofacial surgery practice within the last decade.1 In pathologic resections of the head and neck cysts and tumors in particular, a virtual wrap is used to delineate the tumor resection margin. However, there has yet to be a study in regard to the accuracy of this wrap and its effect on bony margin status. This study aims to discuss our experiences with the use of wraps created with 3-DSP and explore the accuracy of the wrap for margin status. We hypothesize that the use of a wrap is a predictable method to obtain negative bony margins. Furthermore, we explore the emerging challenges in the use of this technology specific to pathologic resection margins. Methods This is a retrospective chart review. The study included patients over the age of 18 (range, 18-99) treated at 2 centers, John Peter Smith Health Network Oral and Maxillofacial Surgery and Parkland/UTSW Oral and Maxillofacial Surgery. We included patients who obtained a 3-DSP for pathology of the head and neck involving the bone and who also obtained a virtual wrap for bony margins. There were no specific exclusion criteria. There were no exclusions due to racial, ethnic, or gender groups. Data accessed ranged from July 1, 2017, to May 1, 2020. Patient data were collected for processing via multilevel protected electronic health record system (Epic). Once the data were gathered, the identifiable link was destroyed and data were anonymized. Analysis was completed via Excel. Results There were 39 cases, but we excluded 1 that required intraoperative adjustment and thus did not follow preplanned case. One out of the 38 cases involved a bony margin (2.6%; 95% confidence interval, 0.1%, 13.8%). Table 1 defines the pathology. We classified SCC (squamous cell carcinoma) and low-grade osteosarcoma as malignant cases and the rest as benign. There were 16 malignant cases (42%) and 22 benign cases (58%). When stratified by pathology, 1 out of the 16 malignant cases (6.3%; 95% confidence interval, 0.2%, 30%) and 0 out of the 22 benign cases (95% confidence interval, 0%, 15.4%) had a positive margin. Conclusion Three-dimensional surgical planning with wrap margins is a predictable method to obtain negative bony margins in benign and malignant disease of the maxillofacial complex. The surgeon must be prudent to ensure accurate margin delineation by engineers before simulated wrap creation or resection.