Grant: Collaborative Health Research Projects (NSERC partnered)

Advanced head and neck cancers involving the jaw often require aggressive removal of the diseased parts of the jaw. Reconstruction of the resulting defect is typically done with patient donor bone from the fibula. The singular, typically linear, piece of donor bone is cut into pieces and shaped to best recreate occlusion with a curvilinear shape. This process involves multiple complex osteotomies, since the accuracy of the reconstruction significantly impacts cosmetic and functional outcomes. Traditional intraoperative execution of this procedure is challenging, time consuming and may not provide effective eating and speaking outcomes. Recently, some healthcare centers, including our own, have adopted a pre-planning approach. Patient CT scans are used to create a digital 3D model, which can be manipulated to a target reconstruction. Then surgical cutting guides are 3D printed to replicate the plan intraoperatively. This process has been demonstrated to save OR time and lead to higher quality reconstructions. We have developed our own in-house version of this program has been in use for over a year at VGH. However, this approach still has flaws: current planning techniques only seek to optimize occlusion, and do not consider functional outcomes such as chewing, speaking and swallowing. Additionally, these surgeries rely on the optimal resection planes not changing between the day of planning and the day of surgery. We seek to create an Intraoperative Surgical Tools for Advanced Reconstruction Workflow (ISTAR) that solves both of these problems. Rather than planning the case days or even weeks prior to surgery and leaving time for the tumour to grow, ISTAR will enable planning based on intraoperatively defined cutting planes. We will create image guided tools that will facilitate interfacing between the digital and physical space. The planning will be based on advanced functional modeling that can simulate functional outcomes, leading to better reconstructions.