Accuracy of virtual surgical planning for segmental mandibular resections: A comparison of connected resection guides versus separate resection guides in a cadaver study

Mandibular reconstruction after oncologic resection is challenging owing to functional and esthetic demands. Three-dimensional virtual surgical planning enhances surgical predictability and precision. This study compared separate versus connected mandibular resection guides, hypothesizing that connected guides achieve more precise alignment with the virtual surgical plan, thereby improving resection accuracy and reconstruction outcomes. Twelve cadaver heads were used to evaluate the 2 guides. Preoperative computed tomography (CT) scans were used to create a virtual surgical plan. The resections were then performed either using the connected or separate guide design. Post-operative CT scans were conducted to evaluate the accuracy of the guide positioning and resection planes. The connected guide group showed significantly better translational alignment, with a median error of 0.7 mm versus 2.1 mm in the separate guide group (p = 0.02). However, the differences in rotational alignment (pitch and yaw) of the guides and subsequent resections planes were not statistically significant. The separate guide group exhibited a broader range of errors. In conclusion, the connected guide design demonstrated significantly better translation accuracy and narrower error ranges, making it more predictable and reliable. Although separate guides offer greater flexibility, their higher variability in positioning makes them less consistent for achieving precise resections.