(49) Integrating VSP and Patient Specific Cutting Guide for Intraoral Resection of a Giant Coronoid Process Osteoma

Abstract: An osteoma is a slow-growing, benign tumor that is very uncommon in the maxillofacial region and can cause functional limitations. It can be central, peripheral, or extra-skeleton in origin, exhibiting trabecular and cortical bone as part of its histology. Some osteomas can grow very large, making their removal challenging in confined spaces. Multiple factors need to be considered in the removal of these benign lesions to minimize the morbidity and mortality from the procedures. We present a case of a 65-year-old male referred for evaluation of a right mandible coronoid process lesion. A unique aspect of this presentation was the lack of any functional limitation in his maximal incisal opening despite its size and proximity to the zygomatic arch and anterior skull base. Medical-grade CT maxillofacial was obtained for virtual surgical planning (VSP). A CT angiogram of the head and neck also was obtained to establish the relationship of any major vessels around and associated with the lesion. Treatment included complete surgical excision, with final pathology confirming the mass to be an osteoma. This case report highlights the utilization of virtual surgical planning, patient-specific cutting guide and piezo instrumentation to guide the resection of a giant mandibular osteoma involving the coronoid process close to the anterior skull base through a intraoral approach. The cutting guide planned with VSP significantly improved the resection accuracy, reducing the intraoperative time, decreasing the potential for major intraoperative complications and improving patient outcome. ReferencesSayan, N. B., Uçok, C., Karasu, H. A., & Günhan, O. (2002). Peripheral osteoma of the oral and maxillofacial region: a study of 35 new cases. Journal of Oral and Maxillofacial Surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 60(11), 1299–1301. https://doi.org/10.1053/joms.2002.35727Larrea-Oyarbide, N., Valmaseda-Castellón, E., Berini-Aytés, L., & Gay-Escoda, C. (2008). Osteomas of the craniofacial region. Review of 106 cases. Journal of Oral Pathology & Medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 37(1), 38–42. https://doi.org/10.1111/j.1600-0714.2007.00590.x

Figure 1: Patient Specific Cutting Guide - VSP
Figure 2: Patient Specific Cutting Guide - IntraOp
Figure 3: Right Mandible Osteoma - Specimen