Résumé
Purpose: Mandibular reconstruction using fibula free flap is a challenging surgical procedure. To assist osteotomies, computer assisted surgery (CAS) can be used. Nevertheless, precise registration is required and often necessitates anchored markers that disturb the patient and clinical flow. This work proposes a new contactless surface-based method adapted to featureless anatomies such as fibula to achieve a fast, precise and reproducible registration. Methods: Preoperatively, a CT-scan of the patient is realized and osteotomies are virtually planned. During surgery, a structured-light camera digitizes the fibula. The obtained intraoperative point cloud is coarsely registered with the preoperative model using 3 points defined in the CT-scan and located on the patient's bone with a laser beam. Then, a fine registration is performed using an ICP algorithm. The registration accuracy was evaluated comparing the position of points engraved in a 3D-printed fibula with their position in the registered model and evaluating resulting osteotomies. Accuracy and execution time were compared to a conventional stylus-based registration method. The work was validated in-vivo. Results: The experiment performed on a 3D-printed model showed that execution time is equivalent to surface-based registration using a stylus, with a better accuracy (mean TRE of 0.88 mm vs 1.26 mm using stylus) and guarantee good osteotomies. The preliminary in-vivo study proved the feasibility of the method. Conclusion: The proposed contactless surface-based registration method using structured-light camera gave promising results in terms of accuracy and execution speed and should be useful to implement CAS for mandibular reconstruction.