Improving accuracy of pterygoid plate resection using real-time navigated piezoelectric surgery and a three-dimensionally printed guide.

Surgical resection of the pterygoid plate is technically demanding, with risks of inadequate margins and complications. This preclinical study evaluated the accuracy of two novel technologies for improving pterygoid plate osteotomy: a real-time navigated piezo-electric system (RNPS) and a custom surgical guide. An optical navigation system was integrated with a piezo-electric instrument (RNPS), and a patient-specific surgical guide was three-dimensionally printed. The positional and rotational accuracy of both systems was evaluated by performing pterygoid plate resections on 20 phantom models and compared against a conventional freehand technique. Both technologies demonstrated significantly higher accuracy than the conventional approach. The RNPS group showed a mean positional error of 0.92 ± 0.59 mm, significantly lower than the control mean of 2.65 ± 1.07 mm (P < 0.05), and achieved better rotational accuracy. The surgical guide also resulted in a significantly lower mean positional error compared to the control group (1.18 ± 0.95 mm vs 2.75 ± 0.92 mm; P < 0.05). In this preclinical setting, both the RNPS and the custom surgical guide significantly improved the accuracy of pterygoid plate resection. These technologies show strong potential to enhance surgical precision and safety, which may lead to improved oncological outcomes in complex maxillofacial surgery.