Barriers and Facilitators of Three-Dimensional Surgical Guides in Mandibular Reconstruction in Africa: A Scoping Review

Résumé fourni par la source

The mandible is susceptible to a spectrum of pathological conditions, including oral squamous cell carcinoma (OSCC), odontogenic tumours, osteoradionecrosis, and traumatic injuries. In sub-Saharan Africa, head and neck squamous cell carcinoma represents a growing proportion of cancer burden, often presenting at advanced stages owing to delayed diagnosis and limited specialist access.1 Such advanced presentations frequently necessitate segmental or hemi-mandibulectomy, making quality reconstructive surgery a critical determinant of patient survival, functional restoration, and quality of life. Mandibular defects profoundly compromise mastication, swallowing, speech, and facial aesthetics. Without adequate reconstruction, the resultant functional and psychosocial sequelae are severe. Traditional mandibular reconstruction relies on intraoperative tactile assessment and analogue bending of reconstruction plates, a technique prone to positional inaccuracies and prolonged ischaemia times. The advent of virtual surgical planning (VSP) and 3D-printed surgical guides has fundamentally altered the reconstructive workflow. Preoperative CT-derived digital models allow surgeons to plan osteotomies virtually, fabricate patient-specific cutting and positioning guides, and pre-contour fixation hardware, all before the patient enters the operating theatre. Systematic reviews and meta-analyses consistently demonstrate that VSP-guided reconstruction significantly reduces operative and ischaemic times, improves osteotomy accuracy, and optimises occlusal and aesthetic outcomes compared with conventional freehand methods. Despite the proven clinical benefits of 3D surgical guides, their integration into African surgical practice lags considerably behind that of high-income countries. A 2025 scoping review on pharmaceutical 3D printing in Africa found that only two African countries had produced original research on 3D printing, with 50% of studies receiving no dedicated funding, underscoring the profound research-to-implementation gap that characterises additive manufacturing in resource-constrained African settings. No scoping review has yet systematically mapped the evidence on barriers and facilitators specific to 3D surgical guide adoption in mandibular reconstruction in African settings

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