Guided tongue reconstruction: Feasibility analysis of additively manufactured surgical toolkit on a silicone tongue model

OBJECTIVE: Virtual Surgical Planning (VSP) for tongue reconstruction promises patient-specific optimizations, but its utility is limited by the difficulty of translating a digital plan to a deformable organ. This study evaluated the feasibility and anatomical accuracy of a patient-specific, additively manufactured surgical toolkit through benchtop experiments on soft-tissue phantoms. METHOD: Four distinct hemiglossectomy reconstruction cases were planned using VSP and executed on patient-specific silicone tongue phantoms. The guided workflow, performed by an independent surgeon, incorporated: (1) resection marking guide, (2) intraoperative volume inspection guide, (3) donor flap harvesting guide with decoupled planar and volumetric control, and (4) marker-guided flap insetting. High-resolution 3D surface scans were used to quantify anatomical fidelity by measuring the surface deviation between the pre- and post-procedure scans. RESULTS: All four guided reconstructions were successfully completed. Mean surface deviation was 0.76-1.26 mm, and the 99th percentile (robust maximum) ranged 3.37-4.13 mm. This accuracy is comparable to that reported for established patient-specific osseous reconstructions. The operating surgeon found the toolkit intuitive, the workflow sequencing clear, and the volumetric inspection step practical. CONCLUSION: This benchtop study demonstrates that a patient-specific, guided surgical toolkit can feasibly and reliably translate tongue VSP into accurate reconstructions on soft-tissue phantoms. By introducing a volume feedback mechanism and decoupling the flap's planar shape from its volume, the system provides adaptive guidance that is both geometry- and volume-aware. These findings support progression to cadaveric studies and early clinical validation to evaluate overbulking strategies, intraoperative adaptability, and correlation with functional outcomes.