A cost effective custom dental guard for transoral robotic surgery.

There has been an increasing use of transoral robotic surgery (TORS) as studies have demonstrated its effectiveness for treating a variety of conditions. Postoperative complications of TORS include hemorrhage, tooth injury, dehydration, aspiration pneumonia, and prolonged percutaneous endoscopic gastrostomy (PEG) tube dependency. Dental injury has not been adequately discussed although it has been reported to be a common complication in multiple studies, with repair costs ranging from $700 to $3000 and average time spent to address the injury estimated to be 2.6 h. The incidence of this injury is likely due to the standard dental guard, which is not customizable to the patient's teeth, therefore, not optimal for dental protection. Many alternative dental guards have been proposed to reduce the rate of dental injury. However, the previously presented alternatives are high cost, not time efficient, or have the potential for molding error rendering them less effective. We propose a guard that is cheap, time efficient, and effective in preventing dental injury. A retrospective study of 124 patients who underwent TORS over a period of 6 years with the proposed dental guard was conducted. No dental complications were observed in any of these cases. A cost analysis showed that this guard saved $4526.64 for our relatively small patient cohort. This guard can save money, time, and stress for both the patient and the surgeon, as well as reduce the number and severity of medico-legal claims related to perioperative dental injury.