Virtual planning for craniomaxillofacial surgery – 7 Years of experience (original) (raw)
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Virtual Surgical Planning in Craniofacial Surgery
Seminars in Plastic Surgery, 2014
The complex three-dimensional (3D) anatomy of the craniofacial skeleton increases the complexity of reconstructing this region and creates a challenge when attempting to achieve excellent aesthetic outcomes. Traditionally, reconstructive surgery for conditions such as craniosynostosis and complex facial malformations has relied on the surgeon's subjective assessment of form and aesthetics preoperatively and intraoperatively, with intraoperative decision making based on such factors as the location of bone cuts and the shape of bone segments for craniofacial reconstruction. Although good outcomes can and are often achieved, the highly subjective nature of this process results in variable surgeon-specific outcomes and can also lead to prolonged surgical time.
A Web-Based, Integrated Simulation System for Craniofacial Surgical Planning
2009
Background: Advances in computing over the last 10 years have rapidly improved imaging and simulation in health care. Implementation of three-dimensional protocols and image fusion techniques are moving diagnosis, treatment planning, and teaching to a next-generation paradigm. In addition, decreasing cost and increasing availability make generalized use of these techniques possible. Methods: In this article, the authors present a Web-based, integrated simulation system for craniofacial surgical planning and treatment. Image fusion technology was utilized to create a realistic virtual image that can be manipulated in real time. The resultant data can then be shared over the Internet by distantly located practitioners. Results: Initial use of this system proved to be beneficial from a planning standpoint and to be accurate as to the reliability of landmark identification. Additional case studies are needed to further document the results of actual surgical simulation. Conclusion: This technology presents significant advantages in surgical planning and education, both of which can improve patient safety and outcomes. (Plast.
Computer Assisted Planning in Cranio-Maxillofacial Surgery
Journal of Computing and Information Technology, 2006
In cranio-maxillofacial surgery physicians are often faced with the reconstruction of massively destroyed or radically resected tissue structures caused by trauma or tumours. Also corrections of dislocated bone fragments up to the complete modeling of facial regions in cases of complex congenital malformations are common tasks of plastic and reconstructive surgeons. With regard to the individual anatomy and physiology, such procedures have to be planned and executed thoroughly in order to achieve the best functional as well as an optimal aesthetic rehabilitation. On this account a computer-assisted modeling, planning and simulation approach is presented that allows for preoperative assessment of different therapeutic strategies on the basis of three-dimensional patient models. Bone structures can be mobilized and relocated under consideration of anatomical and functional constraints. The resulting facial appearance is simulated via finite-element methods on the basis of a biomechanical tissue model, and visualized using high quality rendering techniques. Such an approach is not only important for preoperative mental preparation, but also for vivid patient information, documentation, quality assurance as well as for surgical education and training.
The Future in Craniofacial Surgery: Computer-Assisted Planning
Rambam Maimonides Medical Journal, 2012
Advancements in computers, prototyping, and imaging, especially over the last 10 years, have permitted the adoption of three-dimensional imaging protocols in the health care field. In this article, the authors present an integrated simulation system for craniofacial surgical planning and treatment. Image fusion technology, which involves combining different imaging modalities, was utilized to create a realistic prototype and virtual image that can be manipulated in real time. The resultant data can then be shared over the Internet with distantly located practitioners.
Plastic and Reconstructive Surgery, 2010
Background: Craniofacial surgery can be challenging to teach and learn. To augment the intraoperative learning experience for surgical trainees and to provide a resource for practicing craniofacial surgeons to review uncommonly performed procedures before entering the operating room, a series of threedimensional animations were created encompassing the most commonly performed craniofacial procedures. Methods: Previously created three-dimensional craniofacial digital models were used to create digital animations of craniofacial surgical procedures using Maya 8.5. Digital models were altered systematically within Maya to recreate the ordered steps of each craniofacial procedure. Surgical tools were imported into Maya for use in the animations using computer-aided manufacturing files obtained directly from the manufacturer. Results: Nine craniofacial procedures were animated: genioplasty, bilateral sagittal split osteotomy, intraoral vertical ramus osteotomy, Le Fort I osteotomy, unifocal mandibular distraction, mandibular transport distraction, fronto-orbital advancement with cranial vault remodeling, Le Fort III advancement/ distraction, and monobloc advancement/distraction. All major surgical steps are demonstrated, including exposure, execution of the osteotomy, displacement of the bone composite, and the predicted morphologic changes to the craniofacial contour. Throughout the surgical animation, the view of the surgeon in the operating room is incorporated to reproduce the vantage of the surgeon, and the overlying tissue is rendered transparent to illustrate critical underlying anatomical relationships. Conclusions: The first virtual surgical atlas of craniofacial procedures is presented. These animations should serve as a resource for trainees and practicing surgeons in preparation for craniofacial surgical procedures.
Journal of Oral and Maxillofacial Surgery, 2007
Purpose: The purpose of this study was to establish clinical feasibility of our 3-dimensional computeraided surgical simulation (CASS) for complex craniomaxillofacial surgery. Materials and Methods: Five consecutive patients with complex craniomaxillofacial deformities, including hemifacial microsomia, defects after tumor ablation, and deformity after TMJ reconstruction, were used. The patients' surgical interventions were planned by using the authors' CASS planning method. Computed tomography (CT) was initially obtained. The first step of the planning process was to create a composite skull model, which reproduces both the bony structures and the dentition with a high degree of accuracy. The second step was to quantify the deformity. The third step was to simulate the entire surgery in the computer. The maxillary osteotomy was usually completed first, followed by mandibular and chin surgeries. The shape and size of the bone graft, if needed, was also simulated. If the simulated outcomes were not satisfactory, the surgical plan could be modified and simulation could be started over. The final step was to create surgical splints. Using the authors' computer-aided designing/ manufacturing techniques, the surgical splints and templates were designed in the computer and fabricated by a stereolithographic apparatus. To minimize the potential risks to the patients, the surgeries were also planned following the current planning methods, and acrylic surgical splints were created as a backup plan.
Journal of Oral and Maxillofacial Surgery, 2007
Purpose: The purpose of this prospective multicenter study was to assess the accuracy of a computeraided surgical simulation (CASS) protocol for orthognathic surgery. Materials and Methods: The accuracy of the CASS protocol was assessed by comparing planned outcomes with postoperative outcomes of 65 consecutive patients enrolled from 3 centers. Computergenerated surgical splints were used for all patients. For the genioplasty, 1 center used computergenerated chin templates to reposition the chin segment only for patients with asymmetry. Standard intraoperative measurements were used without the chin templates for the remaining patients. The primary outcome measurements were the linear and angular differences for the maxilla, mandible, and chin when the planned and postoperative models were registered at the cranium. The secondary outcome measurements were the maxillary dental midline difference between the planned and postoperative positions and the linear and angular differences of the chin segment between the groups with and without the use of the template. The latter were measured when the planned and postoperative models Received from the Methodist
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014
Background: Surgical correction of craniosynostosis aims to remodel the cranial vault to achieve a morphology approaching that of age-matched norms. However, current surgical technique is highly subjective and based largely on the surgeon's artistic vision in creating a normal head shape. Here, we present our technique and report our experience with the use of virtual surgery using computer-assisted design (CAD)/computer-assisted manufacturing (CAM) techniques to create a prefabricated template for the planning of osteotomies and the placement of bone segments, to achieve standardised, objective and precise correction of craniosynostosis. Methods: Four patients who underwent cranial vault remodelling (CVR; three metopic synostosis and one sagittal synostosis) underwent virtual surgical planning (VSP) preoperatively using CAD/CAM techniques. VSP allows pre-planning of osteotomies to achieve the desired cranial vault shape. Surgical osteotomies and placement of bone segments were performed intraoperatively based on prefabricated templates. Results: All patients demonstrated markedly improved head shape postoperatively. One patient developed a subdural haematoma 6 weeks postoperatively subsequent to a fall where he hit his head. The haematoma was drained and a soft spot was present in that location 3 months postoperatively. Conclusion: The use of virtual surgery and prefabricated cutting guides allows for a more precise and rapid reconstruction. Surgical osteotomies are pre-planned and rapidly performed using a template, and precise placement of calvarial bone segments is achieved without the need for subjective assessment of the desired calvarial shape. In addition, patients and families have a significantly better understanding of the disease process and anticipated surgery
Three-dimensional planning in craniomaxillofacial surgery
Annals of Maxillofacial Surgery, 2016
Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results. Materials and Methods: We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic). The treatment protocol is exposed step by step from virtual planning, design, and printing of the cutting and positioning guides to patients' outcomes. Conclusions: 3D planning reduces the surgical time and allows predicting possible difficulties and complications. On the other hand, it increases preoperative planning time and needs a learning curve. The only drawback is the cost of the procedure. At present, the additional preoperative work can be justified because of surgical time reduction and more predictable results. In the future, the cost and time investment will be reduced. 3D planning is here to stay. It is already a fact in craniofacial surgery and the investment is completely justified by the risk reduction and precise results.