Computer Assisted Planning in Cranio-Maxillofacial Surgery (original) (raw)
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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.
Archives of Plastic Surgery, 2012
Computer aided design and manufacturing (CAD/CAM) technology today is the standard in manufacturing industry. The application of the CAD/CAM technology, together with the emerging 3D medical images based virtual surgical planning (VSP) technology, to craniomaxillofacial reconstruction has been gaining increasing attention to reconstructive surgeons. This article illustrates the components, system and clinical management of the VSP and CAD/CAM technology including: data acquisition, virtual surgical and treatment planning, individual implant design and fabrication, and outcome assessment. It focuses primarily on the technical aspects of the VSP and CAD/CAM system to improve the predictability of the planning and outcome.
2000
This study presents a computer-assisted planning system for dysgnathia treatment. It describes the process of information gathering using a virtual articulator and how the splints are constructed for orthognathic surgery. The deviation of the virtually planned splints is shown in six cases on the basis of conventionally planned cases. In all cases the plaster models were prepared and scanned using a 3D laser scanner. Successive lateral and posterior-anterior cephalometric images were used for reconstruction before surgery. By identifying specific points on the X-rays and marking them on the virtual models, it was possible to enhance the 2D images to create a realistic 3D environment and to perform virtual repositioning of the jaw. A hexapod was used to transfer the virtual planning to the real splints. Preliminary results showed that conventional repositioning could be replicated using the virtual articulator.
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.
Virtual planning for craniomaxillofacial surgery – 7 Years of experience
Journal of Cranio-Maxillofacial Surgery, 2013
Contemporary computer-assisted surgery systems more and more allow for virtual simulation of even complex surgical procedures with increasingly realistic predictions. Preoperative workflows are established and different commercially software solutions are available. Potential and feasibility of virtual craniomaxillofacial surgery as an additional planning tool was assessed retrospectively by comparing predictions and surgical results. Since 2006 virtual simulation has been performed in selected patient cases affected by complex craniomaxillofacial disorders (n ¼ 8) in addition to standard surgical planning based on patient specific 3d-models. Virtual planning could be performed for all levels of the craniomaxillofacial framework within a reasonable preoperative workflow. Simulation of even complex skeletal displacements corresponded well with the real surgical result and soft tissue simulation proved to be helpful. In combination with classic 3d-models showing the underlying skeletal pathology virtual simulation improved planning and transfer of craniomaxillofacial corrections. Additional work and expenses may be justified by increased possibilities of visualisation, information, instruction and documentation in selected craniomaxillofacial procedures.
A prototype system was developed for the surgery planning involving bone cutting and repositioning of the human mandible as well as the prediction of the facial changes through simulation of the virtual orthognathic surgery. Actual preoperative patient data of Asian ethnicity was used and a computerized facial model was derived. The finite element method (FEM) was employed to accommodate numerical solution for mathematical formulations used for representing material properties of biological tissues. The study also includes the contact analysis of FEM, which predicts the facial changes due to the underlying mandibular repositioning through dependent association in between the bone and the tissue.
Models for Planning and Simulation in Computer Assisted Orthognatic Surgery
Lecture Notes in Computer Science, 2002
Two aspects required to establish a planning in orthognatic surgery are addressed in this paper. First, a 3D cephalometric analysis, which is clinically essential for the therapeutic decision. Then, an original method to build a biomechanical model of patient face soft tissue, which provides evaluation of the aesthetic outcomes of an intervention. Both points are developed within a clinical application context for computer aided maxillofacial surgery.
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.
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