Computer Planning and Intraoperative Navigation in Cranio-Maxillofacial Surgery
ABSTRACT Preoperative computer design and stereolithographic modeling combined with intraoperative navigation provide a useful guide for and possibly more accurate reconstruction of a variety of complex cranio-maxillofacial deformities. Although probably not necessary for routine use, the author's early experience confirms that of other surgeons with more than a decade of experience: computer-assisted surgery is indicated for complex posttraumatic or postablative reconstruction of the orbits, cranium, maxilla, and mandible; total temporomandibular joint replacement; orthognathic surgery; and complex dental/craniofacial implantology. Further study is needed to provide outcomes data and cost-benefit analyses for each of these indications.
International Journal of Computer Assisted Radiology and Surgery; 06/2014
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ABSTRACT: Orthognathic surgery has traditionally been performed using stone model surgery. This involves translating desired clinical movements of the maxilla and mandible into stone models that are then cut and repositioned into class I occlusion from which a splint is generated. Model surgery is an accurate and reproducible method of surgical correction of the dentofacial skeleton in cleft and noncleft patients, albeit considerably time-consuming. With the advent of computed tomography scanning, 3D imaging and virtual surgical planning (VSP) have gained a foothold in orthognathic surgery with VSP rapidly replacing traditional model surgery in many parts of the country and the world. What has yet to be determined is whether the application and feasibility of virtual model surgery is at a point where it will eliminate the need for traditional model surgery in both the private and academic setting. Traditional model surgery was compared with VSP splint fabrication to determine the feasibility of use and accuracy of application in orthognathic surgery within our institution. VSP was found to generate acrylic splints of equal quality to model surgery splints in a fraction of the time. Drawbacks of VSP splint fabrication are the increased cost of production and certain limitations as it relates to complex craniofacial patients. It is our opinion that virtual model surgery will displace and replace traditional model surgery as it will become cost and time effective in both the private and academic setting for practitioners providing orthognathic surgical care in cleft and noncleft patients.02/2015; 3(2):e307. DOI:10.1097/GOX.0000000000000184
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ABSTRACT: Objectives/Hypothesis:To evaluate the use of computer‐assisted design and rapid prototype modeling to improve the speed and accuracy of mandibular reconstruction. Study Design:Case‐control study. Methods:Between 2005 and 2011, 38 subjects underwent fibula free flap mandibular reconstruction using computer‐assisted design and rapid prototype modeling. Titanium plates were prebent using the models prior to surgery. Direct plate bending on the native mandible to accurately restore occlusion would not have been possible in 11 patients with exophytic tumors, nine patients with pathologic fractures, and 10 patients with a prior segmental mandibulectomy. Computer‐generated cutting guides were utilized to facilitate fibular osteotomies. Results:The mean operative time for subjects was 8.8 ± 1.0 hours compared to the mean operative time defect‐matched control group, for whom computer‐assisted design and models were not used, of 10.5 ± 1.4 hours (P = .0006). Comparison of the preoperative and postoperative mandibles demonstrated that the mean change in position of selected bony landmarks (condyles, gonions, and gnathion) was less in the subject group than in the control group (4.11 ± 3.09 mm vs. 6.92 ± 5.64 mm, respectively; P = .001) Comparison of postoperative mandibles with preoperative virtual plans showed a mean deviation of 2.40 ± 2.06 mm from planned fibular segment lengths and 3.51 ± 2.69° from planned angles between fibular segments. Conclusions:Computer‐assisted design and rapid prototype modeling have the potential to increase the speed and accuracy of mandibular reconstruction. We believe these technologies are particularly useful for cases in which the original architecture of the mandible has been distorted or destroyed. Laryngoscope, 2013The Laryngoscope 03/2013; 123(3). DOI:10.1002/lary.23717 · 2.03 Impact Factor