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: 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). · 2.03 Impact Factor
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ABSTRACT: Numerous publications regarding virtual surgical planning protocols have been published, most reporting only one or two case reports to emphasize the hands-on planning. None have systematically reviewed the data published from clinical trials. This systematic review analyzes the precision and accuracy of three-dimensional (3D) virtual surgical planning of orthognathic procedures compared with the actual surgical outcome following orthognathic surgery reported in clinical trials. A systematic search of the current literature was conducted to identify clinical trials with a sample size of more than five patients, comparing the virtual surgical plan with the actual surgical outcome. Search terms revealed a total of 428 titles, out of which only seven articles were included, with a combined sample size of 149 patients. Data were presented in three different ways: intra-class correlation coefficient, 3D surface area with a difference <2mm, and linear and angular differences in three dimensions. Success criteria were set at 2mm mean difference in six articles; 125 of the 133 patients included in these articles were regarded as having had a successful outcome. Due to differences in the presentation of data, meta-analysis was not possible. Virtual planning appears to be an accurate and reproducible method for orthognathic treatment planning. A more uniform presentation of the data is necessary to allow the performance of a meta-analysis. Currently, the software system most often used for 3D virtual planning in clinical trials is SimPlant (Materialise). More independent clinical trials are needed to further validate the precision of virtual planning.International Journal of Oral and Maxillofacial Surgery 04/2014; · 1.52 Impact Factor