Computer Planning and Intraoperative Navigation in Cranio-Maxillofacial Surgery
Oral and Maxillofacial Surgery Service, Legacy Emanuel Hospital and Health Center, Head and Neck Surgical Associates, Oregon Health & Science University, 1849 NW Kearney, Suite 300, Portland, OR 97209, USA. Oral and maxillofacial surgery clinics of North America
(Impact Factor: 0.58).
02/2010; 22(1):135-56. DOI: 10.1016/j.coms.2009.10.010
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.
Available from: Erwin Keeve
- "Computer-assisted surgery has gained increasing importance in the field of craniomaxillofacial surgery, as the technologies offer improved possibilities for preoperative planning, surgical transfer and quality control of the procedures [1, 2]. Within the special field of orthognathic surgery, preoperative model surgery and the subsequent manufacture of one or more surgical splints for the transfer of the surgical planning has been the gold standard until now . "
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Within the domain of craniomaxillofacial surgery, orthognathic surgery is a special field dedicated to the correction of dentofacial anomalies resulting from skeletal malocclusion. Generally, in such cases, an interdisciplinary orthodontic and surgical treatment approach is required. After initial orthodontic alignment of the dental arches, skeletal discrepancies of the jaws can be corrected by distinct surgical strategies and procedures in order to achieve correct occlusal relations, as well as facial balance and harmony within individualized treatment concepts. To transfer the preoperative surgical planning and reposition the mobilized dental arches with optimal occlusal relations, surgical splints are typically used. For this purpose, different strategies have been described which use one or more splints. Traditionally, these splints are manufactured by a dental technician based on patient-specific dental casts; however, computer-assisted technologies have gained increasing importance with respect to preoperative planning and its subsequent surgical transfer.
: In a pilot study of 10 patients undergoing orthognathic corrections by a one-splint strategy, two final occlusal splints were produced for each patient and compared with respect to their clinical usability. One splint was manufactured in the traditional way by a dental technician according to the preoperative surgical planning. After performing a CBCT scan of the patient’s dental casts, a second splint was designed virtually by an engineer and surgeon working together, according to the desired final occlusion. For this purpose, RapidSplint®, a custom-made software platform, was used. After post-processing and conversion of the datasets into .stl files, the splints were fabricated by the PolyJet procedure using photo polymerization. During surgery, both splints were inserted after mobilization of the dental arches then compared with respect to their clinical usability according to the occlusal fitting.
Using the workflow described above, virtual splints could be designed and manufactured for all patients in this pilot study. Eight of 10 virtual splints could be used clinically to achieve and maintain final occlusion after orthognathic surgery. In two cases virtual splints were not usable due to insufficient occlusal fitting, and even two of the traditional splints were not clinically usable. In five patients where both types of splints were available, their occlusal fitting was assessed as being equivalent, and in one case the virtual splint showed even better occlusal fitting than the traditional splint. In one case where no traditional splint was available, the virtual splint proved to be helpful in achieving the final occlusion.
In this pilot study it was demonstrated that clinically usable splints for orthognathic surgery can be produced by computer-assisted technology. Virtual splint design was realized by RapidSplint®, an in-house software platform which might contribute in future to shorten preoperative workflows for the production of orthognathic surgical splints.
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ABSTRACT: Der aktuelle Stand von klinischer Untersuchungsmethodik und bildgebender Diagnostik wurde in Teil 1 dieser Übersicht besprochen. Jetzt sollen die chirurgischen Behandlungsprinzipien bei Frakturen des Mittelgesichtsskeletts und der Orbitawände von der Initialversorgung bis zur definitiven Therapie synoptisch und an Hand repräsentativer Fallbeispiele dargestellt werden. Neuigkeiten und Fortschritte ergeben sich durch die Auswahl limitierter anstelle ausgedehnter operativer Zugangswege, durch Verbesserungen bei der Reposition der Fragmente, die zunehmende Standardisierung der Osteosynthesen in Bezug zu den Pfeilerstrukturen, die Verwendung präformierter Titanmeshes und insbesondere bei komplexen Frakturmustern durch die Kontrolle der exakten anatomischen Wiederherstellung durch Endoskopie, Navigation und intraoperative Schnittbildverfahren. Um Ptosiseffekte im Wangen- und Nasolabialbereich zu reduzieren und um das vormalige Aussehen und die Gesichtsästhetik wieder zu erreichen, bieten sich resorbierbare Vielpunktfixationssysteme an.
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ABSTRACT: Numerical diffraction coefficients (NDC) of a multiple layer dielectrics coated conducting strip for TE and TM waves incidence are obtained by using the concepts of polarized electric and magnetic currents and Hurst's (1992) method. The scattering properties of a multiple layer dielectric coated conducting strip are researched, and some meaning results are obtained
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