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Oley MH, Oley MC, Sukarno V, Faruk M. Advances in Three-Dimensional Printing for Craniomaxillofacial Trauma Reconstruction: A Systematic Review. J Craniofac Surg 2024:00001665-990000000-01748. [PMID: 38958985 DOI: 10.1097/scs.0000000000010451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
Craniomaxillofacial (CMF) fractures present significant challenges for plastic surgeons due to their intricate nature. Conventional methods such as autologous bone grafts have limitations, necessitating advancements in reconstructive surgery techniques. This study reviewed the use of three-dimensional printing for CMF trauma reconstruction using human studies. A systematic search of PubMed, EMBASE, and Google Scholar was conducted in February 2024 for case reports, case series, and clinical trials related to CMF trauma reconstruction using three-dimensional printing technology. The authors' systematic review included 20 studies and a total of 170 participants with CMF bone defects. In general, the authors observed low bias risk in analyzed case reports and series, serious bias risk in nonrandomized controlled trials, and moderate bias risk in randomized controlled trials. The printed objects included CMF structure model prototypes, patient-specific implants, and other custom surgical devices. Studies reveal successful outcomes, including restored facial symmetry and function, restored orbital occlusion, resolved enophthalmos and diplopia, achieved cosmetically symmetrical lower face reconstruction, and precise fitting of surgical devices, enhancing patient and surgeon comfort. However, complications such as local infection, implant exposure, and persistent diplopia were reported. Three-dimensional printed devices reduced surgery time but increased preparation time and production costs. In-house production options could mitigate these time and cost expenditures. Three-dimensional printing holds potential in CMF trauma reconstruction, addressing both functional and esthetic restoration. Nevertheless, challenges persist in implementing this advanced technology in resource-limited environments.
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Affiliation(s)
- Mendy Hatibie Oley
- Division of Plastic Reconstructive and Esthetic Surgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University
- Division of Plastic Reconstructive and Esthetic Surgery, Department of Surgery, Kandou Hospital
- Hyperbaric Centre Siloam Hospital
| | - Maximillian Christian Oley
- Hyperbaric Centre Siloam Hospital
- Division of Neurosurgery, Faculty of Medicine, Department of Surgery, Sam Ratulangi University
- Division of Neurosurgery, Department of Surgery, Kandou Hospital, Manado
| | | | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Bildstein AC, Dubois G, Preud'homme R, Rouch P, Veyssière A, Bénateau H. Mechanical characterization of soft-tissue stiffness during mandibular distraction. J Craniomaxillofac Surg 2024; 52:860-864. [PMID: 38796333 DOI: 10.1016/j.jcms.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/25/2024] [Accepted: 04/27/2024] [Indexed: 05/28/2024] Open
Abstract
The purpose of this study was to determine the stiffness of mandibular soft tissues during mandibular distraction, from the perspective of improving distraction devices such as automated continuous distractors. Uncompleted osteotomy was performed on 11 fresh human hemimandibles via a greenstick fracture, to preserve the uplift of the internal periosteum of the mandibular corpus. In order to replicate continuous distraction, direct measurements were performed through a uniaxial quasi-static tensile test. For all specimens, linear regression was applied to the force-displacement curve for a force region of 10-20 N, and the slope extracted. The mean stiffness was estimated to be 9.12 ± 3.56 N/mm. This study is the first to measure directly the stiffness of the surrounding tissues of the human mandibular corpus, and paves the way to the design of a new generation of distractor devices.
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Affiliation(s)
| | - Guillaume Dubois
- Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers Institute of Technology, 151 Boulevard de l'Hôpital, 75013, Paris, France; Materialise, Malakoff, France
| | | | - Philippe Rouch
- Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers Institute of Technology, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Alexis Veyssière
- Department of Maxillo Facial Surgery, Caen University Hospital, France
| | - Hervé Bénateau
- Department of Maxillo Facial Surgery, Caen University Hospital, France
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Lo LJ, Lin HH. Applications of three-dimensional imaging techniques in craniomaxillofacial surgery: A literature review. Biomed J 2023; 46:100615. [PMID: 37343928 PMCID: PMC10339193 DOI: 10.1016/j.bj.2023.100615] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/02/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023] Open
Abstract
Three-dimensional (3D) imaging technologies are increasingly used in craniomaxillofacial (CMF) surgery, especially to enable clinicians to get an effective approach and obtain better treatment results during different preoperative and postoperative phases, namely during image acquisition and diagnosis, virtual surgical planning (VSP), actual surgery, and treatment outcome assessment. The article presents an overview of 3D imaging technologies used in the aforementioned phases of the most common CMF surgery. We searched for relevant studies on 3D imaging applications in CMF surgery published over the past 10 years in the PubMed, ProQuest (Medline), Web of Science, Science Direct, Clinical Key, and Embase databases. A total of 2094 articles were found, of which 712 were relevant. An additional 26 manually searched articles were included in the analysis. The findings of the review demonstrated that 3D imaging technology is becoming increasingly popular in clinical practice and an essential tool for plastic surgeons. This review provides information that will help researchers and clinicians consider the use of 3D imaging techniques in CMF surgery to improve the quality of surgical procedures and achieve satisfactory treatment outcomes.
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Affiliation(s)
- Lun-Jou Lo
- Plastic & Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hsiu-Hsia Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Weill P, Dubois G, Preudhomme R, Rouch P, Veyssiere A, Benateau H. [Improving the accuracy of the preoperative planning of mandibular osteogenic distraction by an external custom-made device]. ANN CHIR PLAST ESTH 2023; 68:113-122. [PMID: 36670044 DOI: 10.1016/j.anplas.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this study was to analyze the predictability of virtual surgical planning of mandibular reconstruction by osteogenic distraction (OD) with a custom-made osteogenic distraction device (DEOS) after ballistic trauma and to make recommendations to mitigate potential sources of discrepancy. METHODS This retrospective study involved 12 patients who were victims of facial mandibular ballistic trauma and were reconstructed with osteogenic distraction with a DEOS device. Postoperative images were compared to the planned situation by means of several measures made in two plans : distraction plane and frontal plane. RESULTS The mean bone loss was 54.2mm. The anteroposterior difference was systematically inferior or equal postoperatively (10.8mm). The interrami angle difference in the frontal plane was positive, with an average of 4.8°. There was a significant negative correlation in univariate analysis between the antero-posterior difference measurement and the difference of the interrami angle in distraction. CONCLUSION A significant difference between the planning and postoperative results was shown, explained by the device being too adjustable leading to the loosening of the locking screws of the device. A static analysis showed that there are significant rotational forces at the carriages, which can lead to the loosening of the locking elements. It is then proposed that the device be optimized by customization of some elements.
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Affiliation(s)
- Pierre Weill
- Centre Francois Baclesse, service chirurgie maxillo-faciale, 14000 Caen, France.
| | - Guillaume Dubois
- Faculté de médecine du Caen, université de Caen Basse-Normandie, 14032 Caen cedex 5, France
| | - Renaud Preudhomme
- Service de chirurgie maxillo-faciale, centre hospitalo-universitaire de Caen, France; Faculté de médecine du Caen, université de Caen Basse-Normandie, 14032 Caen cedex 5, France
| | - Philippe Rouch
- Institut de biomécanique humaine Georges Charpak, arts et metiers paristech, 75013 Paris, France; EPF-École supérieure d'ingénieurs, 3, bis rue Lakanal, 92330 Sceaux, France
| | - Alexis Veyssiere
- Service de chirurgie maxillo-faciale, centre hospitalo-universitaire de Caen, France; Faculté de médecine du Caen, université de Caen Basse-Normandie, 14032 Caen cedex 5, France; Normandie university unicaen, Bioconnect, 14000 Caen, France
| | - Hervé Benateau
- Service de chirurgie maxillo-faciale, centre hospitalo-universitaire de Caen, France; Faculté de médecine du Caen, université de Caen Basse-Normandie, 14032 Caen cedex 5, France; Normandie university unicaen, Bioconnect, 14000 Caen, France
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Knudson SA, Day KM, Kelley P, Padilla P, Collier IX, Henry S, Harshbarger R, Combs P. Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review. Craniomaxillofac Trauma Reconstr 2022; 15:206-218. [PMID: 36081679 PMCID: PMC9446274 DOI: 10.1177/19433875211026432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
Study Design Retrospective case series; systematic review. Objective It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.
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Affiliation(s)
- Sean A. Knudson
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
| | - Kristopher M. Day
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Patrick Kelley
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Pablo Padilla
- Department of Plastic Surgery,
University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Ian X. Collier
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Steven Henry
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Raymond Harshbarger
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Patrick Combs
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
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Khatib B, Gelesko S, Amundson M, Cheng A, Patel A, Bui T, Dierks EJ, Bell RB. Updates in Management of Craniomaxillofacial Gunshot Wounds and Reconstruction of the Mandible. Oral Maxillofac Surg Clin North Am 2021; 33:359-372. [PMID: 34210400 DOI: 10.1016/j.coms.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article includes updates in the management of mandibular trauma and reconstruction as they relate to maxillomandibular fixation screws, custom hardware, virtual surgical planning, and protocols for use of computer-aided surgery and navigation when managing composite defects from gunshot injuries to the face.
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Affiliation(s)
- Baber Khatib
- Advanced Craniomaxillofacial and Trauma Surgery/Head and Neck Oncologic and Microvascular Reconstructive Surgery, Department of Surgery, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Portland Hospital, 4805 NE Glisan Street, Portland, OR 97213, USA; Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA.
| | - Savannah Gelesko
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA
| | - Melissa Amundson
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - Allen Cheng
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, 1015 NW 22nd Avenue, Portland, OR 97210, USA
| | - Ashish Patel
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
| | - Tuan Bui
- Oral and Maxillofacial Pathology, Sanford Health, E - 1717 S University Drive Fargo, ND 58103, USA
| | - Eric J Dierks
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - R Bryan Bell
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA; Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
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Paré A, Bossard A, Laure B, Weiss P, Gauthier O, Corre P. Reconstruction of segmental mandibular defects: Current procedures and perspectives. Laryngoscope Investig Otolaryngol 2019; 4:587-596. [PMID: 31890875 PMCID: PMC6929581 DOI: 10.1002/lio2.325] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/02/2019] [Accepted: 10/21/2019] [Indexed: 11/11/2022] Open
Abstract
Background The reconstruction of segmental mandibular defects remains a challenge for the reconstructive surgeon, from both a functional and an esthetic point of view. Methods This clinical review examines the different techniques currently in use for mandibular reconstruction as related to a range of etiologies, including the different bone donor sites, the alternatives to free flaps (FFs), as well as the contribution of computer‐assisted surgery. Recent progress and the perspectives in bone tissue engineering (BTE) are also discussed. Results Osseous FF allows reliable and satisfying outcomes. However, locoregional flap, distraction osteogenesis, or even induced membrane techniques are other potential options in less favorable cases. Obtaining an engineered bone with satisfactory mechanical properties and sufficient vascular supply requires further investigations. Conclusions Osseous FF procedure remains the gold standard for segmental mandible reconstruction. BTE strategies offer promising alternatives.
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Affiliation(s)
- Arnaud Paré
- Service de Chirurgie Maxillo Faciale Plastique et Brulés, Hôpital Trousseau, CHU de Tours Tours France.,Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,UFR Médecine Université de Tours Tours France.,UFR Odontologie Université́ de Nantes Nantes France
| | - Adeline Bossard
- ONIRIS Nantes-Atlantic College of Veterinary Medicine Centre de Rechecherche et D'investigation Préclinique (CRIP) Nantes France
| | - Boris Laure
- Service de Chirurgie Maxillo Faciale Plastique et Brulés, Hôpital Trousseau, CHU de Tours Tours France
| | - Pierre Weiss
- Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,UFR Odontologie Université́ de Nantes Nantes France
| | - Olivier Gauthier
- Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,ONIRIS Nantes-Atlantic College of Veterinary Medicine Centre de Rechecherche et D'investigation Préclinique (CRIP) Nantes France
| | - Pierre Corre
- Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,UFR Odontologie Université́ de Nantes Nantes France.,Service de Chirurgie Maxillo-Faciale et Stomatologie CHU de Nantes Nantes France
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Leng S, Bici K, Facchini F, Volpe Y, Uccheddu F, Furferi R, Governi L, Carfagni M, Ghionzoli M, Messineo A. Customized Cutting Template to Assist Sternotomy in Pectus Arcuatum. Ann Thorac Surg 2018; 107:1253-1258. [PMID: 30508532 DOI: 10.1016/j.athoracsur.2018.10.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/07/2018] [Accepted: 10/25/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Pectus arcuatum is an anterior chest wall deformity that requires transverse wedge sternotomy. Determining and delivering the correct cutting angle are crucial for successful correction. This report describes the early clinical experience with a novel cutting template technology able to deliver the optimal cutting angle. DESCRIPTION From patients' computed tomographic scans, the optimal cutting angle is obtained using computer-aided design. A template comprising slots tilted at the right cutting angle and a safety block to avoid damaging the posterior periosteum is printed through additive manufacturing. EVALUATION The template allows surgeons to perform a precise wedge sternotomy, safely sparing the posterior periosteum in all patients, without complications. Postoperative chest roentgenograms and clinical photographs demonstrate optimal sternal realignment and cosmetic outcome. In this report, the mean operative time was 110 minutes. All patients were successfully discharged, with a mean length of stay of 4 days. CONCLUSIONS Transverse wedge sternotomy aided by a computer-aided design-devised cutting template may reduce the technical challenge of this procedure, thereby increasing its safety and reducing operative times and hospital stay. Further research on long-term patient outcomes is necessary.
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Affiliation(s)
- Stella Leng
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Kejd Bici
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Flavio Facchini
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Yary Volpe
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Francesca Uccheddu
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Rocco Furferi
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Lapo Governi
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Monica Carfagni
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy.
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Jansen J, Schreurs R, Dubois L, Maal TJ, Gooris PJ, Becking AG. The advantages of advanced computer-assisted diagnostics and three-dimensional preoperative planning on implant position in orbital reconstruction. J Craniomaxillofac Surg 2018; 46:715-721. [DOI: 10.1016/j.jcms.2018.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/24/2018] [Accepted: 02/13/2018] [Indexed: 11/30/2022] Open
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10
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Khatib B, Gelesko S, Amundson M, Cheng A, Patel A, Bui T, Dierks EJ, Bell RB. Updates in Management of Craniomaxillofacial Gunshot Wounds and Reconstruction of the Mandible. Facial Plast Surg Clin North Am 2018; 25:563-576. [PMID: 28941508 DOI: 10.1016/j.fsc.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article includes updates in the management of mandibular trauma and reconstruction as they relate to maxillomandibular fixation screws, custom hardware, virtual surgical planning, and protocols for use of computer-aided surgery and navigation when managing composite defects from gunshot injuries to the face.
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Affiliation(s)
- Baber Khatib
- Advanced Craniomaxillofacial and Trauma Surgery/Head and Neck Oncologic and Microvascular Reconstructive Surgery, Department of Surgery, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Portland Hospital, 4805 NE Glisan Street, Portland, OR 97213, USA; Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA.
| | - Savannah Gelesko
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA
| | - Melissa Amundson
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - Allen Cheng
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, 1015 NW 22nd Avenue, Portland, OR 97210, USA
| | - Ashish Patel
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
| | - Tuan Bui
- Oral and Maxillofacial Pathology, Sanford Health, E - 1717 S University Drive Fargo, ND 58103, USA
| | - Eric J Dierks
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - R Bryan Bell
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA; Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
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11
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Virtual Surgical Planning: The Pearls and Pitfalls. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1443. [PMID: 29464146 PMCID: PMC5811276 DOI: 10.1097/gox.0000000000001443] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/20/2017] [Indexed: 11/26/2022]
Abstract
Objective Over the past few years, virtual surgical planning (VSP) has evolved into a useful tool for the craniofacial surgeon. Virtual planning and computer-aided design and manufacturing (CAD/CAM) may assist in orthognathic, cranio-orbital, traumatic, and microsurgery of the craniofacial skeleton. Despite its increasing popularity, little emphasis has been placed on the learning curve. Methods A retrospective analysis of consecutive virtual surgeries was done from July 2012 to October 2016 at the University of Montreal Teaching Hospitals. Orthognathic surgeries and free vascularized bone flap surgeries were included in the analysis. Results Fifty-four virtual surgeries were done in the time period analyzed. Forty-six orthognathic surgeries and 8 free bone transfers were done. An analysis of errors was done. Eighty-five percentage of the orthognathic virtual plans were adhered to completely, 4% of the plans were abandoned, and 11% were partially adhered to. Seventy-five percentage of the virtual surgeries for free tissue transfers were adhered to, whereas 25% were partially adhered to. The reasons for abandoning the plans were (1) poor communication between surgeon and engineer, (2) poor appreciation for condyle placement on preoperative scans, (3) soft-tissue impedance to bony movement, (4) rapid tumor progression, (5) poor preoperative assessment of anatomy. Conclusion Virtual surgical planning is a useful tool for craniofacial surgery but has inherent issues that the surgeon must be aware of. With time and experience, these surgical plans can be used as powerful adjuvants to good clinical judgement.
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