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Altwaijri A. Minimally Invasive Approaches in Orthognathic Surgery: A Narrative Review of Contemporary Techniques and their Clinical Outcomes. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1652-S1656. [PMID: 38882864 PMCID: PMC11174174 DOI: 10.4103/jpbs.jpbs_1226_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 06/18/2024] Open
Abstract
Maxillofacial surgery has evolved significantly, particularly in orthognathic procedures, shifting from invasive methods to minimally invasive techniques (MITs). Innovations, like 3D imaging, computer-aided simulations, piezoelectric surgery, and endoscopic assistance, have revolutionized patient care. These methods notably reduce bleeding, scarring, hospital stays, and recovery time, while enhancing surgical precision and outcomes. Our review focuses on modern MITs, including endoscopically assisted maxillomandibular advancement (EAMMA) and CAD/CAM technology. We conducted a thorough literature search, identifying 21 relevant articles from an initial pool of 423. The review evaluates the efficacy, complication rates, and long-term stability of these techniques, addressing challenges and future prospects. Emphasizing the significance of MI methods in orthognathic surgery, it advocates for further research and clinical adoption.
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Affiliation(s)
- Abdulrahman Altwaijri
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Qassim University, Qassim, Saudi Arabia
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Barros Padilha DXD, Veiga NJ, Mello-Moura ACV, Nunes Correia P. Virtual reality and behaviour management in paediatric dentistry: a systematic review. BMC Oral Health 2023; 23:995. [PMID: 38087294 PMCID: PMC10717698 DOI: 10.1186/s12903-023-03595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Virtual reality (VR) has emerged as an innovative tool in medicine and dentistry, improving anxiety and pain management in children. The immersive and interactive environments of VR technology facilitate positive engagement of young patients during dental procedures via distraction, potentially reducing anxiety levels and improving treatment experience. The aim of this review was to provide current evidence-based guidance on the usage of VR in the clinical practice of paediatric dentistry. METHODS A systematic review was conducted according to the PRISMA guidelines with the following research question using the PICO format: Does VR (I) effectively manage anxiety and pain (O) during a paediatric dental consultation (P) compared to alternative behavioural control techniques (C)? PubMed/Medline®, SCOPUS and Web of Science databases were searched and analysed. RESULTS A total of 22 randomised control trials were included in this review. These studies have shown that VR is a highly effective method of behaviour management, successfully alleviating pain and anxiety in children during dental treatment, surpassing traditional tools. Selected studies included participants with a large age range and dental procedures varied greatly, from first consultations to infiltration of local anaesthetic and other invasive procedures. VR was mostly used during treatment delivery and different immersive VR techniques were considered. Behaviour, anxiety and pain scales were used to determine efficacy and patient satisfaction. CONCLUSIONS VR offers an engaging and immersive experience, effectively diverting patients' attention away from the clinical environment, fostering a positive and enjoyable treatment experience. However, it is important to acknowledge the limitations of existing studies and the need for further research to enhance the understanding of VR's full potential in paediatric dentistry.
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Grants
- UIDB/04279/2020. This work is financially supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia, I.P., under the project
- UIDB/04279/2020. This work is financially supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia, I.P., under the project
- UIDB/04279/2020. This work is financially supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia, I.P., under the project
- UIDB/04279/2020. This work is financially supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia, I.P., under the project
- This work is financially supported by National Funds through FCT – Fundação para a Ciência e a Tecnologia, I.P., under the project
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Affiliation(s)
| | - Nélio Jorge Veiga
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505, Viseu, Portugal
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505, Viseu, Portugal
| | - Anna Carolina Volpi Mello-Moura
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505, Viseu, Portugal
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505, Viseu, Portugal
| | - Patrícia Nunes Correia
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505, Viseu, Portugal.
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505, Viseu, Portugal.
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Peng MJ, Lin Z, Tan Z, Hu Y, Chen P, To MKT. Virtual operation for hip joint replacement implemented by Sensable_FreeForm_Modelling: A surgical drill. Int J Med Robot 2023; 19:e2552. [PMID: 37489032 DOI: 10.1002/rcs.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To design a virtual operation of joint replacement for surgical drills using a haptic device, SenSable_FreeForm_Modelling (SFM), to enhance surgeons' efficiency and enable "Virtual tutorial without reality" for interns. METHOD A patient with hip joint osteoarthritis is randomly selected to perform Total Hip Replacement (THR). The hip images were input into Mimics in the format of *.dicom after CT scan and then exported to SFM using the stereolithographic (*.stl) format. A surgical toolkit can be created virtually with Computer Aided Design software such as Pro-E or Ghost SDK and a visual drill scenario of THR directed by a force-respondent stick, namely Phantom. RESULT 3D models of the hip joint were rebuilt illustrating clearly that the geometrical shapes of the surgical equipment created are similar to real instruments, and the THR operation is emulated distinctly in novelty. CONCLUSION In obedience to an ancient maxim, so called 'genuine knowledge originated from practice', this simulative operation offers hands-on experience for students in the orthopaedics field with remarkable effects, contributing not only teaching cases for medical courses but also a planning basis for physical surgery.
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Affiliation(s)
- Matthew JianQiao Peng
- Department of Spinal Surgery, Affiliated JiangMen Hospital of TCM @ Ji'Nan University, JiangMen, China
| | - Ze Lin
- Department of Orthopedics, PuNing People's Hospital, GuangDong, China
| | - ZhiJia Tan
- Department of Orthopedics & Traumatology, University of HongKong - Shenzhen Hospital, Shenzhen, GuangDong, China
| | - Yong Hu
- Department of Orthopedics & Traumatology, University of HongKong - Shenzhen Hospital, Shenzhen, GuangDong, China
| | - Peikai Chen
- Department of Orthopedics & Traumatology, University of HongKong - Shenzhen Hospital, Shenzhen, GuangDong, China
| | - Michael Kai-Tsun To
- Department of Orthopedics & Traumatology, University of HongKong - Shenzhen Hospital, Shenzhen, GuangDong, China
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Malenova Y, Ortner F, Liokatis P, Haidari S, Tröltzsch M, Fegg F, Obermeier KT, Hartung JT, Kakoschke TK, Burian E, Otto S, Sabbagh H, Probst FA. Accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. Clin Oral Investig 2023; 27:5063-5072. [PMID: 37382718 PMCID: PMC10492762 DOI: 10.1007/s00784-023-05125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To determine the accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. MATERIAL AND METHODS A retrospective analysis of 28 patients that underwent virtually planned orthognathic surgery with maxillary Le Fort I osteotomy either using VSP-generated splints (n = 13) or patient-specific implants (PSI) (n = 15) was conducted. The accuracy and surgical outcome of both techniques were compared by superimposing preoperative surgical planning with postoperative CT scans and measurement of translational and rotational deviation for each patient. RESULTS The 3D global geometric deviation between the planned position and the postoperative outcome was 0.60 mm (95%-CI 0.46-0.74, range 0.32-1.11 mm) for patients with PSI and 0.86 mm (95%-CI 0.44-1.28, range 0.09-2.60 mm) for patients with surgical splints. Postoperative differences for absolute and signed single linear deviations between planned and postoperative position were a little higher regarding the x-axis and pitch but lower regarding the y- and z-axis as well as yaw and roll for PSI compared to surgical splints. There were no significant differences regarding global geometric deviation, absolute and signed linear deviations in the x-, y-, and z-axis, and rotations (yaw, pitch, and roll) between both groups. CONCLUSIONS Regarding accuracy for positioning of maxillary segments after Le Fort I osteotomy in orthognathic surgery patient-specific implants and surgical splints provide equivalent high accuracy. CLINICAL RELEVANCE Patient-specific implants for maxillary positioning and fixation facilitate the concept of splintless orthognathic surgery and can be reliably used in clinical routines.
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Affiliation(s)
- Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany.
| | - Florian Ortner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Matthias Tröltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
- Center for Oral, Maxillofacial, and Facial Reconstructive Surgery, Ansbach, Germany
| | - Florian Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Katharina T Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Jens T Hartung
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Tamara K Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Egon Burian
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital LMU Munich, Munich, Germany
| | - Florian A Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
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Zhao C, Kim AS, Beams R, Badano A. Spatiotemporal image quality of virtual reality head mounted displays. Sci Rep 2022; 12:20235. [PMID: 36424434 PMCID: PMC9691731 DOI: 10.1038/s41598-022-24345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
Virtual reality (VR) head mounted displays (HMDs) require both high spatial resolution and fast temporal response. However, methods to quantify the VR image quality in the spatiotemporal domain when motion exists are not yet standardized. In this study, we characterize the spatiotemporal capabilities of three VR devices: the HTC VIVE, VIVE Pro, and VIVE Pro 2 during smooth pursuit. A spatiotemporal model for VR HMDs is presented using measured spatial and temporal characteristics. Among the three evaluated headsets, the VIVE Pro 2 improves the display temporal performance using a fast 120 Hz refresh rate and pulsed emission with a small duty cycle of 5%. In combination with a high pixel resolution beyond 2 k [Formula: see text] 2 k per eye, the VIVE Pro 2 achieves an improved spatiotemporal performance compared to the VIVE and VIVE Pro in the high spatial frequency range above 8 cycles per degree during smooth pursuit. The result demonstrates that reducing the display emission duty cycle to less than 20% is beneficial to mitigate motion blur in VR HMDs. Frame rate reduction (e.g., to below 60 Hz) of the input signal compared to the display refresh rate of 120 Hz yields replicated shadow images that can affect the image quality under motion. This work supports the regulatory science research efforts in development of testing methods to characterize the spatiotemporal performance of VR devices for medical use.
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Affiliation(s)
- Chumin Zhao
- grid.417587.80000 0001 2243 3366Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA
| | - Andrea S. Kim
- grid.417587.80000 0001 2243 3366Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA
| | - Ryan Beams
- grid.417587.80000 0001 2243 3366Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA
| | - Aldo Badano
- grid.417587.80000 0001 2243 3366Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA
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Apostolakis D, Michelinakis G, Kamposiora P, Papavasiliou G. The current state of Computer Assisted Orthognathic Surgery: A narrative review. J Dent 2022; 119:104052. [DOI: 10.1016/j.jdent.2022.104052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 12/23/2022] Open
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A Novel Precise Optical Navigation System for Craniomaxillofacial Surgery Registered With an Occlusal Splint. J Craniofac Surg 2021; 33:344-349. [PMID: 34260445 PMCID: PMC8694255 DOI: 10.1097/scs.0000000000007833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND An augmented reality tool allows visual tracking of real anatomical structures and superimposing virtual images, so it can be used for navigation of important structures during surgery. OBJECTIVES The authors have developed a new occlusal splint-based optical navigation system for craniomaxillofacial surgery. In this study, the authors aim to measure the accuracy of the system and further analyze the main factors influencing precision. METHODS Ten beagle dogs were selected and a three-dimensional model was established through computed tomography scanning, dental model making, and laser scanning, and then registration was performed according to the tooth marking points. The bilateral mandibular osteotomy was performed on Beagle dogs under navigation system based on the occlusal splint. The left side was taken to compare the deviation between the preoperative plan and the surgical results, and the accuracy of distance and angle and the stability of the system were analyzed. RESULTS The average position deviation between the preoperative design and intraoperative navigation was: 0.01 ± 0.73 mm on the lateral height of the mandibular ramus, 0.26 ± 0.57 mm on the inner height of the mandibular ramus, and 0.20 ± 0.51 mm on the osteotomy length. The average angle deviation is 0.94° ± 1.38° on the angle between the mandibular osteotomy plane and ramus plane and 0.66° ± 0.97° on the angle of the retained mandibular angle. And most of the data showed good consistency. CONCLUSIONS In summary, the accuracy of the system can meet clinical requirements and can be used as a useful tool to improve the accuracy of craniomaxillofacial surgery.
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Active learning for accuracy enhancement of semantic segmentation with CNN-corrected label curations: Evaluation on kidney segmentation in abdominal CT. Sci Rep 2020; 10:366. [PMID: 31941938 PMCID: PMC6962335 DOI: 10.1038/s41598-019-57242-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/24/2019] [Indexed: 01/10/2023] Open
Abstract
Segmentation is fundamental to medical image analysis. Recent advances in fully convolutional networks has enabled automatic segmentation; however, high labeling efforts and difficulty in acquiring sufficient and high-quality training data is still a challenge. In this study, a cascaded 3D U-Net with active learning to increase training efficiency with exceedingly limited data and reduce labeling efforts is proposed. Abdominal computed tomography images of 50 kidneys were used for training. In stage I, 20 kidneys with renal cell carcinoma and four substructures were used for training by manually labelling ground truths. In stage II, 20 kidneys from the previous stage and 20 newly added kidneys were used with convolutional neural net (CNN)-corrected labelling for the newly added data. Similarly, in stage III, 50 kidneys were used. The Dice similarity coefficient was increased with the completion of each stage, and shows superior performance when compared with a recent segmentation network based on 3D U-Net. The labeling time for CNN-corrected segmentation was reduced by more than half compared to that in manual segmentation. Active learning was therefore concluded to be capable of reducing labeling efforts through CNN-corrected segmentation and increase training efficiency by iterative learning with limited data.
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Liu Z, Gao W, Sun Y, Su Y, Zhu J, Xu L, Fu Y. A non-contact interactive stereo display system for exploring human anatomy. Comput Assist Surg (Abingdon) 2019; 24:131-136. [PMID: 30741020 DOI: 10.1080/24699322.2018.1557899] [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] [Indexed: 10/27/2022] Open
Abstract
Stereoscopic display based on Virtual Reality (VR) can facilitate clinicians observing 3 D anatomical models with the depth cue which lets them understand the spatial relationship between different anatomical structures intuitively. However, there are few input devices available in the sterile field of the operating room for controlling 3 D anatomical models. This paper presents a cost-effective VR application for stereo display of 3 D anatomical models with non-contact interaction. The system is integrated with hand gesture interaction and voice interaction to achieve non-contact interaction. Hand gesture interaction is based on Leap Motion. Voice interaction is implemented based on Bing Speech for English language and Aitalk for Chinese language. A local database is designed to record the anatomical terminologies organized in a tree structure, and provided to the speech recognition engine for querying these uncommon words. Ten participants were asked to practice the proposed system and compare it with the common interactive manners. The results show that our system is more efficient than the common interactive manner and prove the feasibility and practicability of the proposed system used in the sterile field.
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Affiliation(s)
- Ziteng Liu
- School of Life Science and Technology, Harbin Institute of Technology , Harbin , China
| | - Wenpeng Gao
- School of Life Science and Technology, Harbin Institute of Technology , Harbin , China
| | - Yu Sun
- State Key Laboratory of Robotics and System, Harbin Institute of Technology , Harbin , China
| | - Yixian Su
- State Key Laboratory of Robotics and System, Harbin Institute of Technology , Harbin , China
| | - Jiahua Zhu
- State Key Laboratory of Robotics and System, Harbin Institute of Technology , Harbin , China
| | - Lubing Xu
- School of Life Science and Technology, Harbin Institute of Technology , Harbin , China
| | - Yili Fu
- School of Life Science and Technology, Harbin Institute of Technology , Harbin , China
- State Key Laboratory of Robotics and System, Harbin Institute of Technology , Harbin , China
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Qu M, Zhu S, Hu Z, Li Y, Abotaleb B, Bi R, Jiang N. The accuracy of three-dimensional rapid prototyped surgical template guided anterior segmental osteotomy. Med Oral Patol Oral Cir Bucal 2019; 24:e684-e690. [PMID: 31433393 PMCID: PMC6764704 DOI: 10.4317/medoral.23009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/27/2019] [Indexed: 11/16/2022] Open
Abstract
Background Surgical guiding templates provided a reliable way to transfer the simulation to the actual operation. However, there was no template designed for anterior segmental osteotomy so far. The study aimed to introduce and evaluate a set of 3D rapid prototyping surgical templates used in anterior segmental osteotomy. Material and Methods From August 2015 to August 2017, 17 patients with bimaxillary protrusions were recruited and occlusal-based multi-sectional templates were applied in the surgeries. The cephalometric analysis and 3D superimposition were performed to evaluate the differences between the simulations and actual post-operative outcomes. The patients were followed-up for 12 months to evaluate the incidence rate of complications and relapse. Results Bimaxillary protrusion was corrected in all patients with no complication. In radiographic evaluations, there was no statistically significant difference between the actual operations and the computer-aided 3D simulations (p >0.05, the mean linear and angular differences were less than 1.32mm and 1.72° consequently, and 3D superimposition difference was less than 1.4mm). The Pearson intraclass correlation coefficient reliabilities were high (0.897), and the correlations were highly significant (P< 0.001). Conclusions The 3D printed surgical template designed in this study can safely and accurately transfer the computer-aided 3D simulation into real practice. Key words:CAD/CAM; anterior segmental osteotomy; surgical guiding templates; bimaxillary protrusion; virtual surgery simulation.
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Affiliation(s)
- M Qu
- West China College of Stomatology, Sichuan University, Chengdu, Sichuan, 610041 China,
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Three-Dimensional Outcome Assessments of Cleft Lip and Palate Patients Undergoing Maxillary Advancement. Plast Reconstr Surg 2019; 143:1255e-1265e. [PMID: 31136492 DOI: 10.1097/prs.0000000000005646] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this retrospective case series study was to compare three-dimensional postsurgical outcomes of patients with cleft lip and palate following maxillary advancement. METHODS Fifty consecutive cleft lip and palate patients who underwent whole-pieced Le Fort I advancements were assigned to the major (advancement ≥ 5 mm) or minor (advancement < 5 mm) groups. Three-dimensional surgical simulation was used for presurgical evaluation and planning. Virtual triangles of the presurgical, simulated, and 6-month postoperative stages were used for comparison. Translational and angular changes of each endpoint (A-point, MxR, and MxL) on the virtual triangles and reference planes were recorded and analyzed. Relationships between possible related variables and outcome discrepancies from simulations among all subgroups were also investigated. RESULTS Analysis of covariance and the least significant difference test revealed that the outcome discrepancy measurements were affected by different combinations of independent variables. The reliability test showed high consistency of the authors' method for three-dimensional measurements. CONCLUSIONS The actual surgical outcomes of cleft lip and palate patients differed from the virtual simulations. The outcome discrepancies are impacted by multiple factors. The outcome discrepancies of all rotational surgical corrections (roll, yaw, and pitch) were positively correlated to the degree of planned surgical movement. Meanwhile, bilateral cleft lip and palate patients are more likely to incur outcome discrepancies in yaw correction with major maxillary advancement. However, a maxillary advancement cutoff value of 5 mm would not necessarily lead to significant translational outcome discrepancies among cleft lip and palate patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Badiali G, Marcelli E, Bortolani B, Marchetti C, Cercenelli L. An average three-dimensional virtual human skull for a template-assisted maxillofacial surgery. Int J Artif Organs 2019; 42:566-574. [PMID: 31117867 DOI: 10.1177/0391398819849075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Although many advances have been made in three-dimensional virtual planning in maxillofacial surgery, facial harmony is still difficult to achieve and is heavily dependent on the surgeon's experience. The aim of the study is to present a method to build up an average three-dimensional virtual human skull to be used as a reference template for bone repositioning and reconstruction during maxillofacial surgical interventions. METHODS A total of 20 patients (10 females and 10 males) were selected for the optimal outcome after orthognathic surgery. Postoperative cone-beam computed tomography scans were collected and processed in order to obtain three-dimensional digital models of each skull. For male and female subgroups, the three-dimensional skull models were registered and an average three-dimensional virtual skull model was computed. Deviation color maps were calculated to show differences between each postoperative skull model in the population and the obtained average three-dimensional skull. A clinical use case of genioplasty treatment assisted by the provided average three-dimensional skull template was presented. RESULTS The overall mean deviation from the average three-dimensional skull model was 1.3 ± 0.6 and 1.6 ± 0.5 mm in male and female subgroups, respectively. For both groups, the greatest deviations were at the area of the mandible, while almost no deviation was found at the zygomatic and orbital areas. In the presented use case, the female average three-dimensional skull model was effectively used for guiding surgical planning. CONCLUSION The presented method of obtaining an average three-dimensional virtual human skull may offer the interesting perspective of performing an innovative template-assisted maxillofacial surgery.
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Affiliation(s)
- Giovanni Badiali
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Barbara Bortolani
- Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Marchetti
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Lee SJ, Yang HJ, Choi MH, Woo SY, Huh KH, Lee SS, Heo MS, Choi SC, Hwang SJ, Yi WJ. Real-time augmented model guidance for mandibular proximal segment repositioning in orthognathic surgery, using electromagnetic tracking. J Craniomaxillofac Surg 2018; 47:127-137. [PMID: 30447987 DOI: 10.1016/j.jcms.2018.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022] Open
Abstract
It is essential to reposition the mandibular proximal segment (MPS) as close to its original position as possible during orthognathic surgery. Conventional methods cannot pinpoint the exact position of the condyle in the fossa in real time during repositioning. In this study, based on an improved registration method and a separable electromagnetic tracking tool, we developed a real-time, augmented, model-guided method for MPS surgery to reposition the condyle into its original position more accurately. After virtual surgery planning, using a complex maxillomandibular model, the final position of the virtual MPS model was simulated via 3D rotations. The displacements resulting from the MPS simulation were applied to the MPS landmarks to indicate their final postoperative positions. We designed a new registration body with 24 fiducial points for registration, and determined the optimal point group on the registration body through a phantom study. The registration between the patient's CT image and physical spaces was performed preoperatively using the optimal points. We also developed a separable frame for installing the electromagnetic tracking tool on the patient's MPS. During MPS surgery, the electromagnetic tracking tool was repeatedly attached to, and separated from, the MPS using the separable frame. The MPS movement resulting from the surgeon's manipulation was tracked by the electromagnetic tracking system. The augmented condyle model and its landmarks were visualized continuously in real time with respect to the simulated model and landmarks. Our method also provides augmented 3D coronal and sagittal views of the fossa and condyle, to allow the surgeon to examine the 3D condyle-fossa positional relationship more accurately. The root mean square differences between the simulated and intraoperative MPS models, and between the simulated and postoperative CT models, were 1.71 ± 0.63 mm and 1.89 ± 0.22 mm respectively at three condylar landmarks. Thus, the surgeons could perform MPS repositioning conveniently and accurately based on real-time augmented model guidance on the 3D condyle positional relationship with respect to the glenoid fossa, using augmented and simulated models and landmarks.
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Affiliation(s)
- Sang-Jeong Lee
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea
| | - Hoon Joo Yang
- Orthognathic Surgery Center (Head: Soon Jung Hwang, DDS, MD, PhD), Seoul National University Dental Hospital, South Korea
| | - Min-Hyuk Choi
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea
| | - Sang-Yoon Woo
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea
| | - Soon Jung Hwang
- Department of Oral and Maxillofacial Surgery (Head: Jin-Young Choi, DDS, MD, PhD), School of Dentistry, Dental Research Institute, BK21 Plus, Seoul National University, South Korea.
| | - Won-Jin Yi
- Department of Biomedical Radiation Sciences (Head: Sung-Joon Ye, PhD), Graduate School of Convergence Science and Technology, Seoul National University, South Korea; Department of Oral and Maxillofacial Radiology (Head: Min-Suk Heo, DDS, PhD), School of Dentistry and Dental Research Institute, Seoul National University, South Korea.
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14
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Lutz JC, Hostettler A, Agnus V, Nicolau S, George D, Soler L, Rémond Y. A New Software Suite in Orthognathic Surgery : Patient Specific Modeling, Simulation and Navigation. Surg Innov 2018; 26:5-20. [PMID: 30270757 DOI: 10.1177/1553350618803233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Orthognathic surgery belongs to the scope of maxillofacial surgery. It treats dentofacial deformities consisting in discrepancy between the facial bones (upper and lower jaws). Such impairment affects chewing, talking, and breathing and can ultimately result in the loss of teeth. Orthognathic surgery restores facial harmony and dental occlusion through bone cutting, repositioning, and fixation. However, in routine practice, we face the limitations of conventional tools and the lack of intraoperative assistance. These limitations occur at every step of the surgical workflow: preoperative planning, simulation, and intraoperative navigation. The aim of this research was to provide novel tools to improve simulation and navigation. We first developed a semiautomated segmentation pipeline allowing accurate and time-efficient patient-specific 3D modeling from computed tomography scans mandatory to achieve surgical planning. This step allowed an improvement of processing time by a factor of 6 compared with interactive segmentation, with a 1.5-mm distance error. Next, we developed a software to simulate the postoperative outcome on facial soft tissues. Volume meshes were processed from segmented DICOM images, and the Bullet open source mechanical engine was used together with a mass-spring model to reach a postoperative simulation accuracy <1 mm. Our toolset was completed by the development of a real-time navigation system using minimally invasive electromagnetic sensors. This navigation system featured a novel user-friendly interface based on augmented virtuality that improved surgical accuracy and operative time especially for trainee surgeons, therefore demonstrating its educational benefits. The resulting software suite could enhance operative accuracy and surgeon education for improved patient care.
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Affiliation(s)
- Jean-Christophe Lutz
- 1 Maxillo-Facial and Plastic Surgery Department, Strasbourg University Hospital, France.,2 Department of Computer Science, Research and Development, IRCAD, France.,3 Laboratory of Engineering Science, Computer Science and Imaging, CNRS, University of Strasbourg, France
| | | | - Vincent Agnus
- 2 Department of Computer Science, Research and Development, IRCAD, France
| | - Stéphane Nicolau
- 2 Department of Computer Science, Research and Development, IRCAD, France
| | - Daniel George
- 3 Laboratory of Engineering Science, Computer Science and Imaging, CNRS, University of Strasbourg, France
| | - Luc Soler
- 2 Department of Computer Science, Research and Development, IRCAD, France
| | - Yves Rémond
- 3 Laboratory of Engineering Science, Computer Science and Imaging, CNRS, University of Strasbourg, France
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15
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Knoops PGM, Borghi A, Ruggiero F, Badiali G, Bianchi A, Marchetti C, Rodriguez-Florez N, Breakey RWF, Jeelani O, Dunaway DJ, Schievano S. A novel soft tissue prediction methodology for orthognathic surgery based on probabilistic finite element modelling. PLoS One 2018; 13:e0197209. [PMID: 29742139 PMCID: PMC5942840 DOI: 10.1371/journal.pone.0197209] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/27/2018] [Indexed: 12/02/2022] Open
Abstract
Repositioning of the maxilla in orthognathic surgery is carried out for functional and aesthetic purposes. Pre-surgical planning tools can predict 3D facial appearance by computing the response of the soft tissue to the changes to the underlying skeleton. The clinical use of commercial prediction software remains controversial, likely due to the deterministic nature of these computational predictions. A novel probabilistic finite element model (FEM) for the prediction of postoperative facial soft tissues is proposed in this paper. A probabilistic FEM was developed and validated on a cohort of eight patients who underwent maxillary repositioning and had pre- and postoperative cone beam computed tomography (CBCT) scans taken. Firstly, a variables correlation assessed various modelling parameters. Secondly, a design of experiments (DOE) provided a range of potential outcomes based on uniformly distributed input parameters, followed by an optimisation. Lastly, the second DOE iteration provided optimised predictions with a probability range. A range of 3D predictions was obtained using the probabilistic FEM and validated using reconstructed soft tissue surfaces from the postoperative CBCT data. The predictions in the nose and upper lip areas accurately include the true postoperative position, whereas the prediction under-estimates the position of the cheeks and lower lip. A probabilistic FEM has been developed and validated for the prediction of the facial appearance following orthognathic surgery. This method shows how inaccuracies in the modelling and uncertainties in executing surgical planning influence the soft tissue prediction and it provides a range of predictions including a minimum and maximum, which may be helpful for patients in understanding the impact of surgery on the face.
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Affiliation(s)
- Paul G. M. Knoops
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- * E-mail:
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Federica Ruggiero
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Oral and Maxillofacial Surgery Unit, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Badiali
- Oral and Maxillofacial Surgery Unit, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alberto Bianchi
- Oral and Maxillofacial Surgery Unit, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudio Marchetti
- Oral and Maxillofacial Surgery Unit, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Naiara Rodriguez-Florez
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Department of Biomedical Engineering, Mondragon University, Mondragón, Spain
| | - Richard W. F. Breakey
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - David J. Dunaway
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
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16
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Ettinger KS, Alexander AE, Arce K. Computed Tomographic Angiography Perforator Localization for Virtual Surgical Planning of Osteocutaneous Fibular Free Flaps in Head and Neck Reconstruction. J Oral Maxillofac Surg 2018; 76:2220-2230. [PMID: 29730061 DOI: 10.1016/j.joms.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
Virtual surgical planning (VSP), computer-aided design and computer-aided modeling, and 3-dimensional printing are 3 distinct technologies that have become increasingly employed in head and neck oncology and microvascular reconstruction. Although each of these technologies have long been utilized for treatment planning in other surgical disciplines such as craniofacial surgery, trauma surgery, temporomandibular joint surgery, and orthognathic surgery, its widespread use in head and neck reconstructive surgery remains a much more recent advent. In response to the growing trend of VSP being used for the planning of fibular free flaps in head and neck reconstruction, some surgeons have questioned the technology's implementation based upon its perceived inadequacy in addressing other reconstructive considerations beyond hard tissue anatomy. Detractors of VSP for head and neck reconstruction highlight its lack of capability in accounting for multiple reconstructive factors, such as recipient vessel selection, vascular pedicle reach, need for dead space obliteration, and skin paddle perforator location. It is with this premise in mind that we report a simple technique for anatomically localizing peroneal artery perforators during VSP for osteocutaneous fibular free flaps in which both bone and a soft tissue skin paddle are required for ablative reconstruction. The technique allows for anatomic perforator localization during the VSP session based solely upon data existent within the preoperative computed tomographic angiography (CTA) and it does not require any modifications to preoperative clinical workflows. It is the authors' presumption that many surgeons in the field are unaware of this planning capability within the context of modern VSP for head and neck reconstruction. The primary purpose of this manuscript is to introduce and further familiarize surgeons with the technique of CTA perforator localization as a method of improving intraoperative fidelity for VSP of osteocutaneous fibular free flaps.
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Affiliation(s)
- Kyle S Ettinger
- Mayo Clinic Scholar, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN; Head and Neck Oncologic Surgery and Microvascular Reconstruction Fellow, Department of Oral and Maxillofacial Surgery, Division of Head and Neck Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
| | - Amy E Alexander
- Biomedical Engineer, Anatomic Modeling Lab, Mayo Clinic, Rochester, MN
| | - Kevin Arce
- Assistant Professor of Surgery and Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
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17
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Abstract
A computer-aided 3-dimensional (3D) visualization operation simulation system based on computer-aided design (CAD) Unigraphics NX and Mimics software was established to provide orthopedic surgeons with an actual and reliable system in treating of distal femoral fracture.According to the preoperative CT data, 3D reconstruction of the distal femoral fracture could be achieved by the Mimics software. Then, the CAD Unigraphics NX software was used to measure the model function of all the related surgical instruments, including less invasive stabilization system (LISS) and retrograde intramedullary nail fixation.The function of CAD Unigraphics NX and Mimics software was successful in assisting in the treatment of distal femoral fracture with LISS and retrograde intramedullary nail fixation. The operation procedure was actual, visualized, and lifelike. Moreover, the operation effect could be estimated before surgery.The virtual surgery system may improve the reliability and safety of the operative care of distal femoral fracture.
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18
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Gaber RM, Shaheen E, Falter B, Araya S, Politis C, Swennen GRJ, Jacobs R. A Systematic Review to Uncover a Universal Protocol for Accuracy Assessment of 3-Dimensional Virtually Planned Orthognathic Surgery. J Oral Maxillofac Surg 2017. [PMID: 28646644 DOI: 10.1016/j.joms.2017.05.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to systematically review methods used for assessing the accuracy of 3-dimensional virtually planned orthognathic surgery in an attempt to reach an objective assessment protocol that could be universally used. MATERIALS AND METHODS A systematic review of the currently available literature, published until September 12, 2016, was conducted using PubMed as the primary search engine. We performed secondary searches using the Cochrane Database, clinical trial registries, Google Scholar, and Embase, as well as a bibliography search. Included articles were required to have stated clearly that 3-dimensional virtual planning was used and accuracy assessment performed, along with validation of the planning and/or assessment method. Descriptive statistics and quality assessment of included articles were performed. RESULTS The initial search yielded 1,461 studies. Only 7 studies were included in our review. An important variability was found regarding methods used for 1) accuracy assessment of virtually planned orthognathic surgery or 2) validation of the tools used. Included studies were of moderate quality; reviewers' agreement regarding quality was calculated to be 0.5 using the Cohen κ test. CONCLUSIONS On the basis of the findings of this review, it is evident that the literature lacks consensus regarding accuracy assessment. Hence, a protocol is suggested for accuracy assessment of virtually planned orthognathic surgery with the lowest margin of error.
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Affiliation(s)
- Ramy M Gaber
- Assistant Lecturer and Doctoral Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt, and Research Fellow, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium.
| | - Eman Shaheen
- Clinical engineer, OMFS-IMPATH research group, Department of Imaging and Pathology, Catholic University of Leuven & Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Leuven, Belgium
| | - Bart Falter
- Consultant, Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Leuven, Belgium
| | | | - Constantinus Politis
- Professor and Head, Department of Oral and Maxillofacial Surgery, Catholic University of Leuven, Leuven, Belgium
| | - Gwen R J Swennen
- Professor, Maxillofacial and Facial Plastic Surgery, Department of Surgery, Cleft and Craniofacial Centre, Bruges, Belgium, and Three-Dimensional Facial Imaging Research Group, General Hospital St Jan, Bruges, Belgium
| | - Reinhilde Jacobs
- Professor, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
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19
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Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning. Int J Comput Assist Radiol Surg 2017; 12:2129-2143. [PMID: 28432489 DOI: 10.1007/s11548-017-1585-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. METHODS The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. RESULT When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. CONCLUSION We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities.
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20
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Virtual Surgery Planning in Orthomorphic Correction of Mandibular Dysmorphology. J Craniofac Surg 2016; 27:2156-2158. [PMID: 28005777 DOI: 10.1097/scs.0000000000003117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Three-dimensional virtual surgery programs are widely available for orthognathic surgery. The advent of imaging software programs has proved to be useful for diagnosis, treatment planning, outcome measurement, and three-dimensional surgical simulation. Complex maxillofacial malformations continue to present challenges in analysis and correction beyond modern technology. Orthomorphic correction for mandibular dysmorphology refers to basal bone movement without any change in dental component. The purpose of this paper is to present a virtual surgery planning for surgeons to perform the orthomorphic surgery with precision and quantification. Moreover, it provides an essential educational tool for patients to foresee predicted surgical outcome.
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21
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Lee SJ, Woo SY, Huh KH, Lee SS, Heo MS, Choi SC, Han JJ, Yang HJ, Hwang SJ, Yi WJ. Virtual skeletal complex model- and landmark-guided orthognathic surgery system. J Craniomaxillofac Surg 2016; 44:557-68. [PMID: 27012762 DOI: 10.1016/j.jcms.2016.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 01/30/2016] [Accepted: 02/19/2016] [Indexed: 11/26/2022] Open
Abstract
In this study, correction of the maxillofacial deformities was performed by repositioning bone segments to an appropriate location according to the preoperative planning in orthognathic surgery. The surgery was planned using the patient's virtual skeletal models fused with optically scanned three-dimensional dentition. The virtual maxillomandibular complex (MMC) model of the patient's final occlusal relationship was generated by fusion of the maxillary and mandibular models with scanned occlusion. The final position of the MMC was simulated preoperatively by planning and was used as a goal model for guidance. During surgery, the intraoperative registration was finished immediately using only software processing. For accurate repositioning, the intraoperative MMC model was visualized on the monitor with respect to the simulated MMC model, and the intraoperative positions of multiple landmarks were also visualized on the MMC surface model. The deviation errors between the intraoperative and the final positions of each landmark were visualized quantitatively. As a result, the surgeon could easily recognize the three-dimensional deviation of the intraoperative MMC state from the final goal model without manually applying a pointing tool, and could also quickly determine the amount and direction of further MMC movements needed to reach the goal position. The surgeon could also perform various osteotomies and remove bone interference conveniently, as the maxillary tracking tool could be separated from the MMC. The root mean square (RMS) difference between the preoperative planning and the intraoperative guidance was 1.16 ± 0.34 mm immediately after repositioning. After surgery, the RMS differences between the planning and the postoperative computed tomographic model were 1.31 ± 0.28 mm and 1.74 ± 0.73 mm for the maxillary and mandibular landmarks, respectively. Our method provides accurate and flexible guidance for bimaxillary orthognathic surgery based on intraoperative visualization and quantification of deviations for simulated postoperative MMC and landmarks. The guidance using simulated skeletal models and landmarks can complement and improve conventional navigational surgery for bone repositioning in the craniomaxillofacial area.
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Affiliation(s)
- Sang-Jeong Lee
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Sang-Yoon Woo
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology, BK21, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology, BK21, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology, BK21, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, BK21, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, BK21, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Hoon Joo Yang
- Department of Oral and Maxillofacial Surgery, BK21, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Soon Jung Hwang
- Department of Oral and Maxillofacial Surgery, BK21, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea.
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology, BK21, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea.
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22
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Presurgical motivations, self-esteem, and oral health of orthognathic surgery patients. J Craniofac Surg 2015; 24:743-7. [PMID: 23714871 DOI: 10.1097/scs.0b013e318285d5a4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate motivations, self-esteem, and oral health for undergoing orthognathic patients by gender in China before orthognathic surgery. PATIENTS AND METHODS Using a prospective and control study design, 429 subjects in China were collected from December 2010 to May 2011. The patient group consisted of 210 consecutive healthy patients, and 219 young individuals comprised the control group. All the subjects filled out a questionnaire and were assessed by Self-esteem Scale and Oral Health Impact Profile validated for Chinese patients before surgery. To measure the discrepancy, the Student t test was computed. P <0.05 was considered significant. RESULTS In China, major motivations for orthognathic surgery are to improve facial appearance (83.33%), occlusion (50%), and self-confidence (48.1%). Females expect to improve facial appearance (83.87%), self-confidence (43.55%), and occlusion (41.94%). Males are for the improvement of facial appearance (82.56%), occlusion (63.95%), and self-confidence (54.65%). Self-esteem in the patient group is obviously lower (P < 0.01). There is a significant difference of self-esteem in female groups (P < 0.01), but none in male groups. Statistically significant differences were observed on oral health between both sexes. CONCLUSIONS (1) Special attention should be paid on patients' ethnic, economic, cultural, and social aspects. In Chinese orthognathic patients, improving facial appearance is the primary motivation. Self-confidence has been more frequently mentioned, while headache far less than other countries. (2) Female patients have less self-esteem than females in the control group. (3) Patients' oral health are worse than those in the control group.
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23
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Uechi J, Tsuji Y, Konno M, Hayashi K, Shibata T, Nakayama E, Mizoguchi I. Generation of virtual models for planning orthognathic surgery using a modified multimodal image fusion technique. Int J Oral Maxillofac Surg 2015; 44:462-9. [DOI: 10.1016/j.ijom.2014.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 07/29/2014] [Accepted: 11/07/2014] [Indexed: 11/16/2022]
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24
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Lee J, Fingeret MC, Bovik AC, Reece GP, Skoracki RJ, Hanasono MM, Markey MK. Eigen-disfigurement model for simulating plausible facial disfigurement after reconstructive surgery. BMC Med Imaging 2015; 15:12. [PMID: 25885763 PMCID: PMC4396629 DOI: 10.1186/s12880-015-0050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 02/18/2015] [Indexed: 11/14/2022] Open
Abstract
Background Patients with facial cancers can experience disfigurement as they may undergo considerable appearance changes from their illness and its treatment. Individuals with difficulties adjusting to facial cancer are concerned about how others perceive and evaluate their appearance. Therefore, it is important to understand how humans perceive disfigured faces. We describe a new strategy that allows simulation of surgically plausible facial disfigurement on a novel face for elucidating the human perception on facial disfigurement. Method Longitudinal 3D facial images of patients (N = 17) with facial disfigurement due to cancer treatment were replicated using a facial mannequin model, by applying Thin-Plate Spline (TPS) warping and linear interpolation on the facial mannequin model in polar coordinates. Principal Component Analysis (PCA) was used to capture longitudinal structural and textural variations found within each patient with facial disfigurement arising from the treatment. We treated such variations as disfigurement. Each disfigurement was smoothly stitched on a healthy face by seeking a Poisson solution to guided interpolation using the gradient of the learned disfigurement as the guidance field vector. The modeling technique was quantitatively evaluated. In addition, panel ratings of experienced medical professionals on the plausibility of simulation were used to evaluate the proposed disfigurement model. Results The algorithm reproduced the given face effectively using a facial mannequin model with less than 4.4 mm maximum error for the validation fiducial points that were not used for the processing. Panel ratings of experienced medical professionals on the plausibility of simulation showed that the disfigurement model (especially for peripheral disfigurement) yielded predictions comparable to the real disfigurements. Conclusions The modeling technique of this study is able to capture facial disfigurements and its simulation represents plausible outcomes of reconstructive surgery for facial cancers. Thus, our technique can be used to study human perception on facial disfigurement. Electronic supplementary material The online version of this article (doi:10.1186/s12880-015-0050-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juhun Lee
- Department of Electrical and Computer Engineering, The University of Texas at Austin, 2501 Speedway, Stop C0803, Austin, TX, 78712, USA. .,Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Michelle C Fingeret
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. .,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Alan C Bovik
- Department of Electrical and Computer Engineering, The University of Texas at Austin, 2501 Speedway, Stop C0803, Austin, TX, 78712, USA.
| | - Gregory P Reece
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Roman J Skoracki
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Matthew M Hanasono
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, 107 W Dean Keeton St, Stop C0800, Austin, TX, 78712, USA. .,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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A Novel Application of Computer-Aided Design and Manufacturing for Reduction Cranioplasty. J Craniofac Surg 2014; 25:172-6. [DOI: 10.1097/scs.0000000000000385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Habib A, Hisham A. The effect of bone displacement operations on facial soft tissues. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:4911-4. [PMID: 24110836 DOI: 10.1109/embc.2013.6610649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A novel biomechanical model for face soft tissue (skin, mucosa, and muscles) is introduced to investigate the effect of mandible and chin bone displacement on the overall appearance of the patient's face. Nonlinear FE analysis is applied to the model and the results obtained are used to help surgeons to decide the amount of displacement required.
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Foley BD, Thayer WP, Honeybrook A, McKenna S, Press S. Mandibular Reconstruction Using Computer-Aided Design and Computer-Aided Manufacturing: An Analysis of Surgical Results. J Oral Maxillofac Surg 2013; 71:e111-9. [DOI: 10.1016/j.joms.2012.08.022] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/24/2012] [Accepted: 08/24/2012] [Indexed: 11/30/2022]
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Olszewski R. Surgical Engineering in Cranio-Maxillofacial Surgery: A Literature Review. JOURNAL OF HEALTHCARE ENGINEERING 2012. [DOI: 10.1260/2040-2295.3.1.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
Bone sawing skill demands a high level of dexterity from the surgeon that can be achieved only with a lot of training. Sawing is a basic skill required in many procedures, such as: osteotomy, ostectomy, amputation and arthroplasty surgery. Inefficient sawing can lead in orthognathic surgery to nerve lesion, bad split and non-union. Using virtual reality technology this complications can be reduced, by training the students on simulators until they assimilate the skill. This paper presents an early prototype for a bone sawing simulator in orthognathic surgery. A voxel-based mandible model obtained from a Computer Tomography is cut by removing the voxels that are inside the saw blade. The collision detection is based on hierarchical bounding volumes. The removal process is observed both visually and haptically.
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Gateno J, Xia JJ, Teichgraeber JF. New Methods to Evaluate Craniofacial Deformity and to Plan Surgical Correction. Semin Orthod 2011; 17:225-234. [PMID: 21927548 DOI: 10.1053/j.sodo.2011.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The success of cranio-maxillofacial (CMF) surgery depends not only on surgical techniques, but also upon an accurate surgical plan. Unfortunately, traditional planning methods are often inadequate for planning complex cranio-maxillofacial deformities. To this end, we developed 3D computer-aided surgical simulation (CASS) technique. Using our CASS method, we are able to treat patients with significant asymmetries in a single operation which in the past was usually completed in two stages. The purpose of this article is to introduce our CASS method in evaluating craniofacial deformities and planning surgical correction. In addition, we discuss the problems associated with the traditional surgical planning methods. Finally, we discuss the strength and pitfalls of using three-dimensional measurements to evaluate craniofacial deformity.
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Affiliation(s)
- Jaime Gateno
- Chairman, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX; Professor of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY; and Associate Professor, Department of Pediatric Plastic Surgery, The University of Texas Health Science Center at Houston, TX
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Aboul-Hosn Centenero S, Hernández-Alfaro F. 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results - our experience in 16 cases. J Craniomaxillofac Surg 2011; 40:162-8. [PMID: 21458285 DOI: 10.1016/j.jcms.2011.03.014] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 12/23/2010] [Accepted: 03/01/2011] [Indexed: 11/29/2022] Open
Abstract
The aim of this article is to determine the advantages of 3D planning in predicting postoperative results and manufacturing surgical splints using CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology in orthognathic surgery when the software program Simplant OMS 10.1 (Materialise(®), Leuven, Belgium) was used for the purpose of this study which was carried out on 16 patients. A conventional preoperative treatment plan was devised for each patient following our Centre's standard protocol, and surgical splints were manufactured. These splints were used as study controls. The preoperative treatment plans devised were then transferred to a 3D-virtual environment on a personal computer (PC). Surgery was simulated, the prediction of results on soft and hard tissue produced, and surgical splints manufactured using CAD/CAM technology. In the operating room, both types of surgical splints were compared and the degree of similitude in results obtained in three planes was calculated. The maxillary osteotomy line was taken as the point of reference. The level of concordance was used to compare the surgical splints. Three months after surgery a second set of 3D images were obtained and used to obtain linear and angular measurements on screen. Using the Intraclass Correlation Coefficient these postoperative measurements were compared with the measurements obtained when predicting postoperative results. Results showed that a high degree of correlation in 15 of the 16 cases. A high coefficient of correlation was obtained in the majority of predictions of results in hard tissue, although less precise results were obtained in measurements in soft tissue in the labial area. The study shows that the software program used in the study is reliable for 3D planning and for the manufacture of surgical splints using CAD/CAM technology. Nevertheless, further progress in the development of technologies for the acquisition of 3D images, new versions of software programs, and further studies of objective data are necessary to increase precision in computerised 3D planning.
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Affiliation(s)
- Samir Aboul-Hosn Centenero
- Instituto de Cirugía Maxilofacial e Implantología, Clínica Teknon, C/Vilana, 12, Office 185, 08022 Barcelona, Spain.
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Gateno J, Xia JJ, Teichgraeber JF. New 3-dimensional cephalometric analysis for orthognathic surgery. J Oral Maxillofac Surg 2011; 69:606-22. [PMID: 21257250 PMCID: PMC3059215 DOI: 10.1016/j.joms.2010.09.010] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 09/22/2010] [Indexed: 11/23/2022]
Abstract
Two basic problems have been associated with traditional 2-dimensional cephalometry. First, many important parameters cannot be measured on plain cephalograms; and second, most 2-dimensional cephalometric measurements are distorted in the presence of facial asymmetry. Three-dimensional cephalometry, which has been facilitated by the introduction of cone-beam computed tomography, can solve these problems. However, before this can be realized, fundamental problems must be solved. These include the unreliability of internal reference systems and some 3-dimensional measurements, and the lack of tools to assess and measure the symmetry. In the present report, we present a new 3-dimensional cephalometric analysis that uses different geometric approaches to solve these fundamental problems. The present analysis allows the accurate measurement of the size, shape, position, and orientation of the different facial units and incorporates a novel method to measure asymmetry.
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Affiliation(s)
- Jaime Gateno
- Chairman, Department of Oral and Maxillofacial Surgery, The Methodist Hospital, Houston, TX; Professor of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY; and Associate Professor, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX
| | - James J. Xia
- Director of Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX; Associate Professor of Surgery (Oral and Maxillofacial Surgery), Weill Medicine College, Cornell University, New York, NY; Associate Professor, Departments of Pediatric Surgery and Orthodontics, The University of Texas Health Science Center at Houston, TX
| | - John F. Teichgraeber
- Professor and Chief, Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX
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Chang YB, Xia JJ, Gateno J, Xiong Z, Zhou X, Wong STC. An automatic and robust algorithm of reestablishment of digital dental occlusion. IEEE TRANSACTIONS ON MEDICAL IMAGING 2010; 29:1652-1663. [PMID: 20529735 PMCID: PMC5668907 DOI: 10.1109/tmi.2010.2049526] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In the field of craniomaxillofacial (CMF) surgery, surgical planning can be performed on composite 3-D models that are generated by merging a computerized tomography scan with digital dental models. Digital dental models can be generated by scanning the surfaces of plaster dental models or dental impressions with a high-resolution laser scanner. During the planning process, one of the essential steps is to reestablish the dental occlusion. Unfortunately, this task is time-consuming and often inaccurate. This paper presents a new approach to automatically and efficiently reestablish dental occlusion. It includes two steps. The first step is to initially position the models based on dental curves and a point matching technique. The second step is to reposition the models to the final desired occlusion based on iterative surface-based minimum distance mapping with collision constraints. With linearization of rotation matrix, the alignment is modeled by solving quadratic programming. The simulation was completed on 12 sets of digital dental models. Two sets of dental models were partially edentulous, and another two sets have first premolar extractions for orthodontic treatment. Two validation methods were applied to the articulated models. The results show that using our method, the dental models can be successfully articulated with a small degree of deviations from the occlusion achieved with the gold-standard method.
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Affiliation(s)
- Yu-Bing Chang
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77841 USA
| | - James J. Xia
- Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, and Department of Surgery (Oral and Maxillofacial Surgery), Weil Medical College of Cornell University, Houston, TX 77030 USA and also with Departments of Pediatric Surgery and Orthodontics, University of Texas Health Science Center, Houston, TX 77030 USA
| | - Jaime Gateno
- Department of Oral and Maxillofacial Surgery, the Methodist Hospital Research Institute, and Department of Surgery (Oral and Maxillofacial Surgery), Weil Medical College of Cornell University, Houston, TX 77030 USA
| | - Zixiang Xiong
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77841 USA
| | | | - Stephen T. C. Wong
- Center for Biotechnology and Informatics, The Methodist Hospital Research Institute and Department of Radiology, The Methodist Hospital, Weill Medical College of Cornell University, Houston, TX 77030 USA
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Xia JJ, Gateno J, Teichgraeber JF. New clinical protocol to evaluate craniomaxillofacial deformity and plan surgical correction. J Oral Maxillofac Surg 2009; 67:2093-106. [PMID: 19761903 PMCID: PMC2763487 DOI: 10.1016/j.joms.2009.04.057] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 03/26/2009] [Accepted: 04/21/2009] [Indexed: 11/28/2022]
Affiliation(s)
- James J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Methodist Hospital Research Institute, Houston, TX 77030, USA.
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Abstract
Three-dimensional (3D) laser surface scanning analysis has taken hold in orthodontics, as well as craniomaxillofacial and plastic surgery as a new tool that can navigate away from the limitations of conventional two-dimensional methods. Various techniques for 3D reconstruction of the face have been used in diagnosis, treatment planning and simulation, and outcomes follow-up. The aim of the current prospective study was to present some technical aspects for the assessment of facial changes after orthodontic and orthognathic surgery treatment using 3D laser surface scanning. The technique proposed for facial surface shape analysis represented three-dimensionally the expected surgical changes, and the reduction of the postoperative swelling was verified. This study provides technical information from the data collection to the 3D virtual soft-tissue analysis that can be useful for diagnostic information, treatment planning, future comparisons of treatment stability or facial postoperative swelling, and soft-tissue profile assessment.
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Kaipatur N, Al-Thomali Y, Flores-Mir C. Accuracy of Computer Programs in Predicting Orthognathic Surgery Hard Tissue Response. J Oral Maxillofac Surg 2009; 67:1628-39. [DOI: 10.1016/j.joms.2009.03.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
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Widmann G, Stoffner R, Bale R. Errors and error management in image-guided craniomaxillofacial surgery. ACTA ACUST UNITED AC 2009; 107:701-15. [DOI: 10.1016/j.tripleo.2009.02.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 12/15/2022]
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Xia JJ, Gateno J, Teichgraeber JF. A new paradigm for complex midface reconstruction: a reversed approach. J Oral Maxillofac Surg 2009; 67:693-703. [PMID: 19231805 DOI: 10.1016/j.joms.2008.08.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 08/08/2008] [Indexed: 11/27/2022]
Affiliation(s)
- James J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX, USA.
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Three-dimensional imaging for virtual assessment and treatment simulation in orthognathic surgery. Oral Maxillofac Surg Clin North Am 2008; 19:287-309, v. [PMID: 18088886 DOI: 10.1016/j.coms.2007.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Conventional two-dimensional imaging for assessing and treatment planning orthognathic surgery has limitations. Three-dimensional imaging offers the ability to more accurately portray maxillofacial anatomy. Three-dimensional CT-based models can be generated for assessment of the dentofacial deformity. Interactive software can simulate surgical moves and algorithms can predict the three-dimensional soft tissue changes that will occur. This will inevitably effect diagnosis and treatment planning for orthognathic surgery in the future.
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Tsai MD, Hsieh MS, Tsai CH. Bone drilling haptic interaction for orthopedic surgical simulator. Comput Biol Med 2007; 37:1709-18. [PMID: 17568576 DOI: 10.1016/j.compbiomed.2007.04.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 03/08/2007] [Accepted: 04/11/2007] [Indexed: 11/25/2022]
Abstract
Drilling procedure is widely used in orthopedic surgery to position reduced fractured bones and prosthetic components. However, successful execution of bone drilling requires a high level of dexterity and experience, because the drilling resistance is large and sometimes vibrates violently to difficultly grasp the hand-piece or even break the slender drill. This paper introduces haptic functions that are added to a volume based surgical simulator to simulate the drilling process. These haptic functions compute drilling forces and torques based on reliable metal removing theorem. Therefore, accurate prediction for the drilling process can be obtained to provide effective surgery training and rehearsal. A simulation example of screw and plate surgery for positioning the hip trochanter fracture illustrates the practicality and versatility of the proposed method.
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Affiliation(s)
- Ming-Dar Tsai
- Institute of Information and Computer Engineering, Chung Yuan Christian University, Chung Li 32023, Taiwan, ROC.
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Chapuis J, Schramm A, Pappas I, Hallermann W, Schwenzer-Zimmerer K, Langlotz F, Caversaccio M. A new system for computer-aided preoperative planning and intraoperative navigation during corrective jaw surgery. ACTA ACUST UNITED AC 2007; 11:274-87. [PMID: 17521077 DOI: 10.1109/titb.2006.884372] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A new system for computer-aided corrective surgery of the jaws has been developed and introduced clinically. It combines three-dimensional (3-D) surgical planning with conventional dental occlusion planning. The developed software allows simulating the surgical correction on virtual 3-D models of the facial skeleton generated from computed tomography (CT) scans. Surgery planning and simulation include dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and segment repositioning. By coupling the software with a tracking system and with the help of a special registration procedure, we are able to acquire dental occlusion plans from plaster model mounts. Upon completion of the surgical plan, the setup is used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with the help of a display showing jaw positions and 3-D positioning guides updated in real time during the surgical procedure. The proposed approach offers the advantages of 3-D visualization and tracking technology without sacrificing long-proven cast-based techniques for dental occlusion evaluation. The system has been applied on one patient. Throughout this procedure, we have experienced improved assessment of pathology, increased precision, and augmented control.
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Affiliation(s)
- Jonas Chapuis
- MEM Research Center, Institute for Surgical Technology and Biomechanics, University of Berne, 3014 Berne, Switzerland.
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Gateno J, Xia JJ, Teichgraeber JF, Christensen AM, Lemoine JJ, Liebschner MAK, Gliddon MJ, Briggs ME. Clinical Feasibility of Computer-Aided Surgical Simulation (CASS) in the Treatment of Complex Cranio-Maxillofacial Deformities. J Oral Maxillofac Surg 2007; 65:728-34. [PMID: 17368370 DOI: 10.1016/j.joms.2006.04.001] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to establish clinical feasibility of our 3-dimensional computer-aided 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. RESULTS All 5 patients were successfully planned using our CASS planning method. The computer-generated surgical splints were successfully used on all patients at the time of the surgery. The backup acrylic surgical splints and plans were never used. Six-week postoperative CT scans showed the surgical plans were precisely reproduced in the operating room and the deformities were corrected as planned. CONCLUSION The results of this study have shown the clinical feasibility of our CASS planning method. Using our CASS method, we were able to treat patients with significant asymmetries in a single operation that in the past was usually completed in 2 stages. We were also able to simulate different surgical procedures to create the appropriate plan. The computerized surgical plan was then transferred to the patient in the operating room using computer-generated surgical splints.
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Affiliation(s)
- Jaime Gateno
- Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX, USA
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Sarti A, Lamberti C, Gori R, Erbacci G, Bassani L, Bianchi A, Marchetti C. Virtual Planning of Facial Reconstructions. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1617-0830.2007.00089.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nakao M, Kuroda T, Oyama H, Sakaguchi G, Komeda M. Physics-based simulation of surgical fields for preoperative strategic planning. J Med Syst 2007; 30:371-80. [PMID: 17069000 DOI: 10.1007/s10916-006-9021-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although careful planning of surgical approach is a key for success of surgery, conventional planning and simulation tools cannot support detailed discussion. This issue is derived from the difficulty of estimating complex physical behavior of soft tissues provided by a series of surgical procedures like cutting and deformation. This paper proposes an adaptive physics-based framework that simulates both interactive cutting and accurate deformation on virtual bodies, and performs preoperative planning for supporting strategic discussion. We focus on limited use of the two models: A particle-based model and an FEM-based model considering required quality and performance in different situations. FEM-based deformation of incision accurately produces estimated surgical fields. Based on the framework, a strategic planning system was developed for supporting decision of surgical approach using 3D representation of the surgical fields. We applied clinical CT dataset of an aortic aneurysm case to the system. Some experiments and usability tests confirmed that the system contributes to grasping 3D shape and location of the target organs and performs detailed discussion on patient-specific surgical approaches.
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Affiliation(s)
- Megumi Nakao
- Graduate School of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, Japan.
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Widmann G. Image-guided surgery and medical robotics in the cranial area. Biomed Imaging Interv J 2007; 3:e11. [PMID: 21614255 PMCID: PMC3097655 DOI: 10.2349/biij.3.1.e11] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 02/21/2007] [Indexed: 11/17/2022] Open
Abstract
Surgery in the cranial area includes complex anatomic situations with high-risk structures and high demands for functional and aesthetic results. Conventional surgery requires that the surgeon transfers complex anatomic and surgical planning information, using spatial sense and experience. The surgical procedure depends entirely on the manual skills of the operator. The development of image-guided surgery provides new revolutionary opportunities by integrating presurgical 3D imaging and intraoperative manipulation. Augmented reality, mechatronic surgical tools, and medical robotics may continue to progress in surgical instrumentation, and ultimately, surgical care. The aim of this article is to review and discuss state-of-the-art surgical navigation and medical robotics, image-to-patient registration, aspects of accuracy, and clinical applications for surgery in the cranial area.
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Affiliation(s)
- G Widmann
- Department of Radiology, Innsbruck Medical University, Anichstr, Austria
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Xia JJ, Phillips CV, Gateno J, Teichgraeber JF, Christensen AM, Gliddon MJ, Lemoine JJ, Liebschner MAK. Cost-Effectiveness Analysis for Computer-Aided Surgical Simulation in Complex Cranio-Maxillofacial Surgery. J Oral Maxillofac Surg 2006; 64:1780-4. [PMID: 17113445 DOI: 10.1016/j.joms.2005.12.072] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 11/18/2005] [Accepted: 12/27/2005] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study is to assess the costs and benefits of computer-aided surgical simulation (CASS) and to compare it with the current surgical planning methods for complex cranio-maxillofacial (CMF) surgery. MATERIALS AND METHODS The comparison of methods applies to all CMF surgeries where the patient's condition is severe enough to undergo a computed tomography scan and a stereolithographic model is necessary for the surgical planning process. The costs for each method can be divided into time and other costs. The time was estimated based on the authors' experience as well as on a survey of a small group of 6 experienced CMF surgeons in the United States. The other costs were estimated based on the authors' experience. RESULTS CASS has lower costs in terms of surgeon time, patient time, and material costs. Specifically, total surgeon hours spent in planning are 5.25 hours compared with 9.75 for current standard methods. Material and scanning costs are Dollars 1,900 for CASS compared with about Dollars 3,510 for standard methods. Patient time for planning is reduced from 4.75 hours to 2.25 hours with CASS. The reduction in both time and other costs remains when the fixed fee costs of CASS are added to the variable costs. Amortized across the 600 patients per year (1,800 for the assumed 3-year life of the training and software), this adds only a few dollars and a fraction of an hour per surgery. Even in the case of a small clinic when the cost is amortized for 6 patients per year (18 patients for the assumed 3-year life of the training and software), the per surgery costs (9.65 hours and Dollars 2,456) will still favor CASS. CONCLUSION Any great new design should consist of at least 2 of the 3 following features: faster, cheaper, and better outcome. This analysis demonstrates that CASS is faster and less costly than the current standard planning methods for complex CMF surgery. Previous studies have also shown that CASS results in better surgical outcomes. Thus, in all regards, CASS appears to be at least as good as the current methods of surgical planning.
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Affiliation(s)
- James J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX, USA.
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Uechi J, Okayama M, Shibata T, Muguruma T, Hayashi K, Endo K, Mizoguchi I. A novel method for the 3-dimensional simulation of orthognathic surgery by using a multimodal image-fusion technique. Am J Orthod Dentofacial Orthop 2006; 130:786-98. [PMID: 17169742 DOI: 10.1016/j.ajodo.2006.03.025] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 02/24/2006] [Accepted: 03/07/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of this study was to establish a novel method for simulating orthognathic surgery in 3-dimensional (3D) space. METHODS This system mainly consists of 6 procedures: (1) reconstruction of a virtual skull model (VS) from presurgical computed tomography scans; (2) reconstruction of virtual dentition models from 3D surface scanning of dental casts occluded at presurgical and postsurgical intercuspal positions (VD1 and VD2, respectively); (3) reconstruction of a preliminary fusion model of VS and VD1 by an initial intermodality registration; (4) reconstruction of another preliminary fusion model of VS, VD1, and VD2 by a second intramodality registration; (5) repositioning of bony segments by a third intramodality registration and reconstruction of final fusion models at presurgery and postsurgery; and (6) 3D analysis of the movement of bony segments. To test this system, 2 patients with severe skeletal deformities, who had undergone presurgical orthodontic treatment, were used as models. Registration accuracy was determined by the root mean squared distance between the corresponding fiducial markers in a set of 2 images. RESULTS AND CONCLUSIONS The sum of the root mean squared error of the 3 registration processes was less than 0.4 mm in both patients. This simulation system could be used to precisely realize the presurgical and postsurgical occlusal relationships and craniofacial morphology of a patient with severe skeletal deformities, and to quantitatively describe the movement of a given anatomical point of bony segments. It is assumed that there could be significant benefits in sharing visual and quantitative 3D information from this simulation system among orthodontists and surgeons.
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Affiliation(s)
- Jun Uechi
- Department of Orthodontics, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-tobetsu, Japan.
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Meller S, Nkenke E, Kalender WA. Statistical face models for the rediction of soft-tissue deformations after orthognathic osteotomies. ACTA ACUST UNITED AC 2006; 8:443-50. [PMID: 16685990 DOI: 10.1007/11566489_55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This paper describes a technique to approximately predict the facial morphology after standardized orthognathic ostoetomies. The technique only relies on the outer facial morphology represented as a set of surface points and does not require computed tomography (CT) images as input. Surface points may either be taken from 3D surface scans or from 3D positions palpated on the face using a tracking system. The method is based on a statistical model generated from a set of pre- and postoperative 3D surface scans of patients that underwent the same standardized surgery. The model contains both the variability of preoperative facial morphologies and the corresponding postoperative deformations. After fitting the preoperative part to 3D data from a new patient the preoperative face is approximated by the model and the preiction of the postoperative morphology can be extracted at the same time. We built a model based on a set of 15 patient data sets and tested the predictive power in leave-one-out tests for a set of relevant cephalometric landmarks. The average prediction error was found to be between 0.3 and 1.2 mm at all important facial landmarks in the relevant areas of upper and lower jaw. Thus the technique provides an easy and powerful way of prediction which avoids time, cost and radiation required by other prediction techniques such as those based on CT scans.
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Affiliation(s)
- Sebastian Meller
- Institute of Medical Physics, University of Erlangen-Nürnberg, Germany.
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Kau CH, Zhurov A, Richmond S, Cronin A, Savio C, Mallorie C. Facial templates: a new perspective in three dimensions. Orthod Craniofac Res 2006; 9:10-7. [PMID: 16420270 DOI: 10.1111/j.1601-6343.2006.00359.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This paper describes the use of adult facial template in gender-specific facial analysis. SUBJECTS AND METHODS Eighty adults, mean age 24.5, were selected for the study. Laser-scanned images of the subjects were obtained under a reproducible and controlled environment with two Minolta Vivid 900 (Osaka, Japan) optical laser-scanning devices assembled as a stereo-pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 s. These scanned images were processed and merged to form a composite three-dimensional soft tissue reproduction of the subjects using commercially available reverse modelling software. The differences in facial morphology were measured using shell deviation colour maps. The facial template was used to compare differences between males vs. females groups and two subjects with facial disproportions. RESULTS The difference between the male and female facial templates was 1.28 +/- 1.02 mm. The areas of greatest deviation were at the nasal, zygomatic area and lower jaw line. The results of the surface deviation maps between the templates and subjects with facial disproportion showed that the results could be applied for orthodontic diagnosis. CONCLUSIONS The construction of the adult facial templates provides an interesting perspective into measuring changes in groups of patients and also acts as a useful template for the comparison of skeletal disproportion.
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Affiliation(s)
- C H Kau
- Department of Dental Health and Biological Sciences, Wales College of Medicine, Biology, Health and Life Sciences, Cardiff University, Cardiff, UK.
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