Three-dimensional planning in craniomaxillofacial surgery

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Abstract

Introduction:

Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results.

Materials and Methods:

We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic). The treatment protocol is exposed step by step from virtual planning, design, and printing of the cutting and positioning guides to patients’ outcomes.

Conclusions:

3D planning reduces the surgical time and allows predicting possible difficulties and complications. On the other hand, it increases preoperative planning time and needs a learning curve. The only drawback is the cost of the procedure. At present, the additional preoperative work can be justified because of surgical time reduction and more predictable results. In the future, the cost and time investment will be reduced. 3D planning is here to stay. It is already a fact in craniofacial surgery and the investment is completely justified by the risk reduction and precise results.

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Most cited references 12

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Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging.

Gwen R.J. Swennen, Wouter Mollemans, Filip Schutyser (2009)

The aim of this report was to present an integrated 3-dimensional (3D) virtual approach toward cone-beam computed tomography-based treatment planning of orthognathic surgery in the clinical routine. We have described the different stages of the workflow process for routine 3D virtual treatment planning of orthognathic surgery: 1) image acquisition for 3D virtual orthognathic surgery; 2) processing of acquired image data toward a 3D virtual augmented model of the patient's head; 3) 3D virtual diagnosis of the patient; 4) 3D virtual treatment planning of orthognathic surgery; 5) 3D virtual treatment planning communication; 6) 3D splint manufacturing; 7) 3D virtual treatment planning transfer to the operating room; and 8) 3D virtual treatment outcome evaluation. The potential benefits and actual limits of an integrated 3D virtual approach for the treatment of the patient with a maxillofacial deformity are discussed comprehensively from our experience using 3D virtual treatment planning clinically.

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3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results - our experience in 16 cases.

Samir Aboul-hosn Centenero, Federico Hernández-Alfaro (2012)

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. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

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Clinical feasibility of computer-aided surgical simulation (CASS) in the treatment of complex cranio-maxillofacial deformities.

Jaime Gateno, James J Xia, John F Teichgraeber … (2007)

The purpose of this study was to establish clinical feasibility of our 3-dimensional computer-aided surgical simulation (CASS) for complex craniomaxillofacial surgery. 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. 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. 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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Author and article information

Journal

Journal ID (nlm-ta): Ann Maxillofac Surg

Journal ID (iso-abbrev): Ann Maxillofac Surg

Journal ID (publisher-id): AMS

Title: Annals of Maxillofacial Surgery

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2231-0746

ISSN (Electronic): 2249-3816

Publication date (Print): Jul-Dec 2016

Volume: 6

Issue: 2

Pages: 281-286

Affiliations

[1]Department of Pediatric Surgery, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain

[1 ]Department of Pediatric Anesthesiology, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain

[2 ]Department of Neurosurgery, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain

[3 ]Department of Orthodontics, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Barcelona, Spain

Author notes

Address for correspondence: Dr. Josep Rubio-Palau, Department of Pediatric Surgery, Hospital Sant Joan de Déu (Barcelona Children's Hospital), Passeig Sant Joan de Déu, 2. 08950 Esplugues de Llobregat, Barcelona, Spain. E-mail: jrubiop@ 123456sjdhospitalbarcelona.org

Article

Publisher ID: AMS-6-281

DOI: 10.4103/2231-0746.200322

PMC ID: 5343642

PubMed ID: 28299272

SO-VID: 12191c2f-4cd0-48d4-a5e5-449e8742830e

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Three-dimensional planning in craniomaxillofacial surgery

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Abstract

Introduction:

Materials and Methods:

Conclusions:

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 12

Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging.

3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results - our experience in 16 cases.

Clinical feasibility of computer-aided surgical simulation (CASS) in the treatment of complex cranio-maxillofacial deformities.

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