Three-dimensional virtual-reality surgical planning and soft-tissue prediction for orthognathic surgery

Volume Manipulations for Simulating Bone and Joint Surgery

Bone and joint surgery is widely used in orthopedic, oral, and maxillofacial, and dental and plasty departments to correct bone and joint pathology such as bone and joint tumors and fractures, and skeletal morphological deformities. This article presents a voxel structure to represent topologically and geometrically correct surfaces and algorithms to accurately compute intersections of tool swept surfaces with bones based on this voxel structure. This article then presents various volume manipulation algorithms to operate on virtual bones, bone grafts, and prostheses for bone and joint surgery simulations. A complicated knee arthroplasty illustrates the practicality and versatility of the proposed method.

Computer aided surgical reconstruction after complex facial burn injuries – opportunities and limitations

In severe facial burn injuries with extensive destruction of anatomical structures, cosmetic and functional outcome of treatment are frequently not satisfactory. Although operative therapy is being continuously refined, the variety and proximity of structures in the facial region is considered a major challenge in reconstructive surgery. We present the case of a 16-year-old patient with a severe facial burn injury. In planning the reconstructive procedures, we used a multimodal approach employing data from computerized tomography imaging, as well as from surface laser scanning, which provided three-dimensional visualization of facial soft tissues. Amount and pattern of structural loss could thus be determined more precisely and studied more vividly than by inspection of two-dimensional imaging alone. Anatomical features to be reconstructed could be projected onto the skin area of the prelaminated vertical rectus abdominis muscle (VRAM) flap that has been chosen to cover the defect. Prior to surgery, correction of the defects was simulated and the results of the virtual procedure superimposed on a three-dimensional head model of the patient. Tissue elasticity and thickness of the flap, however, could not be ascertained in advance, indicating the limitations of the method.

Craniofacial applications of three-dimensional laser surface scanning

Recent innovations in technology have generated a variety of techniques for medical imaging. One of these initially developed for industry is laser surface scanning. Laser surface scanning is a noninvasive method for acquiring three-dimensional (3D) images. In this article, the technology of 3D laser surface scanning is described, and a few applications are reported as it relates to craniofacial research and clinical practice. Advantages and disadvantages of this imaging modality are discussed. Three-dimensional laser surface scanning holds great promise as it relates to the documentation, analysis, and evaluation of treatment results in craniofacial anomalies.

Collagen fiber angle in the submucosa of small intestine and its application in gastroenterology

AIM: To propose a simple and effective method suitable for analyzing the angle and distribution of 2-dimensional collagen fiber in larger sample of small intestine and to investigate the relationship between the angles of collagen fiber and the pressure it undergoes.

METHODS: A kind of 2-dimensional visible quantitative analyzing technique was described. Digital image-processing method was utilized to determine the angle of collagen fiber in parenchyma according to the changes of area analyzed and further to investigate quantitatively the distribution of collagen fiber. A series of intestinal slice’s images preprocessed by polarized light were obtained with electron microscope, and they were processed to unify each pixel. The approximate angles between collagen fibers were obtained via analyzing the images and their corresponding polarized light. The relationship between the angles of collagen fiber and the pressure it undergoes were statistically summarized.

RESULTS: The angle of collagen fiber in intestinal tissue was obtained with the quantitative analyzing method of calculating the ratio of different pixels. For the same slice, with polarized light angle’s variation, the corresponding ratio of different pixels was also changed; for slices under different pressures, the biggest ratio of collagen fiber area was changed either.

CONCLUSION: This study suggests that the application of stress on the intestinal tissue will change the angle and content of collagen fiber. The method of calculating ratios of different pixel values to estimate collagen fiber angle was practical and reliable. The quantitative analysis used in the present study allows a larger area of soft tissue to be analyzed with relatively low cost and simple equipment.

Haptic reproduction and interactive visualization of a beating heart for cardiovascular surgery simulation

This paper aims to achieve haptic reproduction and real-time visualization of a beating heart for cardiac surgery simulation. Unlike most forgoing approaches, the authors focus on time series datasets and propose a new framework for interactive simulation of active tissues. The framework handles both detection and response of collisions between a manipulator and a beating virtual heart. Physics-based force feedback of autonomous cardiac motion is also produced based on a stress-pressure model, which is adapted to elastic objects filled with fluid. Time series datasets of an adult man were applied to an integrated simulation system with a force feedback device. The system displays multi-dimensional representation of a beating heart and provides a basic training environment for surgical palpation. Finally, results of measurement and medical assessment confirm the achieved quality and performance of the presented framework.

Biomedical technology revolution: opportunities and challenges for oral and maxillofacial surgeons

During this 45-minute presentation, I have tried to describe my vision of the exciting future that awaits us. I have tried to impart my enthusiasm for the opportunities provided to us as surgeons by the advances in molecular biology and genetics, imaging, surgical technology and bioinformatics. Most of all, I hope I have transmitted my optimism for the future to our younger members. I think the following statement or observation by the great educator Margaret Mead accurately summarizes our current situation regarding the application of all this new knowledge that will become available to us as surgeons: 'We are now at the point where we must educate people (surgeons) in what nobody knew yesterday, and prepare in our schools (training programs) for what no one knows yet but what some people must know tomorrow.'