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Saigo L, Schrader F, Rana M, Wilkat M. 3-Dimensional accuracy of navigation-guided bimaxillary orthognathic surgery: A systematic review and meta-analysis. J Craniomaxillofac Surg 2024:S1010-5182(24)00235-X. [PMID: 39232862 DOI: 10.1016/j.jcms.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 05/01/2024] [Accepted: 08/19/2024] [Indexed: 09/06/2024] Open
Abstract
The transfer of a virtual orthognathic surgical plan to the patient still relies on the use of occlusal splints, which have limitations for vertical positioning of the maxilla. The use of real-time navigation has been proposed to enhance surgical accuracy. This systematic review (PROSPERO CRD42024497588) aimed to investigate if surgical navigation can improve the three-dimensional accuracy of orthognathic surgery. The inclusion criteria were orthognathic surgery, use of intra-operative navigation and quantitative assessment of surgical accuracy. The exclusion criteria were non-bimaxillary orthognathic surgeries, non-clinical studies, studies without post-operative 3D analysis and publications not in the English language. A search of PubMed, Embase and Cochrane Library generated 940 records, of which 12 were found relevant. Risk of bias was assessed done using the Joanna Briggs Institute Critical Appraisal Checklist Tool. Among the included studies, there were nine of observational character and three randomized control studies (RCTs). All studies demonstrated promising outcomes with reported good surgical accuracy within a 2 mm difference between the planned and post-surgical result. Meta-analysis of two RCTs was carried out and results were in favor of surgical navigation with a total odds ratio of 4.44 [2.11, 9.37] and an overall effect outcome of Z = 3.92 (p < 0.0001). Navigation was up to 0.60 mm more accurate than occlusal wafers only (p < 0.001). However, there were variations in the application of surgical navigation and methods of analysis, leading to a heterogenous data set. Future studies should focus on standardized protocols and analysis methods to further validate the use of surgical navigation in orthognathic surgery. Despite some limitations, surgical navigation shows potential as a valuable tool in improving the accuracy of orthognathic surgery.
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Affiliation(s)
- Leonardo Saigo
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore.
| | - Felix Schrader
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich-Heine University Hospital, Dusseldorf, Germany
| | - Majeed Rana
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich-Heine University Hospital, Dusseldorf, Germany
| | - Max Wilkat
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich-Heine University Hospital, Dusseldorf, Germany
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Han W, Yichi Z, Kim BS, Sun M, Chai G. Correcting facial asymmetry through guided plate assisted mandibular angle osteotomy. Front Surg 2024; 11:1391231. [PMID: 39149133 PMCID: PMC11324470 DOI: 10.3389/fsurg.2024.1391231] [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: 02/25/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024] Open
Abstract
Background Asian women prefer a smooth and narrowed mandibular appearance. The purpose of the retrospective cohort study is to evaluate guide plate-assisted mandibular angle ostectomy (MAO) in improving mandibular symmetry for Asian female patients with mandibular angle hypertrophy (MAH) with normal occlusal relationship. Methods We retrospectively examined 11 patients with asymmetry MAH with normal occlusal relationship who received MAO at Shanghai Ninth People's Hospital between September, 2020, and January, 2022. Preoperative plans were designed based on CT data and executed using metal guide plate during the operation. Preoperative and one-week postoperative CT scans were used to assess measurements including Height_Go, Divergence_Go, ∠ZyZy-GoGo, and osteotomy volume, to evaluate symmetry. For precision, compare the postoperative CT with the preoperative design, assessing osteotomy distance, angle, and volume error. Patient satisfacation was evaluated with Likert Scale in 6-month follow-up. Secondary lipofilling procedures were given as appropriate. Statistical analysis was performed using paired t-tests in SPSS. Results The mean age of the 11 patients was 28.5 years (range 23-34 years). 2 of these underwent lipofilling procedures. No complications were observed during the following-up. Postoperative results were not statistically different from the design, demonstrating a precision of within 2 mm. Height_Go disparity within 5 mm get corrected notably, reducing asymmetry from 15.09% preoperatively to 2.74% postoperatively. Patients satisfaction was rated at 4.5 out of 5 in 6 month follow-up. Conclusions Guide plate-assisted mandibular angle osteotomies achieve effective and precise surgery. This approach demonstrates a safe option for correction for mandibular asymmetry, achieving patient satisfaction.
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Affiliation(s)
- Wenqing Han
- Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhang Yichi
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Byeong Seop Kim
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mengzhe Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Aweeda M, Adegboye F, Yang SF, Topf MC. Enhancing Surgical Vision: Augmented Reality in Otolaryngology-Head and Neck Surgery. JOURNAL OF MEDICAL EXTENDED REALITY 2024; 1:124-136. [PMID: 39091667 PMCID: PMC11290041 DOI: 10.1089/jmxr.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 08/04/2024]
Abstract
Augmented reality (AR) technology has become widely established in otolaryngology-head and neck surgery. Over the past 20 years, numerous AR systems have been investigated and validated across the subspecialties, both in cadaveric and in live surgical studies. AR displays projected through head-mounted devices, microscopes, and endoscopes, most commonly, have demonstrated utility in preoperative planning, intraoperative guidance, and improvement of surgical decision-making. Specifically, they have demonstrated feasibility in guiding tumor margin resections, identifying critical structures intraoperatively, and displaying patient-specific virtual models derived from preoperative imaging, with millimetric accuracy. This review summarizes both established and emerging AR technologies, detailing how their systems work, what features they offer, and their clinical impact across otolaryngology subspecialties. As AR technology continues to advance, its integration holds promise for enhancing surgical precision, simulation training, and ultimately, improving patient outcomes.
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Affiliation(s)
- Marina Aweeda
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Feyisayo Adegboye
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shiayin F. Yang
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael C. Topf
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
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Liu YB, Wu D, Wang JY, Lun XH, Dai W. Meta-analysis of the survival rate and postoperative infection rate of primary and secondary implants after vascularized fibula transplantation for reconstruction of jaw defects. Int J Implant Dent 2023; 9:51. [PMID: 38108942 PMCID: PMC10728391 DOI: 10.1186/s40729-023-00514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Vascularized fibula flap transplantation is the most effective and common method to repair the jaw defects. In addition, implantation is the first choice to restore dentition on the graft fibula. Implants are usually implanted at least 6 months after fibula transplantation. Primary implantation of implants during surgery can restore the dentition earlier, but whether this method can achieve the same restorative effect as secondary implantation is still uncertain. This article aims to compare the survival rate and complications between primary and secondary implantation through meta-analysis. METHODS This meta-analysis was conducted according to PRISMA protocol and the Cochrane Handbook of Systematic Reviews of Interventions. According to the inclusion and exclusion criteria, we selected the PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM) according to established inclusion and exclusion criteria. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Meta-analysis was conducted to compare the survival rate and postoperative infection rate of primary and secondary implantation. RESULTS Seven studies were involved in our research, involving 186 patients. Five of the studies detailed implant success in 106 patients (primary implantation 50, secondary implantation 56), and four studies documented infection after implantation in 117 patients (primary implantation 52, secondary implantation 65); the survival rate of the primary implantation was 93.3%, and the incidence of postoperative infection was 17.3%. The survival rate of the secondary implantation was 93.4%, and 23.1% had postoperative infection. Meta-analysis showed that there was no significant difference in the survival rate between primary implantation and secondary implantation, OR = 0.813 (95% CI 0.383-1.725, P = 0.589 > 0.05), and there was no significant difference in the incidence of postoperative infection, OR = 0.614 (95% CI 0.239-1.581, P = 0.312 > 0.05). CONCLUSIONS Based on the results of this study, the research found no significant difference in the survival rate or infection rates between primary and secondary implantation. After appropriate indications selection, primary implantation can be used to reconstruct the dentition with less waiting time, reduce the impact of radiotherapy, and bring a higher quality of life for patients.
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Affiliation(s)
- Yi-Bo Liu
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, Tianjin Medical University, Tianjin, China
| | - Di Wu
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China
| | - Jun-Yi Wang
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China
| | - Xiao-Han Lun
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China
| | - Wei Dai
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China.
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Zhao Z, Bao J, Shen G, Cai M, Yu H. Integrating Virtual Surgical Planning and 3D-Printed Tools with Iliac Bone Grafts for Orbital and Zygomatic Reconstruction in Hemifacial Microsomia Patients. J Clin Med 2023; 12:7538. [PMID: 38137607 PMCID: PMC10743899 DOI: 10.3390/jcm12247538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Hemifacial Microsomia (HFM) is the second most common congenital craniofacial malformation syndrome, and the complexity of HFM makes its treatment challenging. The present study aimed to introduce a new approach of utilization of virtual surgical planning (VSP) and 3D-printed surgical adjuncts for maxillofacial reconstruction. Five HFM patients were included in this study. All participants were provided with a full VSP, including the design of osteotomy lines, the design and fabrication of 3D-printed cutting guides, fixation plates, and titanium mesh for implantation. With the assistance of 3D-printed cutting guides and fixation plates, the orbital deformities were corrected, and a 3D-printed titanium mesh combined with iliac cancellous bone graft was applied to reconstruct the zygomatic arch. The surgical accuracy, effectiveness, and bone absorption rate were evaluated. All patients completed the entirely digital treatment process without experiencing severe complications. The surgical adjuncts were effective in aligning the movement of the bone segments with the surgical plan, resulting in mean 3D deviations (1.0681 ± 0.15 mm) and maximum 3D deviations (3.1127 ± 0.44 mm). The image fusion results showed that the patients' postoperative position of the maxilla, zygoma, and orbital rim was consistent with the virtual surgical plan, with only a slight increase in the area of bone grafting. The postoperative measurements showed significant improvement in the asymmetry indices of Er (AI of Er: from 17.91 ± 3.732 to 5.427 ± 1.389 mm, p = 0.0001) and FZ (AI of FZ: from 7.581 ± 1.435 to 4.070 ± 1.028 mm, p = 0.0009) points. In addition, the observed bone resorption rate at the 6-month follow-up across the five patients was 45.24% ± 3.13%. In conclusion, the application of VSP and 3D-printed surgical adjuncts demonstrates significant value in enhancing the precision and effectiveness of surgical treatments for HFM. A 3D-printed titanium mesh combined with iliac cancellous bone graft can be considered an ideal alternative for the reconstruction of the zygomatic arch.
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Affiliation(s)
| | | | | | - Ming Cai
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China; (Z.Z.); (J.B.); (G.S.)
| | - Hongbo Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China; (Z.Z.); (J.B.); (G.S.)
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Xie X, Zhu M, He B, Xu J. Image-guided navigation system for minimally invasive total hip arthroplasty (MITHA) using an improved position-sensing marker. Int J Comput Assist Radiol Surg 2023; 18:2155-2166. [PMID: 36892722 DOI: 10.1007/s11548-023-02861-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Minimally invasive total hip arthroplasty (MITHA) is a treatment for hip arthritis, and it causes less tissue trauma, blood loss, and recovery time. However, the limited incision makes it difficult for surgeons to perceive the instruments' location and orientation. Computer-assisted navigation systems can help improve the medical outcome of MITHA. Directly applying existing navigation systems for MITHA, however, suffers from problems of bulky fiducial marker, severe feature-loss, multiple instruments tracking confusion, and radiation exposure. To tackle these problems, we propose an image-guided navigation system for MITHA using a novel position-sensing marker. METHODS A position-sensing marker is proposed to serve as the fiducial marker with high-density and multi-fold ID tags. It results in less feature span and enables the use of ID for each feature, overcoming the problem of bulky fiducial markers and multiple instruments tracking confusion. And the marker can be recognized even when a large part of locating features is obscured. As for the elimination of intraoperative radiation exposure, we propose a point-based method to achieve patient-image registration based on anatomical landmarks. RESULTS Quantitative experiments are conducted to evaluate the feasibility of our system. The accuracy of instrument positioning is achieved at 0.33 ± 0.18 mm, and that of patient-image registration is achieved at 0.79 ± 0.15 mm. And qualitative experiments are also performed, verifying that our system can be used in compact surgical spatial volume and can address severe feature-loss and tracking confusion problems. In addition, our system does not require any intraoperative medical scans. CONCLUSION Experimental results indicate that our proposed system can assist surgeons without larger space occupations, radiation exposure, and extra incision, showing its potential application value in MITHA.
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Affiliation(s)
- Xianzhong Xie
- School of Mechanical Engineering, Fuzhou University, Fuzhou, 350108, Fujian, China
| | - Mingzhu Zhu
- School of Mechanical Engineering, Fuzhou University, Fuzhou, 350108, Fujian, China.
| | - Bingwei He
- School of Mechanical Engineering, Fuzhou University, Fuzhou, 350108, Fujian, China
| | - Jie Xu
- Department of Orthopedic Surgery, Fujian Provincial Hospital, Fuzhou, 350013, Fujian, China
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Si J, Zhang C, Tian M, Jiang T, Zhang L, Yu H, Shi J, Wang X. Intraoral Condylectomy with 3D-Printed Cutting Guide versus with Surgical Navigation: An Accuracy and Effectiveness Comparison. J Clin Med 2023; 12:jcm12113816. [PMID: 37298011 DOI: 10.3390/jcm12113816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/22/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023] Open
Abstract
This study compares the accuracy and effectiveness of our novel 3D-printed titanium cutting guides with intraoperative surgical navigation for performing intraoral condylectomy in patients with mandibular condylar osteochondroma (OC). A total of 21 patients with mandibular condylar OC underwent intraoral condylectomy with either 3D-printed cutting guides (cutting guide group) or with surgical navigation (navigation group). The condylectomy accuracy in the cutting guide group and navigation group was determined by analyzing the three-dimensional (3D) discrepancies between the postoperative computed tomography (CT) images and the preoperative virtual surgical plan (VSP). Moreover, the improvement of the mandibular symmetry in both groups was determined by evaluating the chin deviation, chin rotation and mandibular asymmetry index (AI). The superimposition of the condylar osteotomy area showed that the postoperative results were very close to the VSP in both groups. The mean 3D deviation and maximum 3D deviation between the planned condylectomy and the actual result were 1.20 ± 0.60 mm and 2.36 ± 0.51 mm in the cutting guide group, and 1.33 ± 0.76 mm and 4.27 ± 1.99 mm in the navigation group. Moreover, the facial symmetry was greatly improved in both groups, indicated by significantly decreased chin deviation, chin rotation and AI. In conclusion, our results show that both 3D-printed cutting-guide-assisted and surgical-navigation-assisted methods of intraoral condylectomy have high accuracy and efficiency, while using a cutting guide can generate a relatively higher surgical accuracy. Moreover, our cutting guides exhibit user-friendly features and simplicity, which represents a promising prospect in everyday clinical practice.
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Affiliation(s)
- Jiawen Si
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Chenglong Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Ming Tian
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Tengfei Jiang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Lei Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Hongbo Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Jun Shi
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
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The Feasibility of Electromagnetic Navigation Technique to Achieve Preoperative Plan in Mandibular Angle Osteotomy. J Craniofac Surg 2023; 34:830-833. [PMID: 36745139 DOI: 10.1097/scs.0000000000009168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/02/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In contrast to the most commonly used optical navigation system, electromagnetic navigation has huge potential in operations with a narrow field. The purpose of this experiment was to test and confirm whether the electromagnetic navigation method the authors developed for mandibular angle osteotomy (MAO) met clinical requirements. METHODS Using a dental splint that could be repeatedly mounted on teeth, registration between surgical plan and actual field was performed automatically. RESULTS Navigation of MAO was first performed on 10 mandibular models. The position precision measured using a coordinate measuring machine was 1.30±0.61 mm. Then, a navigation experiment was performed on 4 patients. Accuracy in actual operation measured by the NDI pointing sensor was 1.89±0.76 mm. Our noninvasive automatic registration process reduced the surgical exposure time and eliminated the bias of the manual selection of registration points. CONCLUSIONS This preliminary study confirmed the feasibility of the electromagnetic navigation technique in terms of both applicability and accuracy in MAO surgery.
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Todaro C, Cerri M, Isola G, Manazza A, Storelli S, Rodriguez y Baena R, Lupi SM. Computer-Guided Osteotomy with Simultaneous Implant Placement and Immediately Loaded Full-Arch Fixed Restoration: A Case Report. PROSTHESIS 2023; 5:221-233. [DOI: 10.3390/prosthesis5010017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Aim: This case report aims to illustrate a clinical protocol that allows for the rehabilitation of patients requiring extensive osteotomy, simultaneous implant placement, and full-arch, screwed-in prosthetics in one session. This protocol allows for the improvement of the aesthetics and functionality of the fixed implant-supported prosthesis through the preoperative planning of all surgical procedures, including osteotomy, and of the prosthesis through the application of 3D-printing technology for the creation of surgical templates and prostheses. Methods: This case report concerns a 72-year-old patient, ASA1, who, following diagnosis, the establishment of a treatment plan, and the provision of informed consent, opted for an immediate, full-arch rehabilitation of the lower arch. The digital planning stage started with the correct positioning of the fixtures. The proper bone levels were found and used to guide the creation of the provisional screwed-in prothesis. Two templates with the same supports (landmarks/pins) were then 3D-printed: a positioning template, including a slit to assist the surgeon during the osteotomy, and a surgery template to assist the surgeon during the implants’ positioning. A screwed-in prosthesis encased in resin C&B MFH (NEXTDENT®, Soesterberg, The Netherlands) was delivered. Minimal occlusal adjustments were performed. Results: In a single clinical session, through careful planning and the pre-operative 3D printing of a prosthesis, a temporary implant-supported prosthetic rehabilitation was possible in a case that required an extended osteotomy. Clinically, the correspondence between the virtual design phase and the final realization was consistent. At a functional level, the provisional prosthesis required minimal occlusal adjustments and the DVO values obtained in the immediate post-operative period were found to be comparable to those of the virtual design. By planning the final position of the bone and the implants in advance, it was possible to deliver a full-arch prothesis with proper implant emergence, occlusal vertical dimensions, and occlusal relationship. Conclusion: This fully digital protocol allows the clinician to preview and plan the osteotomy and implant surgery as well as the delivery of the temporary, immediately loaded, complete, fixed prosthesis in patients who are candidates for post-extraction surgery with the need for severe osteotomy.
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Affiliation(s)
- Claudia Todaro
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | | | - Gaetano Isola
- School of Dentistry, Department of General Surgery and Medical and Surgical Specialties, University of Catania, 95124 Catania, Italy
| | | | - Stefano Storelli
- School of Dentistry, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20142 Milan, Italy
| | - Ruggero Rodriguez y Baena
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Saturnino Marco Lupi
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Kang HG, Kang SH, Kim HK, Son YD. Target registration errors in navigation-assisted mandibular surgery according to the tracking methods and the type of markers: experiments using human dry mandibular bone. Oral Radiol 2023; 39:180-190. [PMID: 35578091 DOI: 10.1007/s11282-022-00619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/20/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study was conducted to evaluate the accuracy of navigation process according to the type of tracking methods and registration markers. The target registration errors (TREs) were measured at seven anatomical landmarks of the mandible. METHODS Four different experiments were performed to obtain the TREs using two tracking methods, the optical tracker (Polaris) and the electromagnetic (EM) tracker (Aurora), and two types of registration markers, invasive and noninvasive markers. All comparisons of TREs were statistically analyzed using SPSS and Python-based statistical package. RESULTS The average TRE values obtained from the four experiments were as follows: (1) 0.85 mm (± 0.07) using invasive marker and Aurora, (2) 1.06 mm (± 0.12) using invasive marker and Polaris, (3) 1.43 mm (± 0.15) using noninvasive marker and Aurora, and (4) 1.57 mm (± 0.23) using noninvasive marker and Polaris. Comparisons between all the experimental results revealed statistically significant differences except for the type of tracking system. Although the comparison between the modality of the tracking system showed no significant differences, the EM-based approach consistently demonstrated better performances than the optical type in all comparisons. CONCLUSIONS This study demonstrates that irrespective of the tracking modality, using invasive marker is a better choice in terms of accuracy. When using noninvasive marker, it is important to consider the increased TREs. In this study, the noninvasive marker caused a maximum increment of TREs of 0.81 mm compared with the invasive marker. Furthermore, using an EM-based tracker with invasive marker may result in the best accuracy for navigation.
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Affiliation(s)
- Hee-Guen Kang
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Hang-Keun Kim
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea.
- Neuroscience Research Institute, Gachon University, Incheon, Korea.
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, 13120, Korea.
| | - Young-Don Son
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea
- Neuroscience Research Institute, Gachon University, Incheon, Korea
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, 13120, Korea
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Chegini S, Edwards E, McGurk M, Clarkson M, Schilling C. Systematic review of techniques used to validate the registration of augmented-reality images using a head-mounted device to navigate surgery. Br J Oral Maxillofac Surg 2023; 61:19-27. [PMID: 36513525 DOI: 10.1016/j.bjoms.2022.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/31/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Abstract
Augmented-reality (AR) head-mounted devices (HMD) allow the wearer to have digital images superposed on to their field of vision. They are being used to superpose annotations on to the surgical field akin to a navigation system. This review examines published validation studies on HMD-AR systems, their reported protocols, and outcomes. The aim was to establish commonalities and an acceptable registration outcome. Multiple databases were systematically searched for relevant articles between January 2015 and January 2021. Studies that examined the registration of AR content using a HMD to guide surgery were eligible for inclusion. The country of origin, year of publication, medical specialty, HMD device, software, and method of registration, were recorded. A meta-analysis of the mean registration error was conducted. A total of 4784 papers were identified, of which 23 met the inclusion criteria. They included studies using HoloLens (Microsoft) (n = 22) and nVisor ST60 (NVIS Inc) (n = 1). Sixty-six per cent of studies were in hard tissue specialties. Eleven studies reported registration errors using pattern markers (mean (SD) 2.6 (1.8) mm), and four reported registration errors using surface markers (mean (SD) 3.8 (3.7) mm). Three studies reported registration errors using manual alignment (mean (SD) 2.2 (1.3) mm). The majority of studies in this review used in-house software with a variety of registration methods and reported errors. The mean registration error calculated in this study can be considered as a minimum acceptable standard. It should be taken into consideration when procedural applications are selected.
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Affiliation(s)
- Soudeh Chegini
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom.
| | - Eddie Edwards
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
| | - Mark McGurk
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
| | - Matthew Clarkson
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
| | - Clare Schilling
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
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Yuan Z, He S, Jiang T, Xie Q, Zhou N, Huang X. Augmented reality hologram combined with pre-bent distractor enhanced the accuracy of distraction vector transfer in maxillary distraction osteogenesis, a study based on 3D printed phantoms. Front Surg 2022; 9:1018030. [PMID: 36468075 PMCID: PMC9709275 DOI: 10.3389/fsurg.2022.1018030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Vector control is a significant concern in maxillary distraction osteogenesis (DO). Distraction vector planning on the patient's 3D-printed skull phantom is more intuitive for surgeons and cost-efficient than virtual surgical planning. However, the accuracy of transferring the planned vector to intraoperative (vector transfer) according to the shape of the pre-bent footplate alone is relatively limited. The application of augmented reality (AR) in surgical navigation has been studied for years. However, few studies have focused on its role in maxillary DO vector transfer. This study aimed to evaluate the accuracy of AR surgical navigation combined with the pre-bent distractor in vector transfer by comparing it with the pre-bent distractor alone. METHODS Ten patients with maxillary hypoplasia were enrolled with consent, and three identical 3D-printed skull phantoms were manufactured based on per patient's corresponding pre-operative CT data. Among these, one phantom was for pre-operative planning (n = 10), while and the other two were for the AR+Pre-bending group (n = 10) and the Pre-bending group (n = 10) for the experimental surgery, respectively. In the Pre-bending group, the distraction vector was solely determined by matching the shape of footplates and maxillary surface. In the AR+Pre-bending group, the distractors were first confirmed to have no deformation. Then AR surgical navigation was applied to check and adjust the vector in addition to the steps as in the Pre-bending Group. RESULTS For the angular deviation of the distraction vector, the AR+Pre-bending group was significantly smaller than the Pre-bending group in spatial (p < 0.001), x-y plane (p = 0.002), and y-z plane (p < 0.001), and there were no significant differences in the x-z plane (p = 0.221). The AR+Pre-bending group was more accurate in deviations of the Euclidean distance (p = 0.004) and the y-axis (p = 0.011). In addition, the AR+Pre-bending group was more accurate for the distraction result. CONCLUSIONS In this study based on 3D printed skull phantoms, the AR surgical navigation combined with the pre-bent distractor enhanced the accuracy of vector transfer in maxillary DO, compared with the pre-bending technique alone.
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Affiliation(s)
- Zongyi Yuan
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Shixi He
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Tianhua Jiang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Qingtiao Xie
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Nuo Zhou
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Xuanping Huang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
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The intraoperative use of augmented and mixed reality technology to improve surgical outcomes: A systematic review. Int J Med Robot 2022; 18:e2450. [DOI: 10.1002/rcs.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/07/2022]
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Lin L, Gao Y, Aung ZM, Xu H, Wang B, Yang X, Chai G, Xie L. Preliminary reports of augmented-reality assisted craniofacial bone fracture reduction. J Plast Reconstr Aesthet Surg 2022; 75:e1-e8. [DOI: 10.1016/j.bjps.2022.06.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 05/01/2022] [Accepted: 06/05/2022] [Indexed: 10/31/2022]
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Lin L, Sun M, Xu C, Gao Y, Xu H, Yang X, He H, Wang B, Xie L, Chai G. Assessment of Robot-Assisted Mandibular Contouring Surgery in Comparison With Traditional Surgery: A Prospective, Single-Center, Randomized Controlled Trial. Aesthet Surg J 2022; 42:567-579. [PMID: 34791018 DOI: 10.1093/asj/sjab392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few clinical studies on robot-assisted surgery (RAS) for mandibular contouring have been reported. OBJECTIVES The aim of this study was to follow the long-term effectiveness and safety of RAS for craniofacial bone surgery. METHODS This small-sample, early-phase, prospective, randomized controlled study included patients diagnosed with mandibular deformity requiring mandibular contouring surgery. Patients of both genders aged 18 to 30 years without complicated craniofacial repair defects were enrolled and randomly assigned in a 1:1 ratio by a permuted-block randomized assignments list generated by the study statistician. The primary outcomes were the positioning accuracy and accuracy of the osteotomy plane angle 1 week after surgery. Surgical auxiliary measurement index, patient satisfaction scale, surgical pain scale, perioperative period, and complications at 1 week, 1 month, and 6 months after surgery were also analyzed. RESULTS One patient was lost to follow-up, resulting in a total of 14 patients in the traditional surgery group and 15 in the robot-assisted group (mean [standard deviation] age, 22.65 [3.60] years). Among the primary outcomes, there was a significant difference in the positioning accuracy (2.91 mm vs 1.65 mm; P < 0.01) and angle accuracy (13.26º vs 4.85º; P < 0.01) between the 2 groups. Secondary outcomes did not significantly differ. CONCLUSIONS Compared to traditional surgery, robot-assisted mandibular contouring surgery showed improved precision in bone shaving, as well as higher safety. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Li Lin
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
| | - Mengzhe Sun
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
| | - Cheng Xu
- Institute of Forming Technology and Equipment, Shanghai Jiao Tong University, Xuhui Campus , Shanghai, China
| | - Yuan Gao
- Institute of Forming Technology and Equipment, Shanghai Jiao Tong University, Xuhui Campus , Shanghai, China
| | - Haisong Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
| | - Xianxian Yang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
| | - Hao He
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Bingshun Wang
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Le Xie
- Institute of Medical Robotics, Shanghai Jiao Tong University, Minhang Campus , Shanghai, China
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
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de Geer A, Brouwer de Koning S, van Alphen M, van der Mierden S, Zuur C, van Leeuwen F, Loeve A, van Veen R, Karakullukcu M. Registration methods for surgical navigation of the mandible: a systematic review. Int J Oral Maxillofac Surg 2022; 51:1318-1329. [DOI: 10.1016/j.ijom.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/18/2021] [Accepted: 01/26/2022] [Indexed: 12/20/2022]
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Assessment of an Artificial Intelligence Mandibular Osteotomy Design System: A Retrospective Study. Aesthetic Plast Surg 2022; 46:1303-1313. [PMID: 35048148 DOI: 10.1007/s00266-021-02698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND In this study, an AI osteotomy software was developed to design the presurgical plan of mandibular angle osteotomy, which is followed by the comparison between the software-designed presurgical plan and the traditional manual presurgical plan, thus assessing the practicability of applying the AI osteotomy software in clinical practices. METHODS (1) Develop an AI osteotomy software: design an algorithm based on convolutional neural networks capable of learning feature point and processing clustering segmentation; then, select 2296 cases of successful 3D mandibular angle osteotomy presurgical plans, followed by using those 2296 cases to train the deep learning algorithm; (2) compare the osteotomy presurgical plan of AI osteotomy software and that of manual: first step: randomly selecting 80 cases of typical female head 3D CTs, and designing those 80 cases by means of AI osteotomy software designing (group A) and manually designing (group B), respectively; second step: comparing several indexes of group A and those of group B, including the efficiency index (time from input original CT data to osteotomy presurgical plan output), the safety index (the minimum distance from the osteotomy plane to the mandibular canal), the symmetry indexes (bilateral difference of mandibular angle, mandibular ramus height and mandibular valgus angle) and aesthetic indexes (width ratio between middle and lower faces (M/L), mandibular angle and mandibular valgus angle). RESULTS The efficiency index: the design time of group A is 1.768 ± 0.768 min and that of group B is 26.108 ± 1.137 min, with P = 0.000; the safety index: The minimum distances from the osteotomy plane to the mandibular canal are 3.908 ± 0.361mm and 3.651 ± 0.437mm, p = 0.117 in groups A and B, respectively; The symmetry indexes: Bilateral differences of mandibular angle are 1.824 ± 1.834° and 1.567 ± 1.059° in groups A and B, respectively, with P = 0.278; bilateral differences of mandibular ramus height are 2.083 ± 1.263 and 2.965 ± 1.433, respectively, with P = 0.119 in groups A and B; Aesthetic indexes: M/L in groups A and B is 1.364 ± 0.074 and 1.371 ± 0.067, respectively, with P = 0.793; mandibular angles in groups A and B are 127.724 ± 5.800° and 127.242 ± 5.545°, respectively, with P = 0.681; Valgus angles in groups A and B are 11.474 ± 5.380 and 9.743 ± 4.620, respectively, with P = 0.273. CONCLUSIONS With high efficiency, as well as safety, symmetry and aesthetics equivalent to those of a manual design, the AI osteotomy software designing can be used as an alternative method for manual osteotomy designing. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Application of Augmented Reality Navigation in Treatment With Fibrosis Dysplasia. J Craniofac Surg 2021; 33:1317-1321. [PMID: 34873103 DOI: 10.1097/scs.0000000000008391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE In order to reduce the possibility of accidental injury to neurovascular and important tissues, this research conduct preoperative design and intraoperative guidance for fibrous dysplasia through augmented reality technology. METHODS Five patients with fibrous dysplasia were selected for three-dimensional (3D) computed tomography (CT) scan and 3D model was reconstructed. Considering the navigation plan was comprehensively, the guide plate (composed of card groove, connector, and fixator) was designed and 3D printed. Three-dimensional software was used to unify the coordinates of the surgical plan and the guide plate, and the relative position was fixed. Then, the virtual and real overlapping registration is completed on the physical model. Pattern recognition technology is used to identify pre-defined markers in the video images before operation. Finally, the registration results are superimposed into the surgical field of vision to guide and remind surgeons. RESULTS In this study, the navigation based on augmented reality technology was used in the surgical treatment of 5 cases patients with fibrous dysplasia. The 3D navigation information was displayed in real time in the operative field. The operation was accurate and the postoperative effect was good. CONCLUSIONS This paper introduces an effective visual navigation surgical method in treatment with fibrous dysplasia. The augmented-reality based navigation system achieves individualized precise treatment by displaying 3D navigation directly in the surgical field. It is an effective auxiliary method for future research on craniofacial surgery.
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Benmahdjoub M, Niessen WJ, Wolvius EB, van Walsum T. Virtual extensions improve perception-based instrument alignment using optical see-through devices. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2021; 27:4332-4341. [PMID: 34449385 DOI: 10.1109/tvcg.2021.3106506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Instrument alignment is a common task in various surgical interventions using navigation. The goal of the task is to position and orient an instrument as it has been planned preoperatively. To this end, surgeons rely on patient-specific data visualized on screens alongside preplanned trajectories. The purpose of this manuscript is to investigate the effect of instrument visualization/non visualization on alignment tasks, and to compare it with virtual extensions approach which augments the realistic representation of the instrument with simple 3D objects. 18 volunteers performed six alignment tasks under each of the following conditions: no visualization on the instrument; realistic visualization of the instrument; realistic visualization extended with virtual elements (Virtual extensions). The first condition represents an egocentric-based alignment while the two other conditions additionally make use of exocentric depth estimation to perform the alignment. The device used was a see-through device (Microsoft HoloLens 2). The positions of the head and the instrument were acquired during the experiment. Additionally, the users were asked to fill NASA-TLX and SUS forms for each condition. The results show that instrument visualization is essential for a good alignment using see-through devices. Moreover, virtual extensions helped achieve the best performance compared to the other conditions with medians of 2 mm and 2° positional and angular error respectively. Furthermore, the virtual extensions decreased the average head velocity while similarly reducing the frustration levels. Therefore, making use of virtual extensions could facilitate alignment tasks in augmented and virtual reality (AR/VR) environments, specifically in AR navigated surgical procedures when using optical see-through devices.
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Winnand P, Ayoub N, Redick T, Gesenhues J, Heitzer M, Peters F, Raith S, Abel D, Hölzle F, Modabber A. Navigation of iliac crest graft harvest using markerless augmented reality and cutting guide technology: A pilot study. Int J Med Robot 2021; 18:e2318. [PMID: 34328700 DOI: 10.1002/rcs.2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/27/2021] [Accepted: 03/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Defects of the facial skeleton often require complex reconstruction with vascularized grafts. This trial elucidated the usability, visual perception and accuracy of a markerless augmented reality (AR)-guided navigation for harvesting iliac crest transplants. METHODS Random CT scans were used to virtually plan two common transplant configurations on 10 iliac crest models, each printed four times. The transplants were harvested using projected AR and cutting guides. The duration and accuracies of the angulation, distance and volume between the planned and executed osteotomies were measured. RESULTS AR was characterized by the efficient use of time and accurate rendition of preoperatively planned geometries. However, vertical osteotomies and complex anatomical settings displayed significant inferiority of AR guidance compared to cutting guides. CONCLUSIONS This study demonstrated the usability of a markerless AR setup for harvesting iliac crest transplants. The visual perception and accuracy of the AR-guided osteotomies constituted remaining weaknesses against cutting guide technology.
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Affiliation(s)
- Philipp Winnand
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Nassim Ayoub
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Tim Redick
- Institute of Automatic Control, RWTH Aachen University, Aachen, Germany
| | - Jonas Gesenhues
- Institute of Automatic Control, RWTH Aachen University, Aachen, Germany
| | - Marius Heitzer
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Stefan Raith
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Dirk Abel
- Institute of Automatic Control, RWTH Aachen University, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Abstract
PURPOSE OF REVIEW Image guided navigation has had significant impact in head and neck surgery, and has been most prolific in endonasal surgeries. Although conventional image guidance involves static computed tomography (CT) images attained in the preoperative setting, the continual evolution of surgical navigation technologies is fast expanding to incorporate both real-time data and bioinformation that allows for improved precision in surgical guidance. With the rapid advances in technologies, this article allows for a timely review of the current and developing techniques in surgical navigation for head and neck surgery. RECENT FINDINGS Current advances for cross-sectional-based image-guided surgery include fusion of CT with other imaging modalities (e.g., magnetic resonance imaging and positron emission tomography) as well as the uptake in intraoperative real-time 'on the table' imaging (e.g., cone-beam CT). These advances, together with the integration of virtual/augmented reality, enable potential enhancements in surgical navigation. In addition to the advances in radiological imaging, the development of optical modalities such as fluorescence and spectroscopy techniques further allows the assimilation of biological data to improve navigation particularly for head and neck surgery. SUMMARY The steady development of radiological and optical imaging techniques shows great promise in changing the paradigm of head and neck surgery.
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Benmahdjoub M, van Walsum T, van Twisk P, Wolvius EB. Augmented reality in craniomaxillofacial surgery: added value and proposed recommendations through a systematic review of the literature. Int J Oral Maxillofac Surg 2020; 50:969-978. [PMID: 33339731 DOI: 10.1016/j.ijom.2020.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
This systematic review provides an overview of augmented reality (AR) and its benefits in craniomaxillofacial surgery in an attempt to answer the question: Is AR beneficial for craniomaxillofacial surgery? This review includes a description of the studies conducted, the systems used and their technical characteristics. The search was performed in four databases: PubMed, Cochrane Library, Embase, and Web of Science. All journal articles published during the past 11 years related to AR, mixed reality, craniomaxillofacial, and surgery were considered in this study. From a total of 7067 articles identified using AR- and surgery-related keywords, 39 articles were finally selected. Based on these articles, a classification of study types, surgery types, devices used, metrics reported, and benefits were collected. The findings of this review indicate that AR could provide various benefits, addressing the challenges of conventional navigation systems, such as hand-eye coordination and depth perception. However, three main concerns were raised while performing this study: (1) it is complicated to aggregate the metrics reported in the articles, (2) it is difficult to obtain statistical value from the current studies, and (3) user evaluation studies are lacking. This article concludes with recommendations for future studies by addressing the latter points.
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Affiliation(s)
- M Benmahdjoub
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - T van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P van Twisk
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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A surgical navigated cutting guide for mandibular osteotomies: accuracy and reproducibility of an image-guided mandibular osteotomy. Int J Comput Assist Radiol Surg 2020; 15:1719-1725. [PMID: 32725399 DOI: 10.1007/s11548-020-02234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/14/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE 3D-printed cutting guides are the current standard to translate the virtual surgery plan to the intraoperative setting. The production of these patient-specific cutting guides is time-consuming and costly, and therefore, alternative approaches are currently subject of research. The aim of this study was to assess the accuracy and reproducibility of using a novel electromagnetic (EM) navigated surgical cutting guide to perform virtually planned osteotomies in mandible models. METHODS A novel 3D navigated cutting guide (dubbed Bladerunner) was designed and evaluated with a total of 20 osteotomies, performed on plaster mandibular models according to preoperative planning using EM navigation. The pre- and postoperative scans were registered, and the difference between the preoperatively planned osteotomy and the performed osteotomy was expressed as the distance between the planned and performed cutting planes, and the yaw and roll angles between the planes. RESULTS The mean difference in distance between the planned osteotomy and performed osteotomy was 1.1 mm (STD 0.6 mm), the mean yaw was 1.8° (STD 1.4°), and mean roll was 1.6° (STD 1.3°). CONCLUSION The proposed EM navigated cutting guide for mandibular osteotomies demonstrated accurate positioning of the cutting plane according to the preoperative virtual surgical plan with respect to distance, yaw and roll angles. This novel approach has the potential to make the use of 3D-printed cutting guides obsolete, thereby decreasing the interval between diagnosis and surgery, reduce cost and allow for adaptation of the virtual plan in case of rapid tumor proliferation or unanticipated in situ deviations from the preoperative CT/MR imaging.
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Vles MD, Terng NCO, Zijlstra K, Mureau MAM, Corten EML. Virtual and augmented reality for preoperative planning in plastic surgical procedures: A systematic review. J Plast Reconstr Aesthet Surg 2020; 73:1951-1959. [PMID: 32622713 DOI: 10.1016/j.bjps.2020.05.081] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/15/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Virtual and augmented reality (VR and AR) are fast-developing technologies that allow the three-dimensional visualization of digital information. OBJECTIVE This systematic review aimed to compare the application of VR and AR to conventional methods in preoperative planning of plastic surgical procedures. METHOD A systematic literature search was conducted in Embase, Medline (Ovid), Web-of-Science, Cochrane, and Google Scholar databases on October 11, 2019. All literature comparing AR and/or VR with conventional methods for preoperative planning was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy of the procedure, operative time, complications, and costs of total intervention. RESULTS No articles on VR were found. Six articles were found on interventions performed with AR assistance. AR showed to be significantly better for the accuracy of osteotomies in mandibular angle osteotomies and intraoral mandible distraction compared to conventional methods. For synostotic plagiocephaly and orbital hypertelorism correction, the use of AR demonstrated a precise osteotomy. Intraoperative perforator identification in DIEP flap procedures was more accurate with AR compared to Doppler ultrasound. Harvesting time (p < 0.012) and operative time (p < 0.01) in DIEP-flap procedures and mandibular angle osteotomies, respectively, were significantly reduced if AR was used. No articles were found regarding the costs of using AR for preoperative planning. CONCLUSION AR technology has the potential to assist the plastic surgeon in operating more accurately, safely, and fast. Studies on VR technology for preoperative planning in plastic surgery are lacking. More comparative studies are necessary, including data on clinical outcomes and cost-effectiveness.
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Affiliation(s)
- M D Vles
- Erasmus Medical Center, Rotterdam, the Netherlands
| | - N C O Terng
- Leiden University Medical Center, Leiden, the Netherlands
| | - K Zijlstra
- Delft University of Technology, Delft, the Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Centre Rotterdam, Office NA-2214, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - E M L Corten
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Centre Rotterdam, Office NA-2214, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
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Sayadi LR, Naides A, Eng M, Fijany A, Chopan M, Sayadi JJ, Shaterian A, Banyard DA, Evans GRD, Vyas R, Widgerow AD. The New Frontier: A Review of Augmented Reality and Virtual Reality in Plastic Surgery. Aesthet Surg J 2019; 39:1007-1016. [PMID: 30753313 DOI: 10.1093/asj/sjz043] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/12/2019] [Accepted: 02/08/2019] [Indexed: 11/14/2022] Open
Abstract
Mixed reality, a blending of the physical and digital worlds, can enhance the surgical experience, leading to greater precision, efficiency, and improved outcomes. Various studies across different disciplines have reported encouraging results using mixed reality technologies, such as augmented and virtual reality. To provide a better understanding of the applications and limitations of this technology in plastic surgery, we performed a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The initial query of the National Center for Biotechnology Information database yielded 2544 results, and only 46 articles met our inclusion criteria. The majority of studies were in the field of craniofacial surgery, and uses of mixed reality included preoperative planning, intraoperative guides, and education of surgical trainees. A deeper understanding of mixed reality technologies may promote its integration and also help inspire new and creative applications in healthcare.
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Affiliation(s)
| | | | | | | | - Mustafa Chopan
- Resident, Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL
| | | | | | | | | | | | - Alan D Widgerow
- Director of the UC Irvine Center for Tissue Engineering, UC Irvine Department of Plastic Surgery, Center for Tissue Engineering, Orange, CA
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Rose AS, Kim H, Fuchs H, Frahm JM. Development of augmented-reality applications in otolaryngology-head and neck surgery. Laryngoscope 2019; 129 Suppl 3:S1-S11. [PMID: 31260127 DOI: 10.1002/lary.28098] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/16/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Augmented reality (AR) allows for the addition of transparent virtual images and video to one's view of a physical environment. Our objective was to develop a head-worn, AR system for accurate, intraoperative localization of pathology and normal anatomic landmarks during open head and neck surgery. STUDY DESIGN Face validity and case study. METHODS A protocol was developed for the creation of three-dimensional (3D) virtual models based on computed tomography scans. Using the HoloLens AR platform, a novel system of registration and tracking was developed. Accuracy was determined in relation to actual physical landmarks. A face validity study was then performed in which otolaryngologists were asked to evaluate the technology and perform a simulated surgical task using AR image guidance. A case study highlighting the potential usefulness of the technology is also presented. RESULTS An AR system was developed for intraoperative 3D visualization and localization. The average error in measurement of accuracy was 2.47 ± 0.46 millimeters (1.99, 3.30). The face validity study supports the potential of this system to improve safety and efficiency in open head and neck surgical procedures. CONCLUSIONS An AR system for accurate localization of pathology and normal anatomic landmarks of the head and neck is feasible with current technology. A face validity study reveals the potential value of the system in intraoperative image guidance. This application of AR, among others in the field of otolaryngology-head and neck surgery, promises to improve surgical efficiency and patient safety in the operating room. LEVEL OF EVIDENCE 2b Laryngoscope, 129:S1-S11, 2019.
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Affiliation(s)
- Austin S Rose
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Hyounghun Kim
- Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Henry Fuchs
- Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Jan-Michael Frahm
- Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina, U.S.A
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