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Kortman MCP, Jansma J, Schepers RH, Slump CH, Merema BJ, Kraeima J. A method for accuracy of placement analysis on radiolucent polyether-ether-keton facial implants: A case series. J Craniomaxillofac Surg 2024:S1010-5182(24)00192-6. [PMID: 39004536 DOI: 10.1016/j.jcms.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/29/2024] [Accepted: 06/08/2024] [Indexed: 07/16/2024] Open
Abstract
Facial asymmetry is defined as a bilateral difference between facial components. Correction, often desired by the patient, can be performed with the aim of bone born patient-specific solid implants designed using 3D CAD software. This treatment is embedded in the daily practice of today's healthcare. However, an analysis of the implant's accuracy of placement has not been reported. This case series describes the accuracy analysis of bone born aesthetic facial implants manufactured out of polyether-ether-ketone (PEEK). The accuracy analysis was based on postoperative (cone beam) computed tomography ((CB)CT) data and preoperative 3D planning. The analysis showed a median entry point error of 0.7 mm (min: 0.1, max: 3.3, interquartile range: 0.78). The median maximal orientation error was 5.5° (min: 0.1, max: 36.8, interquartile range: 7.13). Both parameters showed an excellent intraobserver and interobserver agreement with an ICC above 0.84. The described cases show that the analysis method is an objective approach for determining the accuracy of PSI placement and indicates that these implants can be placed accurately on the osseous face.
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Affiliation(s)
- M C P Kortman
- University of Twente, Technical Medical Centre, Multi-Modality Medical Imaging (M3i), Faculty of Science & Technology, Enschede, the Netherlands
| | - J Jansma
- Dpt of Oral and Maxillofacial Surgery, Martini Hospital, Groningen, the Netherlands
| | - R H Schepers
- Dpt of Oral and Maxillofacial Surgery, Martini Hospital, Groningen, the Netherlands
| | - C H Slump
- University of Twente, Technical Medical Centre, Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Enschede, the Netherlands
| | - B J Merema
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Dpt of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - J Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Dpt of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
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2
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Akhavan AA, Pang JH, Morrison SD, Satterwhite T. Gender Affirming Facial Surgery-Anatomy and Procedures for Facial Masculinization. Oral Maxillofac Surg Clin North Am 2024; 36:221-236. [PMID: 38458858 DOI: 10.1016/j.coms.2024.01.001] [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: 03/10/2024]
Abstract
For some patients, feminine facial features may cause significant gender dysphoria. Multiple nonsurgical and surgical techniques exist to masculinize facial features. Nonsurgical techniques include testosterone supplementation and dermal fillers. Surgical techniques include soft tissue manipulation, synthetic implants, regenerative scaffolding, or bony reconstruction. Many techniques are derived from experience with cisgender patients, but are adapted with special considerations to differing anatomy between cisgender and transgender men and women. Currently, facial masculinization is less commonly sought than feminization, but demand is likely to increase as techniques are refined and made available.
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Affiliation(s)
- Arya Andre Akhavan
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite E1620, Newark, NJ 07103, USA; Align Surgical Associates, 2299 Post Street, Suite 207, San Francisco, CA 94115, USA
| | - John Henry Pang
- Align Surgical Associates, 2299 Post Street, Suite 207, San Francisco, CA 94115, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356165, Seattle, WA 98195, USA
| | - Thomas Satterwhite
- Align Surgical Associates, 2299 Post Street, Suite 207, San Francisco, CA 94115, USA; Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center.
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Cárdenas-Serres C, Almeida-Parra F, Simón-Flors AM, de Leyva-Moreno P, Ranz-Colio Á, Ley-Urzaiz L, Acero-Sanz J. Custom CAD/CAM Peek Implants for Complex Orbitocranial Reconstruction: Our Experience with 15 Patients. J Clin Med 2024; 13:695. [PMID: 38337393 PMCID: PMC10856719 DOI: 10.3390/jcm13030695] [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: 10/14/2023] [Revised: 12/14/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
Bone defects within the cranio-orbital complex present unique challenges in terms of surgical planning and reconstruction. This article presents a novel approach using PEEK material and advanced surgical technologies to address these challenges. A retrospective analysis of 15 patients who underwent craniofacial reconstruction using patient-specific polyetheretherketone (PEEK) implants between 2016 and 2021 was carried out. Comprehensive preoperative planning was performed, utilizing advanced imaging techniques and specialized software for virtual surgical planning. Patient-specific PEEK PSIs were designed and manufactured based on the preoperative plan. Intraoperative navigation was used to guide the surgical procedure, enabling precise osteotomy and optimal implant placement. This article describes the step-by-step process and the tools utilized in each phase. The etiologies were as follows: meningioma in seven cases, benign lesions in five cases, malignant tumors in two cases, and trauma sequelae in one case. In all cases, 3D-printed PEEK implants were utilized to achieve precise reconstruction. No major complications were described. In one case, an implant replacement was needed with successful outcomes. Our study demonstrates the feasibility and effectiveness of using PEEK patient-specific implants for personalized craniofacial reconstruction. The combination of advanced imaging, virtual planning, and CAD-CAM technology contributes to improved surgical outcomes in terms of oncologic margin control, functional restoration, and aesthetic results.
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Affiliation(s)
- Cristina Cárdenas-Serres
- Department of Oral and Maxillofacial Surgery, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain (P.d.L.-M.); (J.A.-S.)
- Department of Oral and Maxillofacial Surgery, Puerta de Hierro University Hospital, 28222 Majadahonda, Spain
| | - Fernando Almeida-Parra
- Department of Oral and Maxillofacial Surgery, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain (P.d.L.-M.); (J.A.-S.)
- Department of Oral and Maxillofacial Surgery, Puerta de Hierro University Hospital, 28222 Majadahonda, Spain
| | - Anna María Simón-Flors
- Department of Oral and Maxillofacial Surgery, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain (P.d.L.-M.); (J.A.-S.)
- Department of Oral and Maxillofacial Surgery, Puerta de Hierro University Hospital, 28222 Majadahonda, Spain
| | - Patricia de Leyva-Moreno
- Department of Oral and Maxillofacial Surgery, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain (P.d.L.-M.); (J.A.-S.)
- Department of Oral and Maxillofacial Surgery, Puerta de Hierro University Hospital, 28222 Majadahonda, Spain
| | - Álvaro Ranz-Colio
- Department of Oral and Maxillofacial Surgery, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain (P.d.L.-M.); (J.A.-S.)
- Department of Oral and Maxillofacial Surgery, Puerta de Hierro University Hospital, 28222 Majadahonda, Spain
| | - Luis Ley-Urzaiz
- Department of Neurosurgery, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Julio Acero-Sanz
- Department of Oral and Maxillofacial Surgery, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain (P.d.L.-M.); (J.A.-S.)
- Department of Oral and Maxillofacial Surgery, Puerta de Hierro University Hospital, 28222 Majadahonda, Spain
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Long J, Zhang J, Kang J, Fan Y, Zhang Z, Shi J, Zhang Z, Huang Y, Liu S. Customed 3D-printed Polyetheretherketone (PEEK) Implant for Secondary Salvage Reconstruction of Mandibular Defects: Case Report and Literature Review. J Craniofac Surg 2023; 34:2460-2463. [PMID: 37264507 DOI: 10.1097/scs.0000000000009420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/30/2023] [Indexed: 06/03/2023] Open
Abstract
Given the insufficient height of single-barrel fibula and inadequate bone volume of double-barrel vascularized fibula in mandibular reconstruction, it is a better choice to combine the upper full-thickness vascularized fibula with the lower half-thickness nonvascularized fibula. However, the nonvascularized fibula may fail due to complications, affecting the facial shape and occlusal function. Polyetheretherketone is a thermoplastic polymer used for bone defect reconstruction due to its good mechanical properties and biocompatibility. This case report mainly presents a secondary salvage reconstruction of the mandible by using customed 3-dimensional-printing polyetheretherketone, which restored the continuity and symmetry of the mandible, improved the patient's facial shape, and restored functional occlusion through dental implants. After a 28-month follow-up, no complications occurred, and the patient was satisfied with the final restoration.
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Affiliation(s)
- Jiazhen Long
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan
| | - Jianfeng Kang
- School of Mechatronic Engineering and Automation, Foshan University, Foshan, Guangdong, China
| | - Yunjian Fan
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Zhaoqiang Zhang
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Jiayu Shi
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Zhen Zhang
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Yuanjin Huang
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Shuguang Liu
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Gu L, Huang R, Ni N, Gu P, Fan X. Advances and Prospects in Materials for Craniofacial Bone Reconstruction. ACS Biomater Sci Eng 2023; 9:4462-4496. [PMID: 37470754 DOI: 10.1021/acsbiomaterials.3c00399] [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: 07/21/2023]
Abstract
The craniofacial region is composed of 23 bones, which provide crucial function in keeping the normal position of brain and eyeballs, aesthetics of the craniofacial complex, facial movements, and visual function. Given the complex geometry and architecture, craniofacial bone defects not only affect the normal craniofacial structure but also may result in severe craniofacial dysfunction. Therefore, the exploration of rapid, precise, and effective reconstruction of craniofacial bone defects is urgent. Recently, developments in advanced bone tissue engineering bring new hope for the ideal reconstruction of the craniofacial bone defects. This report, presenting a first-time comprehensive review of recent advances of biomaterials in craniofacial bone tissue engineering, overviews the modification of traditional biomaterials and development of advanced biomaterials applying to craniofacial reconstruction. Challenges and perspectives of biomaterial development in craniofacial fields are discussed in the end.
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Affiliation(s)
- Li Gu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Rui Huang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ni Ni
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ping Gu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
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7
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Wei Z, Zhang Z, Zhu W, Weng X. Polyetheretherketone development in bone tissue engineering and orthopedic surgery. Front Bioeng Biotechnol 2023; 11:1207277. [PMID: 37456732 PMCID: PMC10345210 DOI: 10.3389/fbioe.2023.1207277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Polyetheretherketone (PEEK) has been widely used in the medical field as an implant material, especially in bone tissue engineering and orthopedic surgery, in recent years. This material exhibits superior stability at high temperatures and is biosecured without harmful reactions. However, the chemical and biological inertness of PEEK still limits its applications. Recently, many approaches have been applied to improve its performance, including the modulation of physical morphology, chemical composition and antimicrobial agents, which advanced the osteointegration as well as antibacterial properties of PEEK materials. Based on the evolution of PEEK biomedical devices, many studies on the use of PEEK implants in spine surgery, joint surgery and trauma repair have been performed in the past few years, in most of which PEEK implants show better outcomes than traditional metal implants. This paper summarizes recent studies on the modification and application of biomedical PEEK materials, which provides further research directions for PEEK implants.
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Affiliation(s)
- Zhanqi Wei
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Ze Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Wei Zhu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Abdullaev AN, Lasunin NV, Cherekaev VA, Okishev DN, Grigorieva NN. [Domestic software, medical devices and materials in surgery for hyperostotic craniofacial meningiomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:93-99. [PMID: 38054232 DOI: 10.17116/neiro20238706193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The modern concept of resection of hyperostotic craniofacial meningiomas involves the desire for one-stage surgery with excision of tumor and simultaneous extensive skull defect closure. MATERIAL AND METHODS The authors present skull defect closure with an individual implant after resection of cranioorbital meningioma in a 61-year-old man. The neoplasm was accompanied by exophthalmos and eyelid edema. The patient underwent simultaneous microsurgical resection and skull reconstruction with an individual implant. At discharge (7 days after surgery), exophthalmos regressed to 3 mm. After 3 months, ophthalmologist revealed complete regression of exophthalmos. RESULTS Domestic software and 3D printers were used for implant modeling and preparing the necessary physical models and molds. We intraoperatively used domestic polymer and titanium fixation systems for manufacturing and fixation of implant. CONCLUSION This clinical case confirms that resection of hyperostotic craniofacial meningioma with simultaneous bone defect closure using domestic analogues of software, technical equipment, materials and methods is possible at all stages of this procedure.
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Affiliation(s)
| | - N V Lasunin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - D N Okishev
- Burdenko Neurosurgical Center, Moscow, Russia
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