1
|
Jolly L, Sudduth JD, Marquez JL, White M, Collar-Yagas L, Yamashiro D, Siddiqi F, Gociman B. Novel Custom Maxillary Disimpaction Splint. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4976. [PMID: 37180987 PMCID: PMC10171696 DOI: 10.1097/gox.0000000000004976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/15/2023] [Indexed: 05/16/2023]
Abstract
LeFort I, II, and III osteotomies are commonly used in complex craniofacial reconstruction. Patients requiring these procedures typically have a craniofacial cleft, other congenital craniofacial deformities, or severe facial trauma. Both the cleft and traumatized palate have poor bony support, which leads to possible complications when the disimpaction forceps are used during the downfracture of the maxilla. Such potential complications include trauma or formation of a fistula of the palatal, oral, or nasal mucosa; trauma to adjacent teeth; and fracture of the palate and alveolar bone. To help prevent these complications, we developed a custom disimpaction splint. The splint is designed to cover the palate and occlusal surfaces to increase retention and minimize splint movement during the maxillary downfracture portion of the surgical procedure. The base of the splint is fabricated from a two-layered biocryl material, and the palatal area is built with soft-cushion rebase material. This allows for a stable grip of the disimpaction forceps blades and provides protective coverage of the cleft, traumatized palate, or alveolar bone graft site during the downfracture. The custom maxillary disimpaction splint has been routinely used in our clinic from September 2019 to the present for LeFort osteotomies in patients with a compromised primary palate. No surgical complications related to the maxillary downfracture have been noted during this period of time. We conclude that the routine use of a custom maxillary disimpaction splint can result in improved outcomes and decreased complications of LeFort osteotomy procedures in patients with cleft and traumatized palate.
Collapse
Affiliation(s)
- Lisa Jolly
- From the University of Utah Hospital, Department of Surgery, Division of Plastic Surgery, Salt Lake City, Utah
| | - Jack D. Sudduth
- From the University of Utah Hospital, Department of Surgery, Division of Plastic Surgery, Salt Lake City, Utah
| | - Jessica L. Marquez
- From the University of Utah Hospital, Department of Surgery, Division of Plastic Surgery, Salt Lake City, Utah
| | - Michelle White
- From the University of Utah Hospital, Department of Surgery, Division of Plastic Surgery, Salt Lake City, Utah
| | - Lucia Collar-Yagas
- From the University of Utah Hospital, Department of Surgery, Division of Plastic Surgery, Salt Lake City, Utah
| | - Duane Yamashiro
- From the University of Utah Hospital, Department of Surgery, Division of Plastic Surgery, Salt Lake City, Utah
| | - Faizi Siddiqi
- From the University of Utah Hospital, Department of Surgery, Division of Plastic Surgery, Salt Lake City, Utah
| | - Barbu Gociman
- From the University of Utah Hospital, Department of Surgery, Division of Plastic Surgery, Salt Lake City, Utah
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Powell KK, Lewis P, Sesanto R, Waite PD. Does Early Secondary Alveolar Bone Grafting Influence Need for Additional Maxillary Advancement Procedures in Cleft Lip and Palate? Cleft Palate Craniofac J 2021; 59:1279-1285. [PMID: 34514855 DOI: 10.1177/10556656211042789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine if secondary alveolar bone grafting (SABG) timing in patients with cleft lip and palate (CLP) influences the future need for additional maxillary advancement procedures, particularly Le Fort I osteotomy with rigid external distraction (RED). DESIGN Retrospective cohort study. Groups were separated by SABG timing: early mixed dentition (ages 68 years) or late mixed dentition (ages 9-11 years). The criterion for RED was negative overjet ≥8 mm, and sufficient dental development for RED. SETTING Single tertiary care institution. PATIENTS Patients with CLP that underwent SABG from 2010 to 2015. Exclusion criteria included syndromic conditions, SABG surgery at age >12 years, current age <12 years, and <2 years follow-up. 104 patients were included. MAIN OUTCOME MEASURES The number of RED candidates and treated patients. RESULTS There was no statistical difference in the number of RED candidates (P = .0718) nor treated patients (P = .2716) based on SABG timing; stratification by laterality was also insignificant. Early SABG is associated with higher odds of being a RED candidate (pooled, unilateral, bilateral) and treated patient (pooled and unilateral); however, there were no statistically significant associations between SABG timing and the number of RED candidates and treated patients as determined by logistic regression models. CONCLUSION There is no statistically significant association between SABG timing and the odds of being a RED candidate or treated patient. Future prospective studies are recommended to assess the relationship between SABG timing and maxillary growth in patients with CLP.
Collapse
Affiliation(s)
- Kathlyn K Powell
- School of Dentistry, 83488University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Lewis
- School of Dentistry, 83488University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rae Sesanto
- School of Dentistry, 83488University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter D Waite
- School of Dentistry, 83488University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
4
|
Gibreel W, Wlodarczyk JR, Wolfswinkel EM, Yen S, Urata MM, Hammoudeh JA. Cleft Lip and Palate: Le Fort I Distraction Using an Internal Device. Clin Plast Surg 2021; 48:407-417. [PMID: 34051894 DOI: 10.1016/j.cps.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Maxillary hypoplasia is a commonly seen dentofacial anomaly in patients with cleft lip and palate after surgical repair of the cleft anomaly. To facilitate large horizontal movements of the maxilla, distraction osteogenesis is used to slowly stretch the soft tissue envelope with the skeletal advancement preventing tissue recoil and skeletal relapse. Internal distraction devices have the advantage of reducing the amount of physical and psychological stress placed on patients, families, and caregivers. The technique has been successful in producing stable results for large advancements of the facial skeleton when compared with conventional Le Fort I advancement and fixation of the maxilla.
Collapse
Affiliation(s)
- Waleed Gibreel
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA
| | - Jordan R Wlodarczyk
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Erik M Wolfswinkel
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA
| | - Stephen Yen
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Dentistry and Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark M Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA; Division of Dentistry and Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90033, USA; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA; Division of Dentistry and Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|