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Huang XY, Shao Z, Zhong NN, Wen YH, Wu TF, Liu B, Ma SR, Bu LL. Comparative analysis of GoPro and digital cameras in head and neck flap harvesting surgery video documentation: an innovative and efficient method for surgical education. BMC MEDICAL EDUCATION 2024; 24:531. [PMID: 38741079 DOI: 10.1186/s12909-024-05510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND An urgent need exists for innovative surgical video recording techniques in head and neck reconstructive surgeries, particularly in low- and middle-income countries where a surge in surgical procedures necessitates more skilled surgeons. This demand, significantly intensified by the COVID-19 pandemic, highlights the critical role of surgical videos in medical education. We aimed to identify a straightforward, high-quality approach to recording surgical videos at a low economic cost in the operating room, thereby contributing to enhanced patient care. METHODS The recording was comprised of six head and neck flap harvesting surgeries using GoPro or two types of digital cameras. Data were extracted from the recorded videos and their subsequent editing process. Some of the participants were subsequently interviewed. RESULTS Both cameras, set at 4 K resolution and 30 frames per second (fps), produced satisfactory results. The GoPro, worn on the surgeon's head, moves in sync with the surgeon, offering a unique first-person perspective of the operation without needing an additional assistant. Though cost-effective and efficient, it lacks a zoom feature essential for close-up views. In contrast, while requiring occasional repositioning, the digital camera captures finer anatomical details due to its superior image quality and zoom capabilities. CONCLUSION Merging these two systems could significantly advance the field of surgical video recording. This innovation holds promise for enhancing technical communication and bolstering video-based medical education, potentially addressing the global shortage of specialized surgeons.
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Affiliation(s)
- Xin-Yue Huang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhe Shao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yuan-Hao Wen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tian-Fu Wu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Si-Rui Ma
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Vyas K, Suchyta M, Gibreel W, Martinez-Jorge J, Bite U, Sharaf BA, Bradley EA, Amer H, Bakri K, Mardini S. Virtual Surgical Planning and 3D-Printed Surgical Guides in Facial Allotransplantation. Semin Plast Surg 2022; 36:199-208. [PMID: 36506279 PMCID: PMC9729061 DOI: 10.1055/s-0042-1756452] [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: 12/12/2022]
Abstract
The complex three-dimensional (3D) anatomy in facial allotransplantation creates a unique challenge for surgical reconstruction. Evolution of virtual surgical planning (VSP) through computer-aided design and computer-aided manufacturing has advanced reconstructive outcomes for many craniomaxillofacial indications. Surgeons use VSP, 3D models, and surgical guides to analyze and to trial surgical approaches even prior to entering the operating room. This workflow allows the surgeon to plan osteotomies and to anticipate challenges, which improves surgical precision and accuracy, optimizes outcomes, and should reduce operating room time. We present the development, evolution, and utilization of VSP and 3D-printed guides in facial allotransplantation at our institution, from guide conception to first clinical case.
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Affiliation(s)
- Krishna Vyas
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Marissa Suchyta
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Waleed Gibreel
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jorys Martinez-Jorge
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Uldis Bite
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Basel A. Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth A. Bradley
- Division of Oculoplastic Surgery, Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Hatem Amer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota,Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karim Bakri
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Samir Mardini
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota,Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, Mayo Clinic, Rochester, Minnesota,Address for correspondence Samir Mardini, MD Division of Plastic Surgery, Department of Surgery, Obaid Center for Reconstructive Transplant SurgeryMayo Clinic, MA12-44W, 200 First Street SouthwestRochester, MN 55905
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Vyas K, Gibreel W, Mardini S. Virtual Surgical Planning (VSP) in Craniomaxillofacial Reconstruction. Facial Plast Surg Clin North Am 2022; 30:239-253. [DOI: 10.1016/j.fsc.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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4
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Facial Transplantation. Facial Plast Surg Clin North Am 2022; 30:255-269. [DOI: 10.1016/j.fsc.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Alfouzan AF. The role of simulator and digital technologies in head and neck reconstruction. Niger J Clin Pract 2021; 24:1415-1422. [PMID: 34657004 DOI: 10.4103/njcp.njcp_566_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This review summarizes the development of digital technology in the field of head and neck surgeries. Advances in digital technology assist surgeons during preoperative planning, where they can simulate their surgeries with improvement in the resulting accuracy of the surgery. In addition to digital technologies having many applications in the surgical field, they can be used in medical devices, surgical and educational models, and tissue engineering.
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Affiliation(s)
- A F Alfouzan
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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6
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Mortality Within 30 Days After Head and Neck Free Flap Reconstruction: A Systematic Review. J Craniofac Surg 2021; 32:1738-1741. [PMID: 34081420 DOI: 10.1097/scs.0000000000007548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The aim of this systematic review is to analyze the 30-day postoperative mortality in patients undergoing free flap reconstruction for head and neck cancer published in literature and to identify associated factors. METHODS The authors performed a literature search between January 1950 and February 2020 in PubMed, EMBASE, and Scopus, using a combination of Medical Subject Headings headings and text keywords related to head and neck cancer; microsurgery or free flap reconstruction; and 30-day mortality. Inclusion criteria were: original studies in English reporting on 30-day mortality after head and neck free flap reconstruction in adult population. RESULTS Thirty-one publications reported on a total of 13,447 patients who underwent head and neck free flap reconstruction. The published 30-day postoperative mortality ranged from 0% to 6.3%, with an average of 1.21%. A number of studies examined the association between mortality and body mass index, American Society of Anesthesiologists, and comorbidity score and age. One study found that underweight patients had significantly higher mortality. Two studies found no association between the American Society of Anesthesiologists score and 30-day postoperative mortality; however, 1 study reported significantly higher mortality with increased comorbidity score. Regarding association with age, 3 studies found significant higher mortality in older patients, while 5 studies found no difference. CONCLUSIONS The average 30-day postoperative mortality in patients undergoing head and neck free flap reconstruction is 1.21% and is; therefore, not negligible. Careful patient selection and preoperative optimization are essential in order to reduce mortality in head neck free flap reconstruction.
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Membreno PV, Luttrell JB, Mamidala MP, Schwartz DL, Hayes DN, Gleysteen JP, Gillespie MB. Outcomes of primary radiotherapy with or without chemotherapy for advanced oral cavity squamous cell carcinoma: Systematic review. Head Neck 2021; 43:3165-3176. [PMID: 34165221 DOI: 10.1002/hed.26779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/22/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Surgery with adjuvant radiotherapy is the accepted standard for treatment of advanced oral cavity squamous cell carcinoma (OCSCC); however, alternative evidence suggests that definitive (chemo)radiotherapy may have similar outcomes. METHODS Systematic review was performed to assess the therapeutic value of radiotherapy or chemoradiotherapy as a primary modality for treating OCSCC. Meta-analysis of outcomes was performed between articles comparing radiotherapy and primary surgical treatment. RESULTS Meta-analysis showed less favorable results of radiotherapy compared to surgery: overall survival at 3-years (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.34-0.77) and 5-years (OR = 0.42; 95% CI = 0.29-0.60); disease-specific survival at 3-years (OR = 0.55; 95% CI = 0.32-0.96) and 5-years (OR = 0.55; 95% CI = 0.32-0.96). Odds of feeding tube dependency were higher in primary radiotherapy group (OR = 2.67; 95% CI = 1.27-5.64). CONCLUSIONS Results of this study support the current perspective favoring primary surgical treatment for OCSCC in the absence of surgical contraindications.
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Affiliation(s)
- Petra V Membreno
- Department of Otolaryngology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jordan B Luttrell
- Department of Otolaryngology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Madhu P Mamidala
- Department of Otolaryngology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David L Schwartz
- Department of Radiation Oncology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - D Neil Hayes
- Division of Hematology and Oncology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - John P Gleysteen
- Department of Otolaryngology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - M Boyd Gillespie
- Department of Otolaryngology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Frank K, Moellhoff N, Kaiser A, Alfertshofer M, Gotkin RH, Patel A, Smith MP, Mardini S, Gavril D, Cotofana S. Signal-To-Noise Ratio Calculations to Validate Sensor Positioning for Facial Muscle Assessment Using Noninvasive Facial Electromyography. Facial Plast Surg 2021; 37:614-624. [PMID: 33682916 DOI: 10.1055/s-0041-1725168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The evaluation of neuromodulator treatment outcomes can be performed by noninvasive surface-derived facial electromyography (fEMG) which can detect cumulative muscle fiber activity deep to the skin. The objective of the present study is to identify the most reliable facial locations where the motor unit action potentials (MUAPs) of various facial muscles can be quantified during fEMG measurements. The study population consisted of five males and seven females (31.0 [12.9] years, body mass index of 22.15 [1.6] kg/m2). Facial muscle activity was assessed in several facial regions in each patient for their respective muscle activity utilizing noninvasive surface-derived fEMG. Variables of interest were the average root mean square of three performed muscle contractions (= signal) (µV), mean root mean square between those contraction with the face in a relaxed facial expression (= baseline noise) (µV), and the signal to noise ratio (SNR). A total of 1,709 processed fEMG signals revealed one specific reliable location in each investigated region based on each muscle's anatomy, on the highest value of the SNR, on the lowest value for the baseline noise, and on the practicability to position the sensor while performing a facial expression. The results of this exploratory study may help guiding future researchers and practitioners in designing study protocols and measuring individual facial MUAP when utilizing fEMG. The locations presented herein were selected based on the measured parameters (SNR, signal, baseline noise) and on the practicability and reproducibility of sensor placement.
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Affiliation(s)
- Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Antonia Kaiser
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Robert H Gotkin
- Private Practice, New York City, New York.,Private Practice, Greenvale, New York
| | - Ashit Patel
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Michael P Smith
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Samir Mardini
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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9
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Hilven PH, Vranckx JJ. The Iliac Crest Osteomuscular Flap for Bony Reconstruction: Beast or Beauty? A Reassessment of the Value and Donor Site Morbidity in the CAD/CAM Era. J Reconstr Microsurg 2021; 37:671-681. [PMID: 33634440 DOI: 10.1055/s-0041-1724129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The iliac crest bone flap (ICBF), based on the deep circumflex iliac artery, has a bad reputation regarding donor site morbidity. However, the ICBF has an ideal curvature and shape for occlusion-based hemimandibular reconstructions with rapid dental rehabilitation and for vertical class III maxillary reconstructions that require bony support and muscular bulk to fill cavities and to provide intraoral lining. Is this notorious donor site reputation still valid with modern flap procurement using computer aided design/computer aided manufacturing (CAD/CAM) and recipient-site closure techniques? MATERIALS AND METHODS We performed a literature search of the public databases PubMed, Cochrane, Google Scholar, and Web of Science for papers using mesh keywords related to donor site morbidity of the ICBF. We report three illustrative case reports using our current protocols for oncologic bony resection and reconstruction, using in-house CAD/CAM and three-dimensional printing to procure a tight-fit ICBF and minimizing donor site morbidity. RESULTS We found 191 articles in the PubMed database of which we considered 176 nonrelevant. Cochrane Library and Google Scholar database searches resulted in the inclusion of 11 additional papers. The second search resulted in 172 articles of which we used five after excluding nonrelevant papers. Accurate preoperative (CAD/CAM) planning, preservation of the anterior superior iliac spine (ASIS), and paying attention to thoroughly donor site closure make the ICBF a very valuable option for accurate maxillofacial reconstructions with very acceptable comorbidities. This corresponds with our clinical findings. CONCLUSION Dogma never is a good teacher; it remains elementary that routine "knowledge" is (re)questioned. Donor site morbidity of the ICBF is comparable to other bone flaps. The shape and bone stock of the ICBF is ideal and often may be first choice. In combination with CAD/CAM planning, the ICBF is an excellent option for specific maxillofacial reconstructions.
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Affiliation(s)
- Paulien H Hilven
- Department of Plastic and Reconstructive Surgery, KU Leuven University Hospitals, Leuven, Belgium
| | - Jan J Vranckx
- Department of Plastic and Reconstructive Surgery, KU Leuven University Hospitals, Leuven, Belgium
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11
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Mirror Image Based Three-Dimensional Virtual Surgical Planning and Three-Dimensional Printing Guide System for the Reconstruction of Wide Maxilla Defect Using the Deep Circumflex Iliac Artery Free Flap. J Craniofac Surg 2020; 30:1829-1832. [PMID: 31058721 DOI: 10.1097/scs.0000000000005577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A patient was diagnosed with squamous cell carcinoma of the maxillary sinus and consequently underwent a unilateral total maxillectomy and reconstruction using an anterolateral thigh (ALT) free flap. Soft tissue transplantation without a bone graft at the large maxillary defect site caused a midfacial collapse, which worsened, especially after radiotherapy. The 3-dimensional positioning of the composite flap for wide maxillary reconstruction is aesthetically important. To achieve ideal symmetry and aesthetics, a mirror image was created using the normal contralateral side. Through computer simulation, the function and symmetry of the virtually reconstructed maxilla was evaluated, and the surgical guide was made using a 3D printing system. Based on the prepared surgical guide, a deep circumflex iliac artery (DCIA) free flap was harvested, and its implementation in the reconstruction ultimately led to satisfactory results. Utilization of mirror image based virtual surgical planning and a 3D printing guide is a significantly effective method for maxilla reconstruction with DCIA flaps.
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12
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Iyer S. Reconstruction in head and neck cancer surgery: The ways we came through and the path ahead. JOURNAL OF HEAD & NECK PHYSICIANS AND SURGEONS 2020. [DOI: 10.4103/jhnps.jhnps_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Facial Transplantation for an Irreparable Central and Lower Face Injury: A Modernized Approach to a Classic Challenge. Plast Reconstr Surg 2019; 144:264e-283e. [PMID: 31348362 DOI: 10.1097/prs.0000000000005885] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Facial transplantation introduced a paradigm shift in the reconstruction of extensive facial defects. Although the feasibility of the procedure is well established, new challenges face the field in its second decade. METHODS The authors' team has successfully treated patients with extensive thermal and ballistic facial injuries with allotransplantation. The authors further validate facial transplantation as a reconstructive solution for irreparable facial injuries. Following informed consent and institutional review board approval, a partial face and double jaw transplantation was performed in a 25-year-old man who sustained ballistic facial trauma. Extensive team preparations, thorough patient evaluation, preoperative diagnostic imaging, three-dimensional printing technology, intraoperative surgical navigation, and the use of dual induction immunosuppression contributed to the success of the procedure. RESULTS The procedure was performed on January 5 and 6, 2018, and lasted nearly 25 hours. The patient underwent hyoid and genioglossus advancement for floor-of-mouth dehiscence, and palate wound dehiscence repair on postoperative day 11. Open reduction and internal fixation of left mandibular nonunion were performed on postoperative day 108. Nearly 1 year postoperatively, the patient demonstrates excellent aesthetic outcomes, intelligible speech, and is tolerating an oral diet. He remains free from acute rejection. CONCLUSIONS The authors validate facial transplantation as the modern answer to the classic reconstructive challenge imposed by extensive facial defects resulting from ballistic injury. Relying on a multidisciplinary collaborative approach, coupled with innovative emerging technologies and immunosuppression protocols, can overcome significant challenges in facial transplantation and reinforce its position as the highest rung on the reconstructive ladder. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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14
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Computerized Approach to Facial Transplantation: Evolution and Application in 3 Consecutive Face Transplants. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2379. [PMID: 31592022 PMCID: PMC6756666 DOI: 10.1097/gox.0000000000002379] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/14/2019] [Indexed: 01/08/2023]
Abstract
Face transplant (FT) candidates present with unique anatomic and functional defects unsuitable for autologous reconstruction, making the accurate design and transplantation of patient-specific allografts particularly challenging. In this case series, we present our computerized surgical planning (CSP) protocol for FT.
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15
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Esteves Trindade PH, de Camargo Ferraz G, Pereira Lima ML, Negrão JA, Paranhos da Costa MJR. Eye Surface Temperature as a Potential Indicator of Physical Fitness in Ranch Horses. J Equine Vet Sci 2019; 75:1-8. [PMID: 31002082 DOI: 10.1016/j.jevs.2018.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/18/2018] [Accepted: 11/26/2018] [Indexed: 01/04/2023]
Abstract
This study aimed to investigate the use of maximum eye surface temperature (ESTmax), recorded by infrared thermography, as an indicator of physical fitness in ranch horses. Data collection was carried out with 16 horses by recording six physical fitness biomarkers (ESTmax, respiratory rate, creatine kinase activity [CK], and concentrations of total serum protein, plasmatic cortisol, and lactate) before and after a regular working day. We also recorded heart rate during the exercise, exercise duration, average velocity, distance traveled, and air temperature and humidity. The variation between the sampling times was compared by using repeated measures ANOVA or Wilcoxon paired test. The t-test was used to compare ESTmax means of dehydrated and nondehydrated horses. The differences (DIF-) between each variable's sampling times were calculated, and the Spearman's correlation coefficients between DIF-ESTmax and DIF- of other variables were estimated. A hierarchical cluster analysis was used to classify the horses according to their physical fitness. All biomarkers increased after the workday, and the ESTmax means of dehydrated and nondehydrated horses did not differ (P < .05). DIF-CK and DIF-ESTmax were positively correlated (rs = 0.56, P < .05). The cluster analysis defined two groups of horses (LOW and HIGH), with DIF-ESTmax and DIF-CK differing statistically between them. HIGH horses showed CK higher than 350 U/L, indicating some degree of muscle damage. These results suggest that ESTmax has potential to predict changes in CK and, thus could be a useful indicator of physical fitness in ranch horses; although, its effectiveness has to be confirmed in future studies.
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Affiliation(s)
- Pedro Henrique Esteves Trindade
- UNESP, Universidade Estadual Paulista, Programa de Pós-Graduação em Zootecnia, Faculdade de Ciências Agrárias e Veterinárias, Jaboticabal, São Paulo, Brazil
| | - Guilherme de Camargo Ferraz
- UNESP, Universidade Estadual Paulista, Departamento de Morfologia e Fisiologia Animal, Faculdade de Ciências Agrárias e Veterinárias, Jaboticabal, São Paulo, Brazil
| | | | - João Alberto Negrão
- USP, Universidade de São Paulo, Departamento de Ciências Básicas, Faculdade de Zootecnia e Engenharia de Alimentos, Pirassununga, São Paulo, Brazil
| | - Mateus J R Paranhos da Costa
- UNESP, Universidade Estadual Paulista, Departamento de Zootecnia, Faculdade de Ciências Agrárias e Veterinárias, Jaboticabal, São Paulo, Brazil.
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Wyles SP, Hayden RE, Meyer FB, Terzic A. Regenerative medicine curriculum for next-generation physicians. NPJ Regen Med 2019; 4:3. [PMID: 30774984 PMCID: PMC6367326 DOI: 10.1038/s41536-019-0065-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/07/2019] [Indexed: 12/17/2022] Open
Abstract
Regenerative sciences are poised to transform clinical practice. The quest for regenerative solutions has, however, exposed a major gap in current healthcare education. A call for evidence-based adoption has underscored the necessity to establish rigorous regenerative medicine educational programs early in training. Here, we present a patient-centric regenerative medicine curriculum embedded into medical school core learning. Launched as a dedicated portal of new knowledge, learner proficiency was instilled by means of a discovery–translation–application blueprint. Using the “from the patient to the patient” paradigm, student experience recognized unmet patient needs, evolving regenerative technologies, and ensuing patient management solutions. Targeted on the deployment of a regenerative model of care, complementary subject matter included ethics, regulatory affairs, quality control, supply chain, and biobusiness. Completion of learning objectives was monitored by online tests, group teaching, simulated clinical examinations along with longitudinal continuity across medical school training and residency. Success was documented by increased awareness and proficiency in domain-relevant content, as well as specialty identification through practice exposure, research engagement, clinical acumen, and education-driven practice advancement. Early incorporation into mainstream medical education offers a tool to train next-generation healthcare providers equipped to adopt and deliver validated regenerative medicine solutions.
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Affiliation(s)
- Saranya P Wyles
- Department of Dermatology, Rochester, MN USA.,2Mayo Clinic Center for Regenerative Medicine, Rochester, MN USA
| | - Richard E Hayden
- 2Mayo Clinic Center for Regenerative Medicine, Rochester, MN USA.,Department of Otolaryngology, Phoenix, AZ USA
| | - Fredric B Meyer
- 4Mayo Clinic Alix School of Medicine, Rochester, MN USA.,Department of Neurologic Surgery, Rochester, MN USA
| | - Andre Terzic
- 2Mayo Clinic Center for Regenerative Medicine, Rochester, MN USA.,Department of Cardiovascular Medicine, Rochester, MN USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN USA.,8Department of Clinical Genomics, Mayo Clinic, Rochester, MN USA
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17
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Alfouzan AF. Review of surgical resection and reconstruction in head and neck cancer. Traditional versus current concepts. Saudi Med J 2019; 39:971-980. [PMID: 30284578 PMCID: PMC6201028 DOI: 10.15537/smj.2018.10.22887] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This review summarizes the development of head and neck cancer resection and reconstruction. The developments in the treatment of cancer patients are reflected in their surgical outcomes, in addition to functional and aesthetic improvements. New technologies, such as surgical simulation and planning, minimally invasive surgery, and microsurgery have been added to the field to improve surgical resection of the tumor and reconstruction. The field is still growing to optimize the management of head and neck cancer.
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Affiliation(s)
- Afnan F Alfouzan
- Department of Prosthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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19
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Cuesta-González FJ, Arranz-Obispo CD, Pozuelo-Arquimbau L, Sieira-Gil R, Marí-Roig A. Functional outcomes after glossectomies: Pilot study on use of a thrombin-fibrinogen biosponge (TachoSil). Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:24-29. [PMID: 30126804 DOI: 10.1016/j.oooo.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether the use of a thrombin-fibrinogen biosponge (TachoSil) has any advantage in tongue healing. STUDY DESIGN A retrospective study with 30 patients treated with partial glossectomy (below half a tongue) was designed. We compared the results from a group using the biosponge (n =15 patients) and a control group (n = 15). Variables taken into consideration were bolus clearance, frenulum flexibility, and oral transit time. With these parameters, we formulated a "tongue remaining functional" (TRF) scale to assess tongue functionality after the surgery. We also evaluated long-term quality of life by using the Functional Intraoral Glasgow Scale (FIGS). RESULTS In this study, TRF score, bolus clearance, oral transit time, and frenulum flexibility were significantly improved in the biosponge group. However, there were no differences between the 2 groups in the FIGS scores. CONCLUSIONS The use of the biosponge in this pilot study showed positive long-term effects in lingual healing and functionality after partial glossectomies.
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Affiliation(s)
| | - Carlos D Arranz-Obispo
- Department of Oral and Maxillofacial Surgery, Bellvitge University Hospital, L´ Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Pozuelo-Arquimbau
- Department of Oral and Maxillofacial Surgery, Bellvitge University Hospital, L´ Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón Sieira-Gil
- Oral and Maxillofacial Surgery Unit, Clinic University Hospital, Barcelona, Spain
| | - Antoni Marí-Roig
- Department of Oral and Maxillofacial Surgery, Bellvitge University Hospital, L´ Hospitalet de Llobregat, Barcelona, Spain
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20
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Shelmerdine SC, Simcock IC, Hutchinson JC, Aughwane R, Melbourne A, Nikitichev DI, Ong JL, Borghi A, Cole G, Kingham E, Calder AD, Capelli C, Akhtar A, Cook AC, Schievano S, David A, Ourselin S, Sebire NJ, Arthurs OJ. 3D printing from microfocus computed tomography (micro-CT) in human specimens: education and future implications. Br J Radiol 2018; 91:20180306. [PMID: 29698059 DOI: 10.1259/bjr.20180306] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Microfocus CT (micro-CT) is an imaging method that provides three-dimensional digital data sets with comparable resolution to light microscopy. Although it has traditionally been used for non-destructive testing in engineering, aerospace industries and in preclinical animal studies, new applications are rapidly becoming available in the clinical setting including post-mortem fetal imaging and pathological specimen analysis. Printing three-dimensional models from imaging data sets for educational purposes is well established in the medical literature, but typically using low resolution (0.7 mm voxel size) data acquired from CT or MR examinations. With higher resolution imaging (voxel sizes below 1 micron, <0.001 mm) at micro-CT, smaller structures can be better characterised, and data sets post-processed to create accurate anatomical models for review and handling. In this review, we provide examples of how three-dimensional printing of micro-CT imaged specimens can provide insight into craniofacial surgical applications, developmental cardiac anatomy, placental imaging, archaeological remains and high-resolution bone imaging. We conclude with other potential future usages of this emerging technique.
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Affiliation(s)
- Susan C Shelmerdine
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Ian C Simcock
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - John Ciaran Hutchinson
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,3 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Rosalind Aughwane
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Andrew Melbourne
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Daniil I Nikitichev
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK.,5 Department of Medical Physics and Biomedical Engineering, University College London , London , UK
| | - Ju-Ling Ong
- 6 Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | | | | | - Emilia Kingham
- 8 UCL Culture, Bidborough House, 38-50 Bidborough Street, London UK
| | - Alistair D Calder
- 2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Claudio Capelli
- 9 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,10 Institute of Cardiovascular Science, University College London , London , UK
| | - Aadam Akhtar
- 10 Institute of Cardiovascular Science, University College London , London , UK
| | - Andrew C Cook
- 10 Institute of Cardiovascular Science, University College London , London , UK
| | - Silvia Schievano
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,9 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,10 Institute of Cardiovascular Science, University College London , London , UK
| | - Anna David
- 11 Institute for Women's Health, University College London , London , UK
| | - Sebastian Ourselin
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Neil J Sebire
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,3 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Owen J Arthurs
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
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21
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Lin Y, Song W. [Progress of monitoring methods and preventions of disorder of blood supplying of expanded flaps]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:118-124. [PMID: 29806376 PMCID: PMC8414218 DOI: 10.7507/1002-1892.201708056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/14/2017] [Indexed: 11/03/2022]
Abstract
Objective To summarize the monitoring methods and preventions of the disorder of blood supplying of expanded flaps, so as to provide some references for improving the survival of expanded flaps. Methods The domestic and abroad related literature about the disorder of blood supplying of expanded flaps was reviewed and analyzed. Results Handheld Doppler, digital subtraction angiography, computer tomographic angiography, magnetic resonance angiography, and fluorescein angiography can be used as reliable preoperative imaging methods in designing expanded flaps with rich blood supply. Several techniques can be used for monitoring the blood supply of expanded flaps during the early postoperative period including traditional monitoring via physical examination, monitoring via dynamic infrared thermography, near-infrared spectroscopy tissue oximeter, external and implantable Doppler, and more recently developed diffuse correlation spectroscopy. Surgical delay, bloodletting, leech therapy, hyperbaric oxygen, and so on can decrease the risk of necrosis in expanded flaps. Conclusion The survival of expanded flap is influenced by many factors. Preoperative design by using handheld Doppler and new imaging technology and postoperative early detection of blood supply can provide references of timely intervention, so that ischemic necrosis of the flaps can be reduced, and the success rate of surgery can be improved.
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Affiliation(s)
- Yanxian Lin
- Department of Cervicofacial Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China
| | - Weiming Song
- Department of Cervicofacial Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144,
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22
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Jomoto W, Tanooka M, Doi H, Kikuchi K, Mitsuie C, Yamada Y, Suzuki T, Yamano T, Ishikura R, Kotoura N, Yamamoto S. Development of a Three-dimensional Surgical Navigation System with Magnetic Resonance Angiography and a Three-dimensional Printer for Robot-assisted Radical Prostatectomy. Cureus 2018. [PMID: 29531871 PMCID: PMC5837468 DOI: 10.7759/cureus.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We sought to develop a surgical navigation system using magnetic resonance angiography (MRA) and a three-dimensional (3D) printer for robot-assisted radical prostatectomy (RARP). Six patients with pathologically proven localized prostate cancer were prospectively enrolled in this study. Prostate magnetic resonance imaging (MRI), consisting of T2-weighted sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) and true fast imaging with steady-state precession (true FISP), reconstructed by volume rendering, was followed by dynamic contrast-enhanced MRA performed with a volumetric interpolated breath-hold examination (VIBE) during intravenous bolus injection of gadobutrol. Images of arterial and venous phases were acquired over approximately 210 seconds. Selected images were sent to a workstation for generation of 3D volume-rendered images and standard triangulated language (STL) files for 3D print construction. The neurovascular bundles (NVBs) were found in sequence on non-contrast images. Accessory pudendal arteries (APAs) were found in all cases in the arterial phase of contrast enhancement but were ill-defined on non-contrast enhanced MRA. Dynamic contrast-enhanced MRA helped to detect APAs, suggesting that this 3D system using MRI will be useful in RARP.
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Affiliation(s)
- Wataru Jomoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine
| | - Keisuke Kikuchi
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Chiemi Mitsuie
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | - Toru Suzuki
- Department of Urology, Hyogo College of Medicine
| | | | | | - Noriko Kotoura
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
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23
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Fujiwara RJT, Burtness B, Husain ZA, Judson BL, Bhatia A, Sasaki CT, Yarbrough WG, Mehra S. Treatment guidelines and patterns of care in oral cavity squamous cell carcinoma: Primary surgical resection vs. nonsurgical treatment. Oral Oncol 2017; 71:129-137. [PMID: 28688680 DOI: 10.1016/j.oraloncology.2017.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 2017 National Comprehensive Cancer Network Clinical Practice Guidelines recommend surgical resection or definitive radiation therapy for early-stage oral cavity malignancies, and surgical resection or multimodality clinical trials for late-stage disease. Few studies have been conducted to identify predictors of choice of treatment modality for oral cavity malignancies. METHODS All patients in the National Cancer Data Base (NCDB) diagnosed with oral cavity squamous cell carcinoma (OCSCC) between 1998 and 2011 were identified. Chi-square and binary logistic regression were used to identify factors predictive of surgical or nonsurgical treatment; multiple imputation was used for missing data. Cox proportional hazards models were generated to identify associations between treatment modality and overall survival (OS). RESULTS Of 23,459 patients, 4139 (17.6%) underwent primary nonsurgical treatment. Among NCDB-registered facilities, there has been a decrease in use of nonsurgical treatment for OCSCC (OR 0.97, p<0.001). Older age, non-white race, Medicaid insurance, low income, low education, and later-stage disease were associated with nonsurgical therapy, while patients at academic/research programs were more likely to undergo surgery (OR 0.38, p<0.001). Nonsurgical treatment was associated with decreased OS (HR=2.02, p<0.001); this was upheld on subgroup analysis of early- and late-stage disease. CONCLUSIONS Use of primary nonsurgical treatment for OCSCC has decreased over time among NCDB-registered facilities and is associated with factors related to access to care. Surgical resection for the primary treatment of oral cavity cancer may be associated with improved OS, though conclusions regarding survival are limited by the non-randomized nature of the data.
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Affiliation(s)
- Rance J T Fujiwara
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States
| | - Barbara Burtness
- Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, Department of Internal Medicine, United States
| | - Zain A Husain
- Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, Department of Therapeutic Radiology, United States
| | - Benjamin L Judson
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States
| | - Aarti Bhatia
- Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, Department of Internal Medicine, United States
| | - Clarence T Sasaki
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States
| | - Wendell G Yarbrough
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, Department of Pathology, United States
| | - Saral Mehra
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States.
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