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He SX, Ma C, Yuan ZY, Xu TF, Wei JZ, Shang YY, Huang XP. Feasibility of augmented reality combine patient-specific implants (PSI) applied to navigation in mandibular genioplasty: A phantom experiment. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:102039. [PMID: 39244030 DOI: 10.1016/j.jormas.2024.102039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Genitoplasty is becoming more and more common, and it is important to improve the accuracy of the procedure and simplify the procedure. This experiment explores the feasibility of using augmented reality (AR) technology combined with PSI titanium plates for navigational assistance in genioplasty performed on models, aiming to study the precision of such surgical interventions. METHODS Twelve genioplasty procedures were designed and implemented on 3D-printed resin mandibular models by the same surgeon using three different approaches: AR+3DT group (AR+PSI) , 3DT group (patient-specific titanium plate) , and a traditional free-hand group(FH group). Postoperative models were assessed using CBCT to evaluate surgical accuracy. RESULTS In terms of osteotomy accuracy, the AR group demonstrated a surgical error of 0.9440±0.5441 mm, significantly lower than the control group, which had an error of 1.685±0.8907 mm (P < 0.0001). In experiments positioning the distal segment of the chin, the overall centroid shift in the AR group was 0.3661±0.1360 mm, significantly less than the 2.304±0.9629 mm in the 3DT group and 1.562±0.9799 mm in the FH group (P < 0.0001). Regarding angular error, the AR+3DT group showed 2.825±1.373°, significantly <8.283±3.640° in the 3DT group and 7.234±5.241° in the FH group. CONCLUSION AR navigation technology combined with PSI titanium plates demonstrates higher surgical accuracy compared to traditional methods and shows feasibility for use. Further validation through clinical trials is necessary.
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Affiliation(s)
- Shi-Xi He
- Department of Oral and Maxillofacial Surgery, College & Hospital of Stomatology, Guangxi Medical University, Shuangyong Road 10, Nanning, Qingxiu District, Nanning, Guangxi 530021, PR China
| | - Cheng Ma
- Department of Oral and Maxillofacial Surgery, College & Hospital of Stomatology, Guangxi Medical University, Shuangyong Road 10, Nanning, Qingxiu District, Nanning, Guangxi 530021, PR China
| | - Zong-Yi Yuan
- Department of Oral and Maxillofacial Surgery, College & Hospital of Stomatology, Guangxi Medical University, Shuangyong Road 10, Nanning, Qingxiu District, Nanning, Guangxi 530021, PR China
| | - Tian-Feng Xu
- Department of Oral and Maxillofacial Surgery, College & Hospital of Stomatology, Guangxi Medical University, Shuangyong Road 10, Nanning, Qingxiu District, Nanning, Guangxi 530021, PR China
| | - Jin-Zhi Wei
- Department of Oral and Maxillofacial Surgery, College & Hospital of Stomatology, Guangxi Medical University, Shuangyong Road 10, Nanning, Qingxiu District, Nanning, Guangxi 530021, PR China
| | - Yin-Yu Shang
- Department of Oral and Maxillofacial Surgery, College & Hospital of Stomatology, Guangxi Medical University, Shuangyong Road 10, Nanning, Qingxiu District, Nanning, Guangxi 530021, PR China
| | - Xuan-Ping Huang
- Department of Oral and Maxillofacial Surgery, College & Hospital of Stomatology, Guangxi Medical University, Shuangyong Road 10, Nanning, Qingxiu District, Nanning, Guangxi 530021, PR China.
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Msallem B, Veronesi L, Beyer M, Halbeisen FS, Maintz M, Franke A, Korn P, Dragu A, Thieringer FM. Evaluation of the Dimensional Accuracy of Robot-Guided Laser Osteotomy in Reconstruction with Patient-Specific Implants-An Accuracy Study of Digital High-Tech Procedures. J Clin Med 2024; 13:3594. [PMID: 38930123 PMCID: PMC11204867 DOI: 10.3390/jcm13123594] [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: 04/29/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling holes in robotic surgery minimize potential sources of error and yield highly accurate outcomes. Methods: Ten mandibular replicas were evaluated after cutting-guided saw osteotomy and robot-guided laser osteotomy following reconstruction with patient-specific implants. The descriptive data analysis summarizes the mean, standard deviation (SD), median, minimum, maximum, and root mean square (RMS) values of the surface comparison for 3D printed models regarding trueness and precision. Results: The saw group had a median trueness RMS value of 2.0 mm (SD ± 1.7) and a precision of 1.6 mm (SD ± 1.4). The laser group had a median trueness RMS value of 1.2 mm (SD ± 1.1) and an equal precision of 1.6 mm (SD ± 1.4). These results indicate that robot-guided laser osteotomies have a comparable accuracy to cutting-guided saw osteotomies, even though there was a lack of statistical significance. Conclusions: Despite the limited sample size, this digital high-tech procedure has been shown to be potentially equivalent to the conventional osteotomy method. Robotic surgery and laser osteotomy offers enormous advantages, as they enable the seamless integration of precise virtual preoperative planning and exact execution in the human body, eliminating the need for surgical guides in the future.
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Affiliation(s)
- Bilal Msallem
- University Center for Orthopedics, Trauma and Plastic Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, DE-01307 Dresden, Germany;
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
| | - Lara Veronesi
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland
| | - Michel Beyer
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland
| | - Florian S. Halbeisen
- Surgical Outcome Research Center, Department of Clinical Research, University of Basel c/o University Hospital of Basel, CH-4001 Basel, Switzerland;
| | - Michaela Maintz
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts Northwestern Switzerland, CH-4132 Muttenz, Switzerland
| | - Adrian Franke
- Department of Oral and Maxillofacial Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, DE-01307 Dresden, Germany; (A.F.); (P.K.)
| | - Paula Korn
- Department of Oral and Maxillofacial Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, DE-01307 Dresden, Germany; (A.F.); (P.K.)
| | - Adrian Dragu
- University Center for Orthopedics, Trauma and Plastic Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, DE-01307 Dresden, Germany;
| | - Florian M. Thieringer
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (L.V.); (M.B.); (M.M.); (F.M.T.)
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland
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Liu K, Wang X, Guo Y, Zhang Y, Zhang L, Cao J, Wang X. Exploring the distribution of visual attention in genioplasty trainees using eye-tracking technology. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101556. [PMID: 37442345 DOI: 10.1016/j.jormas.2023.101556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE This study aimed to investigate the visual attention of genioplasty trainees using eye-tracking technology, with the goal of providing insights for optimizing genioplasty training strategies. METHODS Trainees were recruited for the study, and their visual attention distribution was monitored with an eye-tracking device while they watched a genioplasty procedure video. The percentage of fixation durations dedicated to areas of interest (surgical objects, instruments manipulated by the primary surgeon, and instruments controlled by assistants) were analyzed for each phase of the procedure. RESULTS A total of 20 surgical trainees (8 males, 12 females; mean age, 27.8 years; range, 22-35 years) participated in the study. During the soft tissue reflection phase, trainees' percentage fixation durations on instruments controlled by the primary surgeon were higher than on surgical objects, but the difference was not significant (p > 0.05). The percentage fixation durations on instruments controlled by assistants were significantly lower than on those controlled by the primary surgeon or on surgical objects (p < 0.05). In the osteotomy, bone fixation, and suturing phases, the percentage fixation durations on surgical objects were highest, followed by instruments manipulated by the primary surgeon and those controlled by assistants, with significant differences (p < 0.05). CONCLUSION Surgical trainees need to invest significant cognitive effort in focusing on the instruments manipulated by the primary surgeon and the surgical objects during the soft tissue reflection phase, as well as on surgical objects during the osteotomy, fixation, and suturing phases. Emphasizing these elements during instruction can help trainees reduce their cognitive load and effectively master genioplasty techniques.
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Affiliation(s)
- Kai Liu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 20011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Xinxi Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 20011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Yuxiang Guo
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 20011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Yujie Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 20011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Lei Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 20011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China.
| | - Jian Cao
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 20011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China.
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Road, Shanghai 20011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China.
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Sneha A, Krishnan M, Satheesh T, Dhasarathan P, Muralidoss H. Patient-Specific Plates for Genioplasty: A Case Report. Cureus 2023; 15:e38746. [PMID: 37303387 PMCID: PMC10248537 DOI: 10.7759/cureus.38746] [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] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
A 20-year-old male patient presented with a retruded chin and crowding of the upper front tooth region. The patient's problem list included skeletal class II malocclusion, retruded chin, and shallow mentolabial sulcus. A treatment plan was curated using clinical examination, cephalometric analysis, and 3D measurements, which included the advancement genioplasty of 5 mm. Osteotomy cut was planned digitally by computer-aided surgical simulation technology (Dolphin Software, Dolphin Imaging Systems, California, USA) and then transferred to Geomagic Software (3D Systems, North Carolina, USA) where patient-specific plates were designed. The patient-specific plates were 3D printed using selective laser melting. Intraoperatively, the osteotomy cut was given using a surgical guide, and an advancement of 5 mm was performed, fixing the segments using patient-specific plates. The outcome was compared with the curated treatment plan to assess accuracy. The primary objective of the case report is to provide a digital method of the treatment plan and surgical accuracy in genioplasty using patient-specific plates.
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Affiliation(s)
- Alladi Sneha
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Tharini Satheesh
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Pradeep Dhasarathan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Hemavathy Muralidoss
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
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Accuracy of mandibular anterior subapical osteotomy by virtual planning in orthognathic surgery using patient-specific implants. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101299. [PMID: 36184071 DOI: 10.1016/j.jormas.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 09/25/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Mandibular anterior subapical osteotomy (MASO) is a complementary procedure during orthognathic surgery to correct proclination or extrusion of the anterior incisors when orthodontic movements fail. The increasing use of patient-specific implants (PSI, titanium plates) in orthognathic surgery has extended to this procedure. Digital orthognathic surgery planning involves manufacturing cutting/drilling guides and specific implants to provide better accuracy and allow complex movement with reduced surgical times compared to conventional planning. This study aimed to assess the accuracy of computer-aided surgery with patient-specific implants in mobilising the MASO segment according to planning. METHODS Eleven consecutive patients with mean age 26.82 years (15-41, SD = 10.65) were treated with MASO in addition to other conventional orthognathic procedures incorporating digital planning and patient-specific implants. A three-dimensional "stl" format file of the mandibular dental arch was obtained using an intraoral scanner at the end of the surgical procedure. The accuracy of the MASO segment displacement imposed by PSI was assessed by comparing preoperative 3D-planned mandibular dental arch with the immediate postoperative 3D-measured arch, using surface superimposition and 7 standard dental landmarks. Deviations between the preoperative and postoperative landmarks were calculated and compared to determine whether MASO segment repositioning is sufficiently accurate to be safely used to reposition the incisor/canine axis. RESULTS Quantitative analysis revealed an absolute linear difference of 0.66 mm (SD = 0.51) between preoperative 3D digital dental arch impression and postoperative planned 3D dental arch. Overall, the median absolute discrepancies in the x-axis (right-left direction), y-axis (antero-posterior direction), and z-axis (supero-inferior direction) were respectively 0.56 mm (SD = 0.42), 0.77 mm (SD = 0.45) and 0.65 mm (SD = 0.61). CONCLUSION A high degree of accuracy between the virtual plan and the immediate postoperative result was observed. According to our results, PSI can be used safely with accuracy in MASO as an adjunct to other conventional orthognathic procedures.
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Three-Dimensional Accuracy and Stability of Personalized Implants in Orthognathic Surgery: A Systematic Review and a Meta-Analysis. J Pers Med 2023; 13:jpm13010125. [PMID: 36675786 PMCID: PMC9867342 DOI: 10.3390/jpm13010125] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
This systematic review aimed to determine the accuracy/stability of patient-specific osteosynthesis (PSI) in orthognathic surgery according to three-dimensional (3D) outcome analysis and in comparison to conventional osteosynthesis and computer-aided designed and manufactured (CAD/CAM) splints or wafers. The PRISMA guidelines were followed and six academic databases and Google Scholar were searched. Records reporting 3D accuracy/stability measurements of bony segments fixated with PSI were included. Of 485 initial records, 21 met the eligibility (566 subjects), nine of which also qualified for a meta-analysis (164 subjects). Six studies had a high risk of bias (29%), and the rest were of low or moderate risk. Procedures comprised either single-piece or segmental Le Fort I and/or mandibular osteotomy and/or genioplasty. A stratified meta-analysis including 115 subjects with single-piece Le Fort I PSI showed that the largest absolute mean deviations were 0.5 mm antero-posteriorly and 0.65° in pitch. PSIs were up to 0.85 mm and 2.35° more accurate than conventional osteosynthesis with CAD/CAM splint or wafer (p < 0.0001). However, the clinical relevance of the improved accuracy has not been shown. The literature on PSI for multi-piece Le Fort I, mandibular osteotomies and genioplasty procedure is characterized by high methodological heterogeneity and a lack of randomized controlled trials. The literature is lacking on the 3D stability of bony segments fixated with PSI.
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Li DTS, Leung YY. Patient-Specific Implants in Orthognathic Surgery. Oral Maxillofac Surg Clin North Am 2022; 35:61-69. [DOI: 10.1016/j.coms.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Reconstruction of maxillofacial bone defects using patient-specific long-lasting titanium implants. Sci Rep 2022; 12:7538. [PMID: 35534499 PMCID: PMC9085892 DOI: 10.1038/s41598-022-11200-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/13/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of this retrospective study is to verify the effectiveness and safety of patient-specific titanium implants on maxillofacial bones, with a long-term follow-up. Total 16 patients with various maxillofacial defects underwent reconstruction using patient-specific titanium implants. Titanium implants, manufactured by electron beam melting, selective laser sintering, or milling, were inserted into the maxilla, mandible, or zygoma. Long-term follow‐up (36.7 ± 20.1 months) was conducted after the surgery. Bone fusion of the titanium implant body, postoperative infection, implant malunion, functional results, patient satisfaction, subsidence, osteolysis around the implants, and complications were recorded and analyzed at the last follow-up. Of the 28 implants, only one failed to unite with the bone; therefore, revision surgery was performed. No osteolysis or subsidence around the titanium implants nor adverse events were observed; the mean VAS score for satisfaction was 9. All patients enrolled in this trial were esthetically and functionally satisfied with their surgical results, and fixation failure and esthetic dissatisfaction complications were well resolved. Patient-specific titanium showed satisfactory outcomes when used to treat various oral and maxillofacial defects. A 3D printed titanium implant can be effectively used in the reconstruction of the zygoma and mandible instead of autogenous bone without donor site morbidity.
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Hajibandeh J, Be A, Lee C. Custom Interlocking Implants for Primary and Secondary Reconstruction of Large Orbital Floor Defects: Case Series and Description of Workflow. J Oral Maxillofac Surg 2021; 79:2539.e1-2539.e10. [PMID: 34453909 DOI: 10.1016/j.joms.2021.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
Large fractures of the orbital floor present several technical challenges for the craniomaxillofacial surgeon. One major challenge is limited surgical access as it pertains to the adaption of a large implant within the confines of a small incision. Transfacial approaches or techniques to extend the incision may improve access but have the potential drawback of creating unesthetic scars, nerve injury, and lid contracture. In this series we present a novel solution combining virtual surgical planning and the use of a 2 piece, interlocking patient specific implant to address the problem of limited surgical access.
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Affiliation(s)
- Jeffrey Hajibandeh
- Instructor, Oral & Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA.
| | - Austin Be
- Resident, Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Cameron Lee
- Resident, Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
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Onodera K, Ohashi Y, Tsunoda N, Kawai T, Miyamoto I, Yamada H. Computer-assisted surgery to treat fracture of an atrophic mandible. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2020. [DOI: 10.1016/j.ajoms.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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