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Arman SS, Shetty A, Ahmed N, Singarapu R, Priya B, Iyengar A. Versatility of Titanium Mesh in Comminuted Maxillofacial Fractures. A Retrospective Study. J Maxillofac Oral Surg 2024; 23:387-393. [PMID: 38601232 PMCID: PMC11001821 DOI: 10.1007/s12663-022-01745-y] [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: 01/27/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Titanium mesh provides three-dimensional stability, it is easier and quick in placement, highly malleable and adaptable hence, proved to be worth in restoring the function and form in cases of comminuted maxillofacial fractures. Materials and Methods A total of 12 patients were included in this retrospective study at Department of Oral and maxillofacial surgery, Sri Rajiv Gandhi College of Dental Science and Hospital, from December 2015 to June 2020. Out of 12 patients, 7 reported with frontal bone fracture and 5 reported with mandibular fracture. Patients were followed up for upto 18 months to evaluate efficacy of titanium mesh on postoperative long-term healing, aesthetic outcomes and return to normal function were evaluated. Results The results have shown that titanium mesh has low complication rates and the ability to maintain occlusion and chewing postoperatively. Union occurred without complication in 90% of fractures, and patients treated for frontal bone fracture had excellent cosmetic results. Conclusion The semi rigid nature of the titanium mesh fixation allows micro movement at the healing bone ends, reduces stress shielding effect which may improve functional bone healing. Bony continuity of the mandible can be restored providing three-dimensional morphology and stability. The versatile placement of screws is the principal advantage.
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Affiliation(s)
- Syeda Sana Arman
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
- No 25, 4th cross, Umarbagh layout, JP nagar, Bangalore, 560078 India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
| | - Nida Ahmed
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
| | - Ravalika Singarapu
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
| | - Bhanu Priya
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
| | - Aditya Iyengar
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
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Yang X, Huang J, Chen C, Zhou L, Ren H, Sun D. Biomimetic Design of Double-Sided Functionalized Silver Nanoparticle/Bacterial Cellulose/Hydroxyapatite Hydrogel Mesh for Temporary Cranioplasty. ACS APPLIED MATERIALS & INTERFACES 2023; 15:10506-10519. [PMID: 36800308 DOI: 10.1021/acsami.2c22771] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A structurally stable and antibacterial biomaterial used for temporary cranioplasty with guided bone regeneration (GBR) effects is an urgent clinical requirement. Herein, we reported the design of a biomimetic Ag/bacterial cellulose/hydroxyapatite (Ag/BC@HAp) hydrogel mesh with a double-sided functionalized structure, in which one layer was dense and covered with Ag nanoparticles and the other layer was porous and anchored with hydroxyapatite (HAp) via mineralization for different durations. Such a double-sided functionalized design endowed the hydrogel with distinguished antibacterial activities for inhibiting potential infections and GBR effects that could prevent endothelial cells and fibroblasts from migrating to a defected area and meanwhile show biocompatibility to MC3T3-E1 preosteoblasts. Furthermore, it was found from in vivo experimental results that the Ag/BC@HAp hydrogel with 7-day mineralization achieved optimal GBR effects by improving barrier functions toward these undesired cells. Moreover, this BC-based hydrogel mesh showed an extremely low swelling ratio and strong mechanical strength, which facilitated the protection of soft brain tissues without gaining the risk of intracranial pressure increase. In a word, this study offers a new approach to double-sided functionalized hydrogels and provides effective and safe biomaterials used for temporary cranioplasty with antibacterial abilities and GBR effects.
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Affiliation(s)
- Xiaoli Yang
- Institute of Chemicobiology and Functional Materials, School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, 200 Xiao Ling Wei, Nanjing 210046, Jiangsu Province, China
| | - Jinjian Huang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China
| | - Chuntao Chen
- Institute of Chemicobiology and Functional Materials, School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, 200 Xiao Ling Wei, Nanjing 210046, Jiangsu Province, China
| | - Lu Zhou
- Institute of Chemicobiology and Functional Materials, School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, 200 Xiao Ling Wei, Nanjing 210046, Jiangsu Province, China
| | - Huajian Ren
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China
| | - Dongping Sun
- Institute of Chemicobiology and Functional Materials, School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, 200 Xiao Ling Wei, Nanjing 210046, Jiangsu Province, China
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Bottauscio O, Arduino A, Chiampi M, Zilberti L. Simplified modeling of implanted medical devices with metallic filamentary closed loops exposed to low or medium frequency magnetic fields. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107316. [PMID: 36566651 DOI: 10.1016/j.cmpb.2022.107316] [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: 06/28/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Electric currents are induced in implanted medical devices with metallic filamentary closed loops (e.g., fixation grids, stents) when exposed to time varying magnetic fields, as those generated during certain diagnostic and therapeutic biomedical treatments. A simplified methodology to efficiently compute these currents, to estimate the altered electromagnetic field distribution in the biological tissues and to assess the consequent biological effects is proposed for low or medium frequency fields. METHODS The proposed methodology is based on decoupling the handling of the filamentary wire and the anatomical body. To do this, a circuital solution is adopted to study the metallic filamentary implant and this solution is inserted in the electromagnetic field solution involving the biological tissues. The Joule losses computed in the implant are then used as a forcing term for the thermal problem defined by the bioheat Pennes' equation. The methodology is validated against a model problem, where a reference solution is available. RESULTS The proposed simplified methodology is proved to be in good agreement with solutions provided by alternative approaches. In particular, errors in the amplitude of the currents induced in the wires result to be always lower than 3%. After the validation, the methodology is applied to check the interactions between the magnetic field generated by different biomedical devices and a skull grid, which represents a complex filamentary wire implant. CONCLUSIONS The proposed simplified methodology, suitable to be applied to closed loop wires in the low to intermediate frequency range, is found to be sufficiently accurate and easy to apply in realistic exposure scenarios. This modeling tool allows analyzing different types of small implants, from coronary and biliary duct stents to orthopedic grids, under a variety of exposure scenarios.
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Affiliation(s)
- Oriano Bottauscio
- Istituto Nazionale di Ricerca Metrologica (INRiM), Strada Delle Cacce 91, 10135 Torino, Italy.
| | - Alessandro Arduino
- Istituto Nazionale di Ricerca Metrologica (INRiM), Strada Delle Cacce 91, 10135 Torino, Italy
| | - Mario Chiampi
- Istituto Nazionale di Ricerca Metrologica (INRiM), Strada Delle Cacce 91, 10135 Torino, Italy
| | - Luca Zilberti
- Istituto Nazionale di Ricerca Metrologica (INRiM), Strada Delle Cacce 91, 10135 Torino, Italy
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Li Z, Ruan C, Niu X. Collagen-based bioinks for regenerative medicine: Fabrication, application and prospective. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2023. [DOI: 10.1016/j.medntd.2023.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Yang N, Bu L, Shan X, Huang Y, Liu F, Sun H, Wang S. Drainage and Orbitofrontal Reconstruction After Removal of a Giant Frontal Sinus Osteoma: A Case Report. EAR, NOSE & THROAT JOURNAL 2022:1455613221098786. [PMID: 35581165 DOI: 10.1177/01455613221098786] [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
After removal of a large frontal sinus osteoma in this case, the contralateral nasofrontal canal was opened to drain the intraoperative fluid and prevent infection, and the defect in the orbitofrontal area was restored using a titanium mesh designed with 3D printing technology.
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Affiliation(s)
- Nan Yang
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
- School of Stomatology of Qingdao University, Qingdao, China
| | - Lingxue Bu
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
- School of Stomatology of Qingdao University, Qingdao, China
| | - Xiaoyang Shan
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
- School of Stomatology of Qingdao University, Qingdao, China
| | - Yan Huang
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Fengzhi Liu
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Huibin Sun
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
- School of Stomatology of Qingdao University, Qingdao, China
| | - Shuangyi Wang
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
- School of Stomatology of Qingdao University, Qingdao, China
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Shepetovsky D, Mezzini G, Magrassi L. Complications of cranioplasty in relationship to traumatic brain injury: a systematic review and meta-analysis. Neurosurg Rev 2021; 44:3125-3142. [PMID: 33686551 PMCID: PMC8592959 DOI: 10.1007/s10143-021-01511-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
Despite being a common procedure, cranioplasty (CP) is associated with a variety of serious, at times lethal, complications. This study explored the relationship between the initial injury leading to decompressive craniectomy (DC) and the rates and types of complications after subsequent CP. It specifically compared between traumatic brain injury (TBI) patients and patients undergoing CP after DC for other indications.A comprehensive search of PubMed, Scopus, and the Cochrane Library databases using PRISMA guidelines was performed to include case-control studies, cohorts, and clinical trials reporting complication data for CP after DC. Information about the patients' characteristics and the rates of overall and specific complications in TBI and non-TBI patients was extracted, summarized, and analyzed.A total of 59 studies, including the authors' institutional experience, encompassing 9264 patients (4671 TBI vs. 4593 non-TBI) met the inclusion criteria; this total also included 149 cases from our institutional series. The results of the analysis of the published series are shown both with and without our series 23 studies reported overall complications, 40 reported infections, 10 reported new-onset seizures, 13 reported bone flap resorption (BFR), 5 reported post-CP hydrocephalus, 10 reported intracranial hemorrhage (ICH), and 8 reported extra-axial fluid collections (EFC). TBI was associated with increased odds of BFR (odds ratio [OR] 1.76, p < 0.01) and infection (OR 1.38, p = 0.02). No difference was detected in the odds of overall complications, seizures, hydrocephalus, ICH, or EFC.Awareness of increased risks of BFR and infection after CP in TBI patients promotes the implementation of new strategies to prevent these complications especially in this category of patients.
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Affiliation(s)
- David Shepetovsky
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 74, 27100, Pavia, Italy
| | - Gianluca Mezzini
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 74, 27100, Pavia, Italy
| | - Lorenzo Magrassi
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 74, 27100, Pavia, Italy. .,IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
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Virtual Surgical Planning and the “In-House” Rapid Prototyping Technique in Maxillofacial Surgery: The Current Situation and Future Perspectives. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11031009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The first applications of computer-aided design/computer-aided manufacturing (CAD/CAM) in maxillofacial surgery date back to the 1980s. Since then, virtual surgical planning (VSP) has undergone significant development and is now routinely used in daily practice. Indeed, in an extraordinary period, such as that of the current COVID-19 pandemic, it offers a valuable tool in relation to the protection of healthcare workers. In this paper we provide a comprehensive summary of the clinical applications reported in the literature and review our experience using an in-house rapid prototyping technique in the field of maxillofacial surgery. methods: Our research was focused on reconstructive surgery, traumatology (especially in relation to orbital floor and zygomatic arch fractures), and COVID-19 masks. The first step was a radiographic study. Next, computed tomography (CT) scans were segmented in order to obtain a three-dimensional (3D) model. Finally, in the editing phase, through the use of specific software, a customized device for each patient was designed and printed. results: Four reconstructive procedures were performed with a perfect fitting of the surgical device produced by means of VSP. In nine orbital floor fracture cases a good overlapping of the mesh on the orbital floor was obtained. In sixteen zygomatic arch cases the post-operative CT scan showed an excellent fitting of the device and a correct fracture reduction. Regarding the COVID-19 period, six masks and shields produced proved to provide effective protection. conclusions: The timescale and costs required for the production of our “home-made” virtual design are low, which makes this method applicable to a large number of cases, for both ordinary and extraordinary activities.
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8
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Nanoparticles and Nanostructured Surface Fabrication for Innovative Cranial and Maxillofacial Surgery. MATERIALS 2020; 13:ma13235391. [PMID: 33260938 PMCID: PMC7731022 DOI: 10.3390/ma13235391] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022]
Abstract
A novel strategy to improve the success of soft and hard tissue integration of titanium implants is the use of nanoparticles coatings made from basically any type of biocompatible substance, which can advantageously enhance the properties of the material, as compared to its similar bulk material. So, most of the physical methods approaches involve the compaction of nanoparticles versus micron-level particles to yield surfaces with nanoscale grain boundaries, simultaneously preserving the chemistry of the surface among different topographies. At the same time, nanoparticles have been known as one of the most effective antibacterial agents and can be used as effective growth inhibitors of various microorganisms as an alternative to antibiotics. In this paper, based on literature research, we present a comprehensive review of the mechanical, physical, and chemical methods for creating nano-structured titanium surfaces along with the main nanoparticles used for the surface modification of titanium implants, the fabrication methods, their main features, and the purpose of use. We also present two patented solutions which involve nanoparticles to be used in cranioplasty, i.e., a cranial endoprosthesis with a sliding system to repair the traumatic defects of the skull, and a cranial implant based on titanium mesh with osteointegrating structures and functional nanoparticles. The main outcomes of the patented solutions are: (a) a novel geometry of the implant that allow both flexible adaptation of the implant to the specific anatomy of the patient and the promotion of regeneration of the bone tissue; (b) porous structure and favorable geometry for the absorption of impregnated active substances and cells proliferation; (c) the new implant model fit 100% on the structure of the cranial defect without inducing mechanical stress; (d) allows all kinds of radiological examinations and rapid osteointegration, along with the patient recover in a shorter time.
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Zheng S, Li J, Jing X, Gong Z. Parameterized design and fabrication of porous bone scaffolds for the repair of cranial defects. Med Eng Phys 2020; 81:39-46. [PMID: 32513524 DOI: 10.1016/j.medengphy.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 11/15/2022]
Abstract
In bone tissue engineering, the structure of a scaffold is very important for cell growth and bone regeneration. It is better to make the scaffold resemble the native cancellous bone because natural cancellous bone can promote scaffold revascularization, which then accelerates cell proliferation. This study presents a parameterized design and fabrication method for cranial scaffold construction. A native human cranial sample was first scanned using micro computed tomography (CT), followed by 3D reconstruction, after which the internal structure of the bone trabecula was created. Based on an extracted negative bone trabecula model, the design components of "cavity", "connecting pipe" and "spatial framework" were proposed to describe the scaffold model. Then, by using the parameterized component model and an assembly and deformation algorithm, the bionic scaffold was designed. Its porous distribution, connection, porosity and area size were easily controlled. Finally, a biomaterial scaffold case was fabricated using a gelcasting process, and cell culture testing was performed in vitro to verify the scaffold's biocompatibility. The results show that the scaffold can promote cell growth and that cells accumulate in the form of a mass within three days.
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Affiliation(s)
- Shuxian Zheng
- Tianjin Key Laboratory of Equipment Design and Manufacturing Technology, Tianjin University, Tianjin 300354, China
| | - Jia Li
- Tianjin Key Laboratory of Equipment Design and Manufacturing Technology, Tianjin University, Tianjin 300354, China
| | - Xiubing Jing
- Tianjin Key Laboratory of Equipment Design and Manufacturing Technology, Tianjin University, Tianjin 300354, China.
| | - Zhenhua Gong
- Tianjin Key Laboratory of Equipment Design and Manufacturing Technology, Tianjin University, Tianjin 300354, China
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Kung WM, Tzeng IS, Lin MS. Three-Dimensional CAD in Skull Reconstruction: A Narrative Review with Focus on Cranioplasty and Its Potential Relevance to Brain Sciences. APPLIED SCIENCES-BASEL 2020. [DOI: https://doi.org/10.3390/app10051847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In patients suffering from severe traumatic brain injury and massive stroke (hemorrhagic or ischemic), decompressive craniectomy (DC) is a surgical strategy used to reduce intracranial pressure, and to prevent brainstem compromise from subsequent brain edema. In surviving patients, cranioplasty surgery helps to protect brain tissue, and correct the external deformity. The aesthetic outcome of cranioplasty using an asymmetrical implant can negatively influence patients physically and mentally, especially young patients. Advancements in the development of biomaterials have now made three-dimensional (3-D) computer-assisted design/manufacturing (CAD/CAM)-fabricated implants an optimal choice for the repair of skull defects following DC. Here, we summarize the various materials for cranioplasty, including xenogeneic, autogenous, and alloplastic grafts. The processing procedures of the CAD/CAM technique are briefly outlined, and reflected our experiences to reconstruct skull CAD models using commercial software, published previously, to assess aesthetic outcomes of regular 3-D CAD models without contouring elevation or depression. The establishment of a 3-D CAD model ensures a possibility for better aesthetic outcomes of CAM-derived alloplastic implants. Finally, clinical consideration of the CAD algorithms for adjusting contours and their potential application in prospective healthcare are briefly outlined.
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Three-Dimensional CAD in Skull Reconstruction: A Narrative Review with Focus on Cranioplasty and Its Potential Relevance to Brain Sciences. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10051847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In patients suffering from severe traumatic brain injury and massive stroke (hemorrhagic or ischemic), decompressive craniectomy (DC) is a surgical strategy used to reduce intracranial pressure, and to prevent brainstem compromise from subsequent brain edema. In surviving patients, cranioplasty surgery helps to protect brain tissue, and correct the external deformity. The aesthetic outcome of cranioplasty using an asymmetrical implant can negatively influence patients physically and mentally, especially young patients. Advancements in the development of biomaterials have now made three-dimensional (3-D) computer-assisted design/manufacturing (CAD/CAM)-fabricated implants an optimal choice for the repair of skull defects following DC. Here, we summarize the various materials for cranioplasty, including xenogeneic, autogenous, and alloplastic grafts. The processing procedures of the CAD/CAM technique are briefly outlined, and reflected our experiences to reconstruct skull CAD models using commercial software, published previously, to assess aesthetic outcomes of regular 3-D CAD models without contouring elevation or depression. The establishment of a 3-D CAD model ensures a possibility for better aesthetic outcomes of CAM-derived alloplastic implants. Finally, clinical consideration of the CAD algorithms for adjusting contours and their potential application in prospective healthcare are briefly outlined.
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12
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Self-Made Rapid Prototyping Technique for Orbital Floor Reconstruction: Showcases for Technical Description. J Craniofac Surg 2019; 30:2106-2110. [PMID: 31513039 DOI: 10.1097/scs.0000000000006004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Restoring the orbital cavity integrity in orbital floor defects is a challenging issue due to the anatomical complexity of the floor's surface. This is a showcase for technical description of a novel "in house" rapid prototyping protocol aimed to customize implant for orbital floor reconstruction. METHODS The authors present 4 cases to show our Computer-aided-design and Computer-aided-manufacturing digital workflow. The system was based on a 3D-printed press that; through a virtually designed mold, was used to conform a patient specific titanium mesh for orbital floor reconstruction. RESULTS The merging procedure analysis by iPlan Cranial 3.0 (Brainlab, Munich, Germany) highlighted a 0.71 ± 0.23 mm (P <0.05) discrepancy in a point-to-point superimposition between the digital planned reconstruction and the real in vivo result. CONCLUSIONS The authors expect that this technique will reduce operative time and cost however further study and larger series may better define the applicability in everyday surgical practice.
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Chen H, Zhang J, Li X, Liu L, Zhang X, Ren D, Ma C, Zhang L, Fei Z, Xu T. Multi-level customized 3D printing for autogenous implants in skull tissue engineering. Biofabrication 2019; 11:045007. [DOI: 10.1088/1758-5090/ab1400] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Volpe Y, Furferi R, Governi L, Uccheddu F, Carfagni M, Mussa F, Scagnet M, Genitori L. Surgery of complex craniofacial defects: A single-step AM-based methodology. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 165:225-233. [PMID: 30337077 DOI: 10.1016/j.cmpb.2018.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/17/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of the present paper is to pave the road to the systematic optimization of complex craniofacial surgical intervention and to validate a design methodology for the virtual surgery and the fabrication of cranium vault custom plates. Recent advances in the field of medical imaging, image processing and additive manufacturing (AM) have led to new insights in several medical applications. The engineered combination of medical actions and 3D processing steps, foster the optimization of the intervention in terms of operative time and number of sessions needed. Complex craniofacial surgical intervention, such as for instance severe hypertelorism accompanied by skull holes, traditionally requires a first surgery to correctly "resize" the patient cranium and a second surgical session to implant a customized 3D printed prosthesis. Between the two surgical interventions, medical imaging needs to be carried out to aid the design the skull plate. Instead, this paper proposes a CAD/AM-based one-in-all design methodology allowing the surgeons to perform, in a single surgical intervention, both skull correction and implantation. METHODS A strategy envisaging a virtual/mock surgery on a CAD/AM model of the patient cranium so as to plan the surgery and to design the final shape of the cranium plaque is proposed. The procedure relies on patient imaging, 3D geometry reconstruction of the defective skull, virtual planning and mock surgery to determine the hypothetical anatomic 3D model and, finally, to skull plate design and 3D printing. RESULTS The methodology has been tested on a complex case study. Results demonstrate the feasibility of the proposed approach and a consistent reduction of time and overall cost of the surgery, not to mention the huge benefits on the patient that is subjected to a single surgical operation. CONCLUSIONS Despite a number of AM-based methodologies have been proposed for designing cranial implants or to correct orbital hypertelorism, to the best of the authors' knowledge, the present work is the first to simultaneously treat osteotomy and titanium cranium plaque.
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Affiliation(s)
- Yary Volpe
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy
| | - Rocco Furferi
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy.
| | - Lapo Governi
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy
| | - Francesca Uccheddu
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy
| | - Monica Carfagni
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy
| | - Federico Mussa
- Department of Pediatric Surgery, Meyer Children's Hospital, Viale Pieraccini 24, 50141 Florence, Italy
| | - Mirko Scagnet
- Department of Pediatric Surgery, Meyer Children's Hospital, Viale Pieraccini 24, 50141 Florence, Italy
| | - Lorenzo Genitori
- Department of Pediatric Surgery, Meyer Children's Hospital, Viale Pieraccini 24, 50141 Florence, Italy
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Autologous Bone Is Inferior to Alloplastic Cranioplasties: Safety of Autograft and Allograft Materials for Cranioplasties, a Systematic Review. World Neurosurg 2018; 117:443-452.e8. [DOI: 10.1016/j.wneu.2018.05.193] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 11/19/2022]
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16
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Reduction of Surgical Site Infections After Cranioplasty With Perioperative Bundle. J Craniofac Surg 2018; 28:1408-1412. [PMID: 28692506 DOI: 10.1097/scs.0000000000003650] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) are the most common complication after cranioplasty and it is associated with poor prognosis. The aim of this study was to identify the risk factors that triggered the development of SSI after cranioplasty and establish a new perioperative bundle and monitoring system to reduce SSI. METHODS A retrospective review of a database that included all cranioplasty patients from 2001 to 2007 was carried out to determine the prevalence of infection. A surveillance team was set up, which assessed the clinical practice and led to the development of a new perioperative bundle and supervision system. A prospective study between 2008 and 2014 was carried out to observe whether infection rates had changed and whether an active surveillance program can change clinical practice. RESULTS Retrospective period included 86 adult patients. The overall rate of infection was 10.5% (9 SSI in 86 patients). Age ≥60 years (OR 1.05; 95% CI: 1.00-1.10; P = 0.04), smoking (OR 9.13; 95% CI: 1.65-50.60; P = 0.01), and duration of operation ≥180 minutes (OR1.19; 95% CI: 1.06-1.34; P < 0.01) as significant predictors of postcranioplasty SSI development. Length of preoperative stay and length of hospitalization was significantly longer among infected patients compared with uninfected patients (P < 0.01, respectively). In prospective period, the general SSI rate was reduced to 1.8% (2 SSI in 113 patients). The difference was statistically significant (P = 0.01). CONCLUSIONS A perioperative bundle and monitoring system may help to reduce SSI rates after cranioplasty. This work also indicates how an active surveillance program can successfully change clinical practice.
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Wong T, Herschman Y, Patel NV, Patel T, Hanft S. Repeat Intracranial Expansion After Skull Regrowth in Hyperostotic Disease: Technical Note. World Neurosurg 2017; 102:555-560. [PMID: 28137547 DOI: 10.1016/j.wneu.2017.01.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE AND IMPORTANCE Camurati-Engelmann disease (CED) is a rare, autosomal-dominant genetic disorder resulting in hyperostosis of the long bones and skull. Patients often develop cranial nerve dysfunction and increased intracranial pressure secondary to stenosis of nerve foramina and hyperostosis. Surgical decompression may provide symptomatic relief in select patients; however, a small number of reports document the recurrence of symptoms due to bony regrowth. We present a patient who had been treated previously with bilateral frontal and parietal craniotomy who experienced recurrence of symptoms due to reossification of her cranial bones. This report underscores the progressive nature of CED and its influence on surgical management. Furthermore, we propose a novel surgical approach with multiple craniectomies and titanium mesh cranioplasties that could potentially offer long-term symptomatic relief. CLINICAL PRESENTATION A 46-year-old female patient with CED who was treated with ventriculoperitoneal shunting, posterior fossa decompression, and multiple craniotomies 2 decades prior presented with signs and symptoms of increased intracranial pressure. Studies of the skull at presentation demonstrated rethickening of cranial bones that resulted in severely decreased intracranial volume. INTERVENTION A radical craniectomy, requiring 4 separate bone flaps made up of bilateral frontal and parietal bones, was performed. The remaining coronal and sagittal bony struts were drilled to approximately 1 cm thick. Cranioplasties with 4 separate titanium meshes were performed to preserve the natural contour of the patient's skull. CONCLUSIONS Although surgical decompression could provide some patients with CED symptomatic relief, clinicians should consider managing CED as a chronic condition. To the authors' knowledge, this is one of few case reports documenting the recurrence of symptoms in a patient with CED treated by surgical intervention. Furthermore, we propose that multiple craniectomies with titanium mesh cranioplasties confer more permanent symptomatic control, and, more importantly, lower the risk of recurrence secondary to cranial hyperostosis.
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Affiliation(s)
- Timothy Wong
- Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
| | | | - Nitesh V Patel
- Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Tushar Patel
- Rutgers, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Simon Hanft
- Rutgers, Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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Cha JH, Lee YH, Ruy WC, Roe Y, Moon MH, Jung SG. Application of Rapid Prototyping Technique and Intraoperative Navigation System for the Repair and Reconstruction of Orbital Wall Fractures. Arch Craniofac Surg 2016; 17:146-153. [PMID: 28913272 PMCID: PMC5556803 DOI: 10.7181/acfs.2016.17.3.146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/09/2016] [Accepted: 09/10/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Restoring the orbital cavity in large blow out fractures is a challenge for surgeons due to the anatomical complexity. This study evaluated the clinical outcomes and orbital volume after orbital wall fracture repair using a rapid prototyping (RP) technique and intraoperative navigation system. METHODS This prospective study was conducted on the medical records and radiology records of 12 patients who had undergone a unilateral blow out fracture reconstruction using a RP technique and an intraoperative navigation system from November 2014 to March 2015. The surgical results were assessed by an ophthalmic examination and a comparison of the preoperative and postoperative orbital volume ratio (OVR) values. RESULTS All patients had a successful treatment outcome without complications. Volumetric analysis revealed a significant decrease in the mean OVR from 1.0952±0.0662 (ranging from 0.9917 to 1.2509) preoperatively to 0.9942±0.0427 (ranging from 0.9394 to 1.0680) postoperatively. CONCLUSION The application of a RP technique for the repair of orbital wall fractures is a useful tool that may help improve the clinical outcomes by understanding the individual anatomy, determining the operability, and restoring the orbital cavity volume through optimal implant positioning along with an intraoperative navigation system.
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Affiliation(s)
- Jong Hyun Cha
- Department of Plastic and Reconstructive Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Yong Hae Lee
- Department of Plastic and Reconstructive Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Wan Chul Ruy
- Department of Plastic and Reconstructive Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Young Roe
- Department of Plastic and Reconstructive Surgery, Inha University School of Medicine, Incheon, Korea
| | - Myung Ho Moon
- Biomedical Engineering, Konyang University College of Medicine, Daejeon, Korea
| | - Sung Gyun Jung
- Department of Plastic and Reconstructive Surgery, National Medical Center, Seoul, Korea
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Colasante C, Sanford Z, Garfein E, Tepper O. Current Trends in 3D Printing, Bioprosthetics, and Tissue Engineering in Plastic and Reconstructive Surgery. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0127-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Clinical application of three-dimensional printing technology in craniofacial plastic surgery. Arch Plast Surg 2015; 42:267-77. [PMID: 26015880 PMCID: PMC4439584 DOI: 10.5999/aps.2015.42.3.267] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 11/08/2022] Open
Abstract
Three-dimensional (3D) printing has been particularly widely adopted in medical fields. Application of the 3D printing technique has even been extended to bio-cell printing for 3D tissue/organ development, the creation of scaffolds for tissue engineering, and actual clinical application for various medical parts. Of various medical fields, craniofacial plastic surgery is one of areas that pioneered the use of the 3D printing concept. Rapid prototype technology was introduced in the 1990s to medicine via computer-aided design, computer-aided manufacturing. To investigate the current status of 3D printing technology and its clinical application, a systematic review of the literature was conducted. In addition, the benefits and possibilities of the clinical application of 3D printing in craniofacial surgery are reviewed, based on personal experiences with more than 500 craniofacial cases conducted using 3D printing tactile prototype models.
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