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Kontio R, Wilkman T, Mesimäki K, Chepurnyi Y, Asikainen A, Haapanen A, Poutala A, Mikkonen M, Slobodianiuk A, Kopchak A. Automated 3-D Computer-Aided Measurement of the Bony Orbit: Evaluation of Correlations among Volume, Depth, and Surface Area. J Pers Med 2024; 14:508. [PMID: 38793092 PMCID: PMC11122174 DOI: 10.3390/jpm14050508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/04/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
(1)The study aimed to measure the depth, volume, and surface area of the intact human orbit by applying an automated method of CT segmentation and to evaluate correlations among depth, volume, and surface area. Additionally, the relative increases in volume and surface area in proportion to the diagonal of the orbit were assessed. (2) CT data from 174 patients were analyzed. A ball-shaped mesh consisting of tetrahedral elements was inserted inside orbits until it encountered the bony boundaries. Orbital volume, area depth, and their correlations were measured. For the validation, an ICC was used. (3) The differences between genders were significant (p < 10-7) but there were no differences between sides. When comparing orbit from larger to smaller, a paired sample t-test indicated a significant difference in groups (p < 10-10). A simple linear model (Volume~1 + Gender + Depth + Gender:Depth) revealed that only depth had a significant effect on volume (p < 10-19). The ICCs were 1.0. (4) Orbital volume, depth, and surface area measurements based on an automated CT segmentation algorithm demonstrated high repeatability and reliability. Male orbits were always larger on average by 14%. There were no differences between the sides. The volume and surface area ratio did not differ between genders and was approximately 0.75.
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Affiliation(s)
- Risto Kontio
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
- Institute of Oral and Maxillofacial Diseases, Helsinki University, 00014 Helsinki, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Karri Mesimäki
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Yurii Chepurnyi
- Department of Maxillofacial Surgery and Modern Dental Technologies, O.O.Bogomolets Medical University, 02000 Kyiv, Ukraine; (Y.C.); (A.K.)
| | - Antti Asikainen
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Aleksi Haapanen
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Arto Poutala
- Disior, Maria 01, Building 2, Lapinlahdenkatu 16, 00180 Helsinki, Finland; (A.P.); (M.M.)
| | - Marko Mikkonen
- Disior, Maria 01, Building 2, Lapinlahdenkatu 16, 00180 Helsinki, Finland; (A.P.); (M.M.)
| | - Alina Slobodianiuk
- Department of Maxillofacial Surgery and Modern Dental Technologies, O.O.Bogomolets Medical University, 02000 Kyiv, Ukraine; (Y.C.); (A.K.)
| | - Andrii Kopchak
- Department of Maxillofacial Surgery and Modern Dental Technologies, O.O.Bogomolets Medical University, 02000 Kyiv, Ukraine; (Y.C.); (A.K.)
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Dubron K, Verbist M, Jacobs R, Olszewski R, Shaheen E, Willaert R. Augmented and Virtual Reality for Preoperative Trauma Planning, Focusing on Orbital Reconstructions: A Systematic Review. J Clin Med 2023; 12:5203. [PMID: 37629251 PMCID: PMC10455745 DOI: 10.3390/jcm12165203] [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: 07/16/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This systematic review summarizes recent literature on the use of extended reality, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), in preoperative planning for orbital fractures. METHODS A systematic search was conducted in PubMed, Embase, Web of Science and Cochrane on 6 April 2023. The included studies compared extended reality with conventional planning techniques, focusing on computer-aided surgical simulation based on Computed Tomography data, patient-specific implants (PSIs), fracture reconstruction of the orbital complex, and the use of extended reality. Outcomes analyzed were technical accuracy, planning time, operative time, complications, total cost, and educational benefits. RESULTS A total of 6381 articles were identified. Four articles discussed the educational use of VR, while one clinical prospective study examined AR for assisting orbital fracture management. CONCLUSION AR was demonstrated to ameliorate the accuracy and precision of the incision and enable the better identification of deep anatomical tissues in real time. Consequently, intraoperative imaging enhancement helps to guide the orientation of the orbital reconstruction plate and better visualize the precise positioning and fixation of the PSI of the fractured orbital walls. However, the technical accuracy of 2-3 mm should be considered. VR-based educational tools provided better visualization and understanding of craniofacial trauma compared to conventional 2- or 3-dimensional images.
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Affiliation(s)
- Kathia Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint Luc, UCLouvain, Av. Hippocrate 10, 1200 Brussels, Belgium
| | - Maarten Verbist
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Raphael Olszewski
- Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint Luc, UCLouvain, Av. Hippocrate 10, 1200 Brussels, Belgium
- Oral and Maxillofacial Surgery Research Lab (OMFS Lab), NMSK, Institut de Recherche Expérimentale et Clinique (IREC), SSS, UCLouvain, 1200 Brussels, Belgium
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Robin Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, 3000 Leuven, Belgium
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Riordan E, Yung A, Cheng K, Lim L, Clark J, Rtshiladze M, Ch'ng S. Modeling Methods in Craniofacial Virtual Surgical Planning. J Craniofac Surg 2023; 34:1191-1198. [PMID: 36806300 DOI: 10.1097/scs.0000000000009187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/09/2022] [Indexed: 02/22/2023] Open
Abstract
Despite the widespread use of virtual surgical planning (VSP), few papers describe the modeling methods used to generate the digital simulations that underpin VSP. This paper aims to review the modeling methods that are currently available for use in VSP and the implications of their use in clinical practice. A literature review was undertaken of the two broad categories of modeling techniques; contour-based planning-namely mirroring from the contralateral side, templating from a normative database, and extrapolation from surrounding landmarks-and occlusal-based planning (OBP). The indications for each modeling method were discussed, including mandibular/maxillary reconstruction, pediatric craniofacial surgery, and orthognathic, as well as the limitations to the accuracy of modeling types. Unilateral defects of the upper/midface, wherein contour accuracy is paramount, are best reconstructed using mirroring methods, whereas bilateral defects-or cases with asymmetry due to craniofacial dysmorphology-are most suited to normative-data-based methods. Cases involving resection of the alveolar margin, in which functional occlusion is the primary outcome are best managed with OBP. Similarly, orthognathic surgery typically uses OBP, although complex cases involving asymmetry, such as clefts, may benefit from a combination of OBP and normative data methods. The choice of modeling methods is, therefore, largely driven by the defect type and the goals of reconstruction.
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Affiliation(s)
- Edward Riordan
- Department of Plastic Surgery, St George Hospital
- Melanoma Institute Australia, The University of Sydney
| | - Amanda Yung
- Melanoma Institute Australia, The University of Sydney
- Sydney Medical School, University of Sydney
| | - Kai Cheng
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
| | - Lydia Lim
- Department of Maxillofacial Surgery, Westmead Hospital
| | - Jonathan Clark
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
- Faculty of Medicine and Health, The University of Sydney
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre
| | - Michael Rtshiladze
- Melanoma Institute Australia, The University of Sydney
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital Randwick
- Department of Plastic Surgery, Prince of Wales Hospital
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
- Faculty of Medicine and Health, The University of Sydney
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Xiong YT, Zeng W, Xu L, Guo JX, Liu C, Chen JT, Du XY, Tang W. Virtual reconstruction of midfacial bone defect based on generative adversarial network. Head Face Med 2022; 18:19. [PMID: 35761334 PMCID: PMC9235085 DOI: 10.1186/s13005-022-00325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/19/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The study aims to evaluate the accuracy of the generative adversarial networks (GAN) for reconstructing bony midfacial defects. METHODS According to anatomy, the bony midface was divided into five subunit structural regions and artificial defects are manually created on the corresponding CT images. GAN is trained to reconstruct artificial defects to their previous normal shape and tested. The clinical defects are reconstructed by the trained GAN, where the midspan defects were used for qualitative evaluation and the unilateral defects were used for quantitative evaluation. The cosine similarity and the mean error are used to evaluate the accuracy of reconstruction. The Mann-Whitney U test is used to detect whether reconstruction errors were consistent in artificial and unilateral clinical defects. RESULTS This study included 518 normal CT data, with 415 in training set and 103 in testing set, and 17 real patient data, with 2 midspan defects and 15 unilateral defects. Reconstruction of midspan clinical defects assessed by experts is acceptable. The cosine similarity in the reconstruction of artificial defects and unilateral clinical defects is 0.97 ± 0.01 and 0.96 ± 0.01, P = 0.695. The mean error in the reconstruction of artificial defects and unilateral clinical defects is 0.59 ± 0.31 mm and 0.48 ± 0.08 mm, P = 0.09. CONCLUSION GAN-based virtual reconstruction technology has reached a high accuracy in testing set, and statistical tests suggest that it can achieve similar results in real patient data. This study has preliminarily solved the problem of bony midfacial defect without reference.
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Affiliation(s)
- Yu-Tao Xiong
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No.14, 3rd section of Ren Min Nan Road, Chengdu, 610041, China
| | - Wei Zeng
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No.14, 3rd section of Ren Min Nan Road, Chengdu, 610041, China
| | - Lei Xu
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, China
| | - Ji-Xiang Guo
- Machine Intelligence Laboratory, College of Computer Science, Sichuan University, Chengdu, 610065, China
| | - Chang Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No.14, 3rd section of Ren Min Nan Road, Chengdu, 610041, China
| | - Jun-Tian Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No.14, 3rd section of Ren Min Nan Road, Chengdu, 610041, China
| | - Xin-Ya Du
- Department of Stomatology, the People's Hospital of Longhua, Shenzhen, 518109, China
| | - Wei Tang
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No.14, 3rd section of Ren Min Nan Road, Chengdu, 610041, China.
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Clinical application of automated virtual orbital reconstruction for orbital fracture management with patient-specific implants: A prospective comparative study. J Craniomaxillofac Surg 2022; 50:686-691. [DOI: 10.1016/j.jcms.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/02/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
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Gellrich NC, Rahlf B, Jehn P, Spalthoff S, Korn P. Outcome and Quality of Life after Individual Computer-AssistedReconstruction of the Midface. Laryngorhinootologie 2022; 101:S90-S102. [PMID: 35605614 DOI: 10.1055/a-1669-6154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Often, midfacial defects are not only relevant regarding functional aspects but also esthetics of such congenital or acquired deformities impair significantly the patients' quality of life. Reconstructions of the midface do not only include replacing lost or non-developed tissue but moreover to achieve predictable results with regard to esthetics as well as function for the individual patient. Digital planning modalities including different surface and volume data in combination with modern additive manufacturing techniques for biomodel and implant production and intraoperative support by using real and virtual 3D volume data for navigation and intraoperative imaging, but also securing the outcome based on postoperative analysis have been implemented in modern midface reconstruction and represent new standards for medical care. The objective of this paper is to describe modern options of patient-specific midfacial reconstruction with integration of computer-assisted planning and production techniques.
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Affiliation(s)
- Nils-Claudius Gellrich
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Björn Rahlf
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philipp Jehn
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Simon Spalthoff
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philippe Korn
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Fuessinger MA, Schwarz S, Gass M, Poxleitner P, Brandenburg L, Schlager S, Metzger MC. The statistical shape model as a quality assurance measure in the treatment of complex midface fractures: a case control study. Head Face Med 2021; 17:44. [PMID: 34670566 PMCID: PMC8527631 DOI: 10.1186/s13005-021-00296-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Complex bilateral midface fractures necessitate a surgically challenging procedure to preserve or restore the occlusion and the sensitive eye area. In this case control study, we aim to show the potential of a statistical shape model (SSM) for measuring the quality of the midface reconstruction, compared to the estimated preoperative situation. Methods An individualized SSM was postoperatively registered on 19 reconstructed complex bilateral midface fractures. Using this SSM, the distances from the simulated preoperative situation to the postoperative positions of the fracture segments were calculated. The fracture lines for Le Fort II, Le Fort III, and NOE fractures were chosen as reference points for the distance measurements. Results The SSM could be registered on all 19 complex bilateral midface fractures. All analyzed fractures showed a dorsal impaction (negative values) of the midface. Le Fort II fractures showed deviation values of –0.98 ± 4.6 mm, Le Fort III fractures showed values of –3.68 ± 3.6 mm, NOE type 2 fractures showed values of –0.25 ± 4.6 mm, and NOE type 1 fractures showed values of –0.25 ± 4.6 mm. Conclusions The SSM can be used to measure the quality of the achieved reduction of complex bilateral midface fractures based on the estimated preoperative situation. Trial registration DRKS00009719.
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Affiliation(s)
- Marc Anton Fuessinger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Steffen Schwarz
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Mathieu Gass
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Leonard Brandenburg
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Stefan Schlager
- Department of Physical Anthropology, Albert-Ludwigs University Freiburg, Hebelstr. 29, 79104, Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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Gass M, Füßinger MA, Metzger MC, Schwarz S, Bähr JD, Brandenburg L, Weingart J, Schlager S. Virtual reconstruction of orbital floor defects using a statistical shape model. J Anat 2021; 240:323-329. [PMID: 34658032 PMCID: PMC8742960 DOI: 10.1111/joa.13550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/03/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The current standard in reconstructing defects of the orbital floor, by using the concept of mirroring, is time-consuming and ignores the natural asymmetry of the skull. By using a statistical shape model (SSM), the reconstruction can be automatized and improved in accuracy. The present study aims to show the possibilities of the virtual reconstruction of artificial defects of the orbital floor using an SSM and its potentials for clinical implementation. METHODS Based on 131 unaffected CT scans of the midface, an SSM was created which contained the shape variability of the orbital floor. Nineteen midface CT scans, that were not included in the SSM, were manually segmented to establish ground truth (control group). Then artificial defects of larger and smaller sizes were created and reconstructed using SSM (Group I) and the gold standard of mirroring (Group II). Eventually, a comparison to the surface of the manual segmentation (control group) was performed. RESULTS The proposed method of reconstruction using an SSM leads to more precise reconstruction results, compared with the conventional method of mirroring. Whereas mirroring led to the reconstruction errors of 0.7 mm for small defects and 0.73 mm for large defects, reconstruction using SSM led to deviations of 0.26 mm (small defect) and, respectively, 0.34 mm (large defect). CONCLUSIONS The presented approach is an effective and accurate method for reconstructing the orbital floor. In connection with modern computer-aided design and manufacturing, individual patient-specific implants could be produced according to SSM-based reconstructions and could replace current methods using manual bending techniques. By acknowledging the natural asymmetry of the human skull, the SSM-based approach achieves higher accuracy in reconstructing injured orbits.
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Affiliation(s)
- Mathieu Gass
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Marc Anton Füßinger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Steffen Schwarz
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Johannes Daniel Bähr
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Leonard Brandenburg
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Julia Weingart
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Stefan Schlager
- Department of Physical Anthropology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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Memon AR, Li J, Egger J, Chen X. A review on patient-specific facial and cranial implant design using Artificial Intelligence (AI) techniques. Expert Rev Med Devices 2021; 18:985-994. [PMID: 34404280 DOI: 10.1080/17434440.2021.1969914] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Researchers and engineers have found their importance in healthcare industry including recent updates in patient-specific implant (PSI) design. CAD/CAM technology plays an important role in the design and development of Artificial Intelligence (AI) based implants.The across the globe have their interest focused on the design and manufacturing of AI-based implants in everyday professional use can decrease the cost, improve patient's health and increase efficiency, and thus many implant designers and manufacturers practice. AREAS COVERED The focus of this study has been to manufacture smart devices that can make contact with the world as normal people do, understand their language, and learn to improve from real-life examples. Machine learning can be guided using a heavy amount of data sets and algorithms that can improve its ability to learn to perform the task. In this review, artificial intelligence (AI), deep learning, and machine-learning techniques are studied in the design of biomedical implants. EXPERT OPINION The main purpose of this article was to highlight important AI techniques to design PSIs. These are the automatic techniques to help designers to design patient-specific implants using AI algorithms such as deep learning, machine learning, and some other automatic methods.
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Affiliation(s)
- Afaque Rafique Memon
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Institute of Bio-medical Manufacturing and Life Quality Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jianning Li
- Faculty of Computer Science and Biomedical Engineering, Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria.,The Laboratory of Computer Algorithm for Medicine, Medical University of Graz, Graz, Austria.,Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - Jan Egger
- Faculty of Computer Science and Biomedical Engineering, Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria.,The Laboratory of Computer Algorithm for Medicine, Medical University of Graz, Graz, Austria.,Department of Neurosurgery, Medical University of Graz, Graz, Austria.,Department of Oral and Maxillofacial Surgery, Medical University of Graz, Graz, Austria
| | - Xiaojun Chen
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Institute of Bio-medical Manufacturing and Life Quality Engineering, Shanghai Jiao Tong University, Shanghai, China
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Tel A, Sembronio S, Costa F, Robiony M. Scoping Zygomaticomaxillary Complex Fractures With the Eyes of Virtual Reality: Operative Protocol and Proposal of a Modernized Classification. J Craniofac Surg 2021; 32:552-558. [PMID: 33704979 DOI: 10.1097/scs.0000000000006941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Fractures of the zygomaticomaxillary complex (ZMC) represent an extremely heterogeneous group of injuries to the midfacial skeleton. Traditionally, the diagnosis of such fractures was based on 2-dimensional radiograms and, more recently, on volumetric computed tomography (CT) scans, while the treatment was exclusively based on the surgeon's experience. Many classification attempts have been made in the past, but no paper has taken into account the importance of virtual surgical planning (VSP) in proving a modernized classification. The authors propose a classification based on the use of VSP which can guide the surgeon to identify the optimal reduction method and reproduce it in the operating room through the use of navigation. METHODS Patients with ZMC fractures were collected to create a study model. The VSP was used to generate 3-dimensional models of fractures. Fractured segments were duplicated and digitally put in the optimal reduction position. Repositioned fragments were overlapped to their original preoperative counterparts and exported to the surgical navigator to be navigated. Planned virtual reduction was overlaid to postoperative CT scan to assess the accuracy of reduction, explored using color maps and the calculation of root mean square error. RESULTS For all patients, the application of VSP was successfully accomplished. High accuracy was confirmed between the planned virtual reduction and the postoperative CT scan. A 5-item classification based on VSP is proposed. All patients were included in the presented subclasses. CONCLUSIONS The adoption of virtual planning in ZMC fractures allows for an improved study of the displacement of the fracture and might indicate to the surgeons the required maneuvers to achieve optimal reduction. The presented proposal of classification might be an aid to simplify the choice of the most appropriate reduction method and might provide a deeper insight into the morphologic characteristics of fractures.
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Affiliation(s)
- Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
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Schreurs R, Klop C, Maal TJJ. Advanced Diagnostics and Three-dimensional Virtual Surgical Planning in Orbital Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2020; 29:79-96. [PMID: 33516541 DOI: 10.1016/j.cxom.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Does Zygomatic Complex Symmetry Differ Between Healthy Individuals and Surgically Treated Patients Using Intraoperative 3-Dimensional Cone Beam Computed Tomographic Imaging? J Oral Maxillofac Surg 2020; 78:798.e1-798.e7. [DOI: 10.1016/j.joms.2019.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
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Risk prediction of posttraummatic enophthalmos development on the basis of orbital volume calculations using multislice computed tomography data. OPHTHALMOLOGY JOURNAL 2018. [DOI: 10.17816/ov11326-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose. To elaborate a method of orbital volume measurement in patients with midface trauma at pre- and postoperative stages on the basis of multislice computed tomography (MSCT); to investigate the capabilities of orbital volume measurement to acquire additional diagnostic information and to estimate the risk of postoperative enophthalmos development.
Materials and methods. A total of 71 patients (100%) with midface trauma were examined at the Sechenov University clinic. At pre- and postoperative stages, all patients (n = 71, 100%) were examined using MSCT (Toshiba Aquilion One 640) with 0.5 mm slice thickness in bone and soft tissue regimen. To measure orbital volume, MSCT data were processed using Vitrea workstation: bone borders of the right and left orbit were marked before and after surgical treatment on every axial slice, and orbital volumes were presented in ml.
Results. Preoperative MSCT data management revealed increased orbital volume due to orbital trauma in 64 patients (90%), the difference between healthy and traumatized orbit was between 2 ml and 14 ml. In these patients, reconstructive surgical procedure was performed. In 7 patients (10%) with mild midface trauma, the difference between orbital volumes was less than 2 ml, this was considered as a positive prognostic factor, and these patients were not subjects to surgical treatment. After surgery, in 55 patients (77%) the orbital volume restored, the difference between orbital volumes was less than 2 ml. In 9 cases (13%), the difference in orbital volume was more than 2 ml, considered as adverse prognostic factor which means that there still was a risk of postoperative enophthalmos development. In this patient group, additional diagnostic examination was necessary, and patients required planning of residual enophthalmos surgical correction with MSCT control during the post-op period.
Conclusion. Postprocessing of the MSCT data gave the possibility to calculate pre-and postoperative orbital volume changes and present it in mathematical units (ml) in 3D mode. As the result the additional information can be acquired in order to identify the risk of postoperative enophthalmos.
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[Reconstructive orbital surgery]. HNO 2018; 66:827-833. [PMID: 30327822 DOI: 10.1007/s00106-018-0568-4] [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: 10/28/2022]
Abstract
BACKGROUND In complex orbital reconstructions ideal positioning of the bony buttress and surrounding soft tissue is a prerequisite for an aesthetic and functional result. The use of computer-assisted surgery can support the surgeon before and during the reconstruction procedure and facilitate quality control processes. This is illustrated using three clinical examples. MATERIAL AND METHODS The areas of interest (bony defect areas, surrounding tissues) are segmented in a 3D image series. In most cases, the contralateral non-affected side can serve as the reference in virtual reconstruction. The virtual model obtained can now be used for the manufacturing of patient specific models and implants, as well as for intraoperative navigation or direct quality control with the use of intraoperative cone beam computed tomography (CBCT). RESULTS For the reconstruction of primary and secondary traumatic defects as well as for congenital malformations or neoplastic diseases, the presented workflow can be used. Preoperative virtual visualization, patient specific reconstruction and direct quality control using intraoperative CBCT ensure that the preoperatively planned result can be achieved. Together with the interplay of hard and soft tissue the best possible results can be achieved. CONCLUSION Computer-assisted surgery has been continuously further developed over the last two decades and is currently used in the clinical routine. Patient specific implants in combination with the use of direct intraoperative quality control facilitate the reconstruction of complex orbital injuries and defects and enable the ideal reconstruction from both aesthetic and functional aspects.
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Schönegg D, Wagner M, Schumann P, Essig H, Seifert B, Rücker M, Gander T. Correlation between increased orbital volume and enophthalmos and diplopia in patients with fractures of the orbital floor or the medial orbital wall. J Craniomaxillofac Surg 2018; 46:1544-1549. [DOI: 10.1016/j.jcms.2018.06.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/26/2022] Open
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Planning of skull reconstruction based on a statistical shape model combined with geometric morphometrics. Int J Comput Assist Radiol Surg 2017; 13:519-529. [DOI: 10.1007/s11548-017-1674-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 10/01/2017] [Indexed: 01/08/2023]
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Ho JPTF, Schreurs R, Aydi S, Rezai R, Maal TJJ, van Wijk AJ, Beenen LFM, Dubois L, Milstein DMJ, Becking AG. Natural variation of the zygomaticomaxillary complex symmetry in normal individuals. J Craniomaxillofac Surg 2017; 45:1927-1933. [PMID: 29046241 DOI: 10.1016/j.jcms.2017.09.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/08/2017] [Accepted: 09/18/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The study aim was to investigate variations in the symmetry of the zygomaticomaxillary complex (ZMC) in normal individuals. METHOD Computed tomography datasets of 200 individuals without facial fractures were analyzed using a validated three-dimensional analysis technique. The absolute average distance (AD) and 90th percentile distance (NPD) were calculated, representing respectively the overall and maximum symmetry between bilateral ZMCs. RESULTS The mean AD and NPD of the total study group was 0.9 ± 0.3 mm (95% CI 0.3-2.3) and 1.7 ± 0.5 mm (95% CI 0.5-3.9), respectively. The mean AD and NPD in males were 1.0 ± 0.3 mm (95% CI 0.28-2.34) and 1.9 ± 0.5 mm (95% CI 0.5-3.9) versus 0.8 ± 0.3 mm (95% CI 0.4-1.7) and 1.6 ± 0.5 mm (95% CI 0.8-2.9), respectively, for females. A statistically significant difference between male and female was found for both AD and NPD (p < 0.01). The male population <40 years had a mean AD and NPD of 1.0 ± 0.3 mm and 1.8 ± 0.5 mm, which was not statistically significant when compared with males >40 years. CONCLUSION The naturally occurring anatomic variation in ZMC symmetry described in this study is proposed as a benchmark for evaluating the amount of preoperative displacement and postoperative reduction of ZMC in trauma cases.
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Affiliation(s)
- Jean Pierre T F Ho
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Ruud Schreurs
- 3D Laboratory of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Souhir Aydi
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Roya Rezai
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Thomas J J Maal
- 3D Laboratory of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Arjen J van Wijk
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands.
| | - Ludo F M Beenen
- Department of Radiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Dan M J Milstein
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Alfred G Becking
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Virtual reconstruction of midface defects using statistical shape models. J Craniomaxillofac Surg 2017; 45:461-466. [DOI: 10.1016/j.jcms.2016.12.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 11/22/2016] [Accepted: 12/20/2016] [Indexed: 11/21/2022] Open
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Lichtenstein JT, Zeller AN, Lemound J, Lichtenstein TE, Rana M, Gellrich NC, Wagner ME. 3D-Printed Simulation Device for Orbital Surgery. JOURNAL OF SURGICAL EDUCATION 2017; 74:2-8. [PMID: 27986443 DOI: 10.1016/j.jsurg.2016.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/16/2016] [Accepted: 07/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Orbital surgery is a challenging procedure because of its complex anatomy. Training could especially benefit from dedicated study models. The currently available devices lack sufficient anatomical representation and realistic soft tissue properties. Hence, we developed a 3D-printed simulation device for orbital surgery with tactual (haptic) correct simulation of all relevant anatomical structures. DESIGN, SETTING, AND PARTICIPANTS Based on computed tomography scans collected from patients treated in a third referral center, the hard and soft tissue were segmented and virtually processed to generate a 3D-model of the orbit. Hard tissue was then physically realized by 3D-printing. The soft tissue was manufactured by a composite silicone model of the nucleus and the surrounding tissue over a negative mold model also generated by 3D-printing. The final model was evaluated by a group of 5 trainees in oral and maxillofacial surgery (1) and a group of 5 consultants (2). All participants were asked to reconstruct an isolated orbital floor defect with a titanium implant. A stereotactic navigation system was available to all participants. Their experience was evaluated for haptic realism, correct representation of surgical approach, general handling of model, insertion of implant into the orbit, placement and fixation of implant, and usability of navigated control. The items were evaluated via nonparametric statistics (1 [poor]-5 [good]). RESULTS Group 1 gave an average mark of 4.0 (±0.9) versus 4.6 (±0.6) by group 2. The haptics were rated as 3.6 (±1.1) [1] and 4.2 (±0.8) [2]. The surgical approach was graded 3.7 (±1.2) [1] and 4.0 (±1.0) [2]. Handling of the models was rated 3.5 (±1.1) [1] and 4 (±0.7) [2]. The insertion of the implants was marked as 3.7 (±0.8) [1] and 4.2 (±0.8) [2]. Fixation of the implants was also perceived to be realistic with 3.6 (±0.9) [1] and 4.2 (±0.45) [2]. Lastly, surgical navigation was rated 3.8 (±0.8) [1] and 4.6 (±0.56) [2]. CONCLUSION In this project, all relevant hard and soft tissue characteristics of orbital anatomy could be realized. Moreover, it was possible to demonstrate that the entire workflow of an orbital procedure may be simulated. Hence, using this model training expenses may be reduced and patient security could be enhanced.
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Affiliation(s)
- Juergen Thomas Lichtenstein
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany; Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
| | | | - Juliana Lemound
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | | | - Majeed Rana
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Maximilian Eberhard Wagner
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany; Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland
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Measuring zygomaticomaxillary complex symmetry three-dimensionally with the use of mirroring and surface based matching techniques. J Craniomaxillofac Surg 2016; 44:1706-1712. [DOI: 10.1016/j.jcms.2016.07.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/17/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022] Open
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