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Hahn HM, Jung YK, Lee IJ, Lim H. Revisiting bilateral bony orbital volumes comparison using 3D reconstruction in Korean adults: a reference study for orbital wall reconstruction, 3D printing, and navigation by mirroring. BMC Surg 2023; 23:351. [PMID: 37978496 PMCID: PMC10657008 DOI: 10.1186/s12893-023-02268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Orbital wall fractures can result in changes to the bony orbital volume and soft tissue. Restoring the bony orbital and intraconal fat volumes is crucial to prevent posttraumatic enophthalmos and hypoglobus. We aimed to establish an evidence-based medical reference point for "mirroring" in orbital wall reconstruction, which incorporates three-dimensional (3D)-printing and navigation-assisted surgery, by comparing bilateral bony orbital volumes. METHODS We retrospectively analyzed the data obtained from 100 Korean adults who did not have orbital wall fractures, categorized by age groups. The AVIEW Research software (Coreline Soft Inc., Seoul, South Korea) was used to generate 3D reformations of the bony orbital cavity, and bony orbital volumes were automatically calculated after selecting the region of interest on consecutive computed tomography slices. RESULTS The mean left and right orbital volume of males in their 20 s was 24.67 ± 2.58 mL and 24.70 ± 2.59 mL, respectively, with no significant difference in size (p = 0.98) and Pearson's correlation coefficient of 0.977 (p < 0.001). No significant differences were found in orbital volumes in other age groups without fractures or in patients with nasal bone fractures (p = 0.84, Pearson's correlation coefficient 0.970, p < 0.001). The interclass correlation coefficients (2,1) for inter- and intrarater reliability were 0.97 (p < 0.001) and 0.99 (p < 0.001), respectively. CONCLUSIONS No significant differences were found in the bilateral bony orbital volumes among males of any age. Thus, the uninjured orbit can be used as a volumetric reference point for the contralateral injured orbit during orbital wall reconstruction.
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Affiliation(s)
- Hyung Min Hahn
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon-Si, Gyeonggi-Do, 16499, Republic of Korea
| | - Yeon Kyo Jung
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon-Si, Gyeonggi-Do, 16499, Republic of Korea
| | - Il Jae Lee
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon-Si, Gyeonggi-Do, 16499, Republic of Korea
| | - Hyoseob Lim
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon-Si, Gyeonggi-Do, 16499, Republic of Korea.
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Hardisty M, Wei YT, Hontscharuk R, Ibrahimi A, Antonyshyn O, Edwards G, Mainprize JG, Whyne CM. Accuracy of Orbital Shape Reconstruction-Comparative Analysis of Errors in Implant Shape Versus Implant Positioning: A Cadaveric Study. J Craniofac Surg 2023; 34:1727-1731. [PMID: 37552131 DOI: 10.1097/scs.0000000000009566] [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: 07/06/2022] [Accepted: 05/24/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Orbital blowout fractures are commonly reconstructed with implants shaped to repair orbital cavity defects, restore ocular position and projection, and correct diplopia. Orbital implant shaping has traditionally been performed manually by surgeons, with more recent use of computer-assisted design (CAD). Accuracy of implant placement is also key to reconstruction. This study compares the placement accuracy of orbital implants, testing the hypothesis that CAD-shaped implants indexed to patient anatomy will better restore orbit geometry compared with manually shaped implants and manually placed implants. METHODS The placement accuracy of orbital implants was assessed within a cadaveric blowout fracture model (3 skulls, 6 orbits) via 3-dimensional CT analysis. Defects were repaired with 4 different techniques: manually placed-manually shaped composite (titanium-reinforced porous polyethylene), manually placed CAD composite, indexed placed CAD composite, and indexed placed CAD titanium mesh. RESULTS Implant placement accuracy differed significantly with the implant preparation method ( P =0.01). Indexing significantly improved the placement accuracy ( P =0.002). Indexed placed titanium mesh CAD implants (1.42±0.33 mm) were positioned significantly closer to the intact surface versus manually placed-manually shaped composite implants (2.12±0.39 mm). DISCUSSION Computer-assisted design implants indexed to patient geometry yielded average errors below the acceptable threshold (2 mm) for enophthalmos and diplopia. This study highlights the importance of adequately indexing CAD-designed implants to patient geometry to ensure accurate orbital reconstructions.
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Affiliation(s)
- Michael Hardisty
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
- Physical Sciences, Sunnybrook Research Institute
- Department of Surgery
| | - Yuan Tao Wei
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
- Biomedical Engineering, University of Toronto
| | | | - Amani Ibrahimi
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
| | - Oleh Antonyshyn
- Department of Surgery
- Division of Plastic Surgery, Sunnybrook Health Sciences Centre
- Calavera Surgical Design, Toronto, Ontario, Canada
| | | | - James G Mainprize
- Physical Sciences, Sunnybrook Research Institute
- Calavera Surgical Design, Toronto, Ontario, Canada
| | - Cari M Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
- Physical Sciences, Sunnybrook Research Institute
- Department of Surgery
- Biomedical Engineering, University of Toronto
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Morgan N, Shujaat S, Jazil O, Jacobs R. Three-dimensional quantification of skeletal midfacial complex symmetry. Int J Comput Assist Radiol Surg 2023; 18:611-619. [PMID: 36272017 DOI: 10.1007/s11548-022-02775-0] [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: 06/07/2022] [Accepted: 10/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Quantification of skeletal symmetry in a healthy population could have a strong impact on the reconstructive surgical procedures where mirroring of the contralateral healthy side acts as a clinical reference for the restoration of unilateral defects. Hence, the aim of this study was to three-dimensionally assess the symmetry of skeletal midfacial complex in skeletal class I patients. METHODS A sample of 100 cone beam computed tomography (CBCT) scans (50 males, 50 females; age range: 19-40 years) were recruited. Automated segmentation of the skeletal midfacial complex was performed to create a three-dimensional (3D) virtual model using a convolutional neural network (CNN)-based segmentation tool. Thereafter, the segmented model was mirrored and registered to quantify skeletal symmetry using a color-coded conformance mapping based on a surface part comparison analysis. RESULTS Overall, the mean and root-mean-square (RMS) differences between complete true and mirrored models were 0.14 ± 0.12 and 0.87 ± 0.21 mm, respectively. Female patients had a significantly more symmetrical midfacial complex (mean difference: 0.11 ± 0.1 mm, RMS: 0.81 ± 0.17 mm) compared to male patients (mean difference: 0.16 ± 0.13 mm, RMS: 0.94 ± 0.23 mm). No significant difference existed between left and right sides irrespective of the patient's gender. CONCLUSION The comparison between true and mirrored complete and left/right split midfacial complex showed symmetry within a clinically acceptable range of 1 mm, which justifies the applicability of using the mirroring technique. The presented data could act as a reference guide for surgeons during planning of reconstructive surgical procedures and outcome assessment at follow-up.
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Affiliation(s)
- Nermin Morgan
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33 bus 7001, 3000, Leuven, Belgium.
- Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33 bus 7001, 3000, Leuven, Belgium
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Omid Jazil
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33 bus 7001, 3000, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33 bus 7001, 3000, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Parameswaran A, Pandey M, Panneerselvam E, Nisar SP, Bachiavathy V, Mukherjee B. Does Intraoperative Navigation Improve Implant Position Accuracy in Orbital Fracture Repair? Facial Plast Surg Aesthet Med 2022. [PMID: 35325573 DOI: 10.1089/fpsam.2021.0379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Our aim was to determine if intraoperative navigation (ION) improved radiographic outcomes in patients undergoing delayed primary/secondary orbital reconstruction for inferomedial defects, as measured by volume restoration, enophthalmos correction, and positional accuracy of implants. Patients and Methods: A prospective quasiexperimental study was performed to compare two groups of patients requiring orbital reconstruction. Use of ION was the exposure evaluated. Outcome measures were (i) intraorbital volume and enophthalmos evaluated radiologically, (ii) implant position accuracy, and (iii) procedural duration. Data were analyzed statistically to compare variance between groups. Results: Forty patients (6 females and 34 males) were recruited into the study with a mean age of 27.3 years. The study group demonstrated a greater reduction of intraorbital volume (0.49 cu.cm; p = 0.02) and enophthalmos (0.72 mm; p = 0.001). Implant positioning was more accurate using ION, with less mediolateral (p = 0.006) and yaw (p = 0.04) deviations. Surgical time for implant positioning was shorter by 17 min, with navigation (p < 0.001). Conclusion: The use of ION demonstrated radiographic improvements in volume restoration, enophthalmos correction, as well as accuracy of implant positioning, in patients requiring delayed primary/secondary orbital reconstruction.
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Affiliation(s)
- Anantanarayanan Parameswaran
- Department of Oral and Maxillofacial Surgery, Meenakshi University of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Meenakshi Pandey
- Department of Oral and Maxillofacial Surgery, Meenakshi University of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital (Ramapuram Campus), Chennai, Tamil Nadu, India
| | - Sonam P Nisar
- Department of Orbit and Oculoplasty, Shankara Nethralaya, Chennai, Tamil Nadu, India
| | - Varsha Bachiavathy
- Department of Orbit and Oculoplasty, Shankara Nethralaya, Chennai, Tamil Nadu, India
| | - Bipasha Mukherjee
- Department of Orbit and Oculoplasty, Shankara Nethralaya, Chennai, Tamil Nadu, India
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Liokatis P, Malenova Y, Fegg F, Haidari S, Probst M, Boskov M, Cornelius C, Troeltzsch M, Probst F. Digital planning and individual implants for secondary reconstruction of midfacial deformities: A pilot study. Laryngoscope Investig Otolaryngol 2022; 7:369-379. [PMID: 35434332 PMCID: PMC9008187 DOI: 10.1002/lio2.753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the feasibility and accuracy of implementing three‐dimensional virtual surgical planning (VSP) and subsequent transfer by additive manufactured tools in the secondary reconstruction of residual post‐traumatic deformities in the midface. Methods Patients after secondary reconstruction of post‐traumatic midfacial deformities were included in this case series. The metrical deviation between the virtually planned and postoperative position of patient‐specific implants (PSI) and bone segments was measured at corresponding reference points. Further information collected included demographic data, post‐traumatic symptoms, and type of transfer tools. Results Eight consecutive patients were enrolled in the study. In five patients, VSP with subsequent manufacturing of combined predrilling/osteotomy guides and PSI was performed. In three patients, osteotomy guides, repositioning guides, and individually prebent plates were used following VSP. The median distances between the virtually planned and the postoperative position of the PSI were 2.01 mm (n = 18) compared to a median distance concerning the bone segments of 3.05 mm (n = 12). In patients where PSI were used, the median displacement of the bone segments was lower (n = 7, median 2.77 mm) than in the group with prebent plates (n = 5, 3.28 mm). Conclusion This study demonstrated the feasibility of VSP and transfer by additive manufactured tools for the secondary reconstruction of complex residual post‐traumatic deformities in the midface. However, the median deviations observed in this case series were unexpectedly high. The use of navigational systems may further improve the level of accuracy. To evaluate the feasibility and accuracy of implementing three‐dimensional virtual surgical planning (VSP) and subsequent transfer by additive manufactured tools in the secondary reconstruction of residual post‐traumatic deformities in the midface. This study demonstrated the feasibility of VSP and transfer by additive manufactured tools for the secondary reconstruction of complex residual post‐traumatic deformities in the midface. However, the median deviations observed in this case series were unexpectedly high. The use of navigational systems may further improve the level of accuracy.
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Affiliation(s)
- Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Florian‐Nepomuk Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine Klinikum rechts der Isar, Technical University of Munich Munich Germany
| | - Marko Boskov
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Carl‐Peter Cornelius
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Florian‐Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
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Is the Mirroring Technology Reliable in the Use of Computer-Aided Design for Orbital Reconstruction? Three-Dimensional Analysis of Asymmetry in the Orbits. Plast Reconstr Surg 2022; 149:453-460. [PMID: 35077421 DOI: 10.1097/prs.0000000000008735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reconstruction of the orbital area remains a challenge in many cases. The recently introduced mirroring technology provides surgeons with patient-specific information for accurate orbital reconstruction; its premise is that the three-dimensional anatomy of craniofacial bone is symmetric. The purpose of this study was to verify this premise of the mirroring technology by assessing three-dimensional asymmetry. METHODS Facial computed tomographic data of 104 patients were imported into iPlan software. Four reference points (i.e., zygomaticofrontal suture, frontomaxillary suture, infraorbital foramen, and optic canal) were set, and the three-dimensional distances from these points to the anterior nasal spine on the mirroring plane were calculated. In addition, the orbital cavity volume and the three-dimensional distances from point optic canal to the other reference points were calculated for the assessment of the orbit anatomy. Three plastic surgeons performed these processes independently. RESULTS No statistically significant difference was found in the three-dimensional distances between anterior nasal spine and the four reference points bilaterally. Also, no statistically significant difference in the three-dimensional distances between the point representing the optic canal and other reference points was detected bilaterally. Orbital cavity volume showed a mild asymmetry, but the discrepancy was acceptable for computer-aided design applications. For all reference points, the maximum value of the 95 percent CI was less than 1.4 mm. CONCLUSIONS The three-dimensional location of the orbits and the three-dimensional anatomy of the orbit were symmetric. Thus, the mirroring technology could be a reliable first step in computer-aided design, computer-assisted surgery, and navigation-assisted surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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García-Sevilla M, Moreta-Martinez R, García-Mato D, Arenas de Frutos G, Ochandiano S, Navarro-Cuéllar C, Sanjuán de Moreta G, Pascau J. Surgical Navigation, Augmented Reality, and 3D Printing for Hard Palate Adenoid Cystic Carcinoma En-Bloc Resection: Case Report and Literature Review. Front Oncol 2022; 11:741191. [PMID: 35059309 PMCID: PMC8763795 DOI: 10.3389/fonc.2021.741191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/26/2021] [Indexed: 12/18/2022] Open
Abstract
Adenoid Cystic Carcinoma is a rare and aggressive tumor representing less than 1% of head and neck cancers. This malignancy often arises from the minor salivary glands, being the palate its most common location. Surgical en-bloc resection with clear margins is the primary treatment. However, this location presents a limited line of sight and a high risk of injuries, making the surgical procedure challenging. In this context, technologies such as intraoperative navigation can become an effective tool, reducing morbidity and improving the safety and accuracy of the procedure. Although their use is extended in fields such as neurosurgery, their application in maxillofacial surgery has not been widely evidenced. One reason is the need to rigidly fixate a navigation reference to the patient, which often entails an invasive setup. In this work, we studied three alternative and less invasive setups using optical tracking, 3D printing and augmented reality. We evaluated their precision in a patient-specific phantom, obtaining errors below 1 mm. The optimum setup was finally applied in a clinical case, where the navigation software was used to guide the tumor resection. Points were collected along the surgical margins after resection and compared with the real ones identified in the postoperative CT. Distances of less than 2 mm were obtained in 90% of the samples. Moreover, the navigation provided confidence to the surgeons, who could then undertake a less invasive and more conservative approach. The postoperative CT scans showed adequate resection margins and confirmed that the patient is free of disease after two years of follow-up.
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Affiliation(s)
- Mónica García-Sevilla
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Rafael Moreta-Martinez
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - David García-Mato
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Gema Arenas de Frutos
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Santiago Ochandiano
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Navarro-Cuéllar
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Guillermo Sanjuán de Moreta
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Otorrinolaringología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Pascau
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Technical Note on Three- and Four-Wall Orbital Reconstructions with Patient-Specific Implants. J Craniofac Surg 2021; 33:991-996. [PMID: 34802019 DOI: 10.1097/scs.0000000000008303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Orbital reconstruction is one of the most complex procedures in maxillofacial surgery. It becomes even more complex when all references to the original anatomy are lost. The purpose of this article is to provide an overview of techniques for complex three- and four-wall orbital reconstructions. Preoperative virtual surgical planning is essential when considering different reconstruction possibilities. The considerations that may lead to different approaches are described, and the advantages and drawbacks of each technique are evaluated. It is recommended to reconstruct solitary three-wall or four-wall orbital defects with multiple patient-specific implants. Optimizations of this treatment protocol are suggested, and their effects on predictability are demonstrated in a case presentation of a four-wall defect reconstruction with multiple patient-specific implants.
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Sharma N, Welker D, Aghlmandi S, Maintz M, Zeilhofer HF, Honigmann P, Seifert T, Thieringer FM. A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction. J Clin Med 2021; 10:3563. [PMID: 34441859 PMCID: PMC8397160 DOI: 10.3390/jcm10163563] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 12/18/2022] Open
Abstract
Pure orbital blowout fractures occur within the confines of the internal orbital wall. Restoration of orbital form and volume is paramount to prevent functional and esthetic impairment. The anatomical peculiarity of the orbit has encouraged surgeons to develop implants with customized features to restore its architecture. This has resulted in worldwide clinical demand for patient-specific implants (PSIs) designed to fit precisely in the patient's unique anatomy. Material extrusion or Fused filament fabrication (FFF) three-dimensional (3D) printing technology has enabled the fabrication of implant-grade polymers such as Polyetheretherketone (PEEK), paving the way for a more sophisticated generation of biomaterials. This study evaluates the FFF 3D printed PEEK orbital mesh customized implants with a metric considering the relevant design, biomechanical, and morphological parameters. The performance of the implants is studied as a function of varying thicknesses and porous design constructs through a finite element (FE) based computational model and a decision matrix based statistical approach. The maximum stress values achieved in our results predict the high durability of the implants, and the maximum deformation values were under one-tenth of a millimeter (mm) domain in all the implant profile configurations. The circular patterned implant (0.9 mm) had the best performance score. The study demonstrates that compounding multi-design computational analysis with 3D printing can be beneficial for the optimal restoration of the orbital floor.
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Affiliation(s)
- Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (D.W.); (M.M.); (P.H.)
| | - Dennis Welker
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (D.W.); (M.M.); (P.H.)
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031 Basel, Switzerland;
| | - Michaela Maintz
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (D.W.); (M.M.); (P.H.)
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts Northwestern Switzerland, CH-4132 Muttenz, Switzerland
| | - Hans-Florian Zeilhofer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
| | - Philipp Honigmann
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (D.W.); (M.M.); (P.H.)
- Hand Surgery, Cantonal Hospital Baselland, CH-4410 Liestal, Switzerland
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, NL-1105 Amsterdam, The Netherlands
| | - Thomas Seifert
- Department of Mechanical and Process Engineering, University of Applied Sciences, DE-77652 Offenburg, Germany;
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland; (D.W.); (M.M.); (P.H.)
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Gooris PJJ, Jansen J, Bergsma JE, Dubois L. Evidence-Based Decision Making in Orbital Fractures: Implementation of a Clinical Protocol. Atlas Oral Maxillofac Surg Clin North Am 2021; 29:109-127. [PMID: 33516533 DOI: 10.1016/j.cxom.2020.11.005] [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)
- Peter J J Gooris
- Department of Oral and Maxillofacial Surgery, University of Washington Seattle, WA, USA; Department of Oral and Maxillofacial Surgery, University Medical Centre Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amphia Hospital Breda, Molengracht 21, Breda 4818 CK, the Netherlands.
| | - Jesper Jansen
- Department of Oral and Maxillofacial Surgery, University Medical Centre Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - J Eelco Bergsma
- Department of Oral and Maxillofacial Surgery, Amphia Hospital Breda, Molengracht 21, Breda 4818 CK, the Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, University Medical Centre Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
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Anand M, Panwar S. Role of Navigation in Oral and Maxillofacial Surgery: A Surgeon's Perspectives. Clin Cosmet Investig Dent 2021; 13:127-139. [PMID: 33883948 PMCID: PMC8055371 DOI: 10.2147/ccide.s299249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/06/2021] [Indexed: 12/21/2022] Open
Abstract
Surgeries related to the maxillofacial area deal with an intricate network of anatomical structures. With the complexity of the vital structures, it necessitates a surgical team to respect each anatomical boundary. In the past, there was an exceptionally high number of cases with surgical errors. These errors were not because of flaws in the surgeon’s skills or techniques but owing to lack of resources. Visualisation is one of the key factors that determines the precision of any surgical outcome. Advances in surgical planning have led to the introduction of a “Navigation” system that helps surgeons to see more, know more and ultimately do more for their patients. The usefulness of the navigation system in oral surgeries has been indicated by its surgical applications in craniomaxillofacial trauma, orthognathic surgeries, head and neck pathological resections, complex skull base surgeries and surgery involving temporomandibular joint. A vast majority of research literature has suggested remarkable improvement in surgical outcomes under the guidance of 3d planning and navigation. However, with such an inordinate advancement, financial expenses and a gradual learning curve are always a constraining factor in surgical navigation. This article overviews indication of navigation in craniofacial surgeries with a focus on applied aspect, planning and solution to the future problem.
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Affiliation(s)
- Manish Anand
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
| | - Shreya Panwar
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
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Schreurs R, Dubois L, Klop C, Beenen LFM, Habets PEMH, Maal TJJ, Becking AG. Surgical instrument to improve implant positioning in orbital reconstruction: a feasibility study. Br J Oral Maxillofac Surg 2021; 59:826-830. [PMID: 34256960 DOI: 10.1016/j.bjoms.2021.02.023] [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: 06/10/2020] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
Adequate positioning of an orbital implant during orbital reconstruction surgery is essential for restoration of the pre-traumatised anatomy, but visual appraisal of its position is limited by the keyhole access and protruding soft tissues. A positioning instrument that attaches to the implant was designed to provide feedback outside the orbit. The goal of this study was to evaluate the accuracy of placement with the instrument and compare it with the accuracy of placement by visual appraisal. Ten orbits in five human cadaver heads were reconstructed twice: once using visual appraisal and once using the instrument workflow. No significant improvement was found for the roll (5.8° vs 3.4°, respectively, p=0.16), pitch (2.1° vs 1.5°, p=0.56), or translation (2.9 mm vs 3.3 mm, p=0.77), but the yaw was significantly reduced if the instrument workflow was used (15.3° vs 2.9°, p=0.02). The workflow is associated with low costs and low logistical demands, and may prevent outliers in implant positioning in a clinical setting when intraoperative navigation or patient-specific implants are not available.
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Affiliation(s)
- R Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - L Dubois
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - L F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P E M H Habets
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - T J J Maal
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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A retrospective study to compare the treatment outcomes with and without surgical navigation for fracture of the orbital wall. Chin J Traumatol 2021; 24:11-17. [PMID: 33246880 PMCID: PMC7878449 DOI: 10.1016/j.cjtee.2020.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 10/09/2020] [Accepted: 10/25/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the outcomes with and without aid of a computer-assisted surgical navigation system (CASNS) for treatment of unilateral orbital wall fracture (OWF). METHODS Patients who came to our hospital for repairing unilateral traumatic OWF from 2014 to 2017 were included in this study. The patients were divided into the navigation group who accepted orbital wall reconstruction aided by CASNS and the conventional group. We evaluated the surgical precision in the navigation group by analyzing the difference between actual postoperative computed tomography data and preoperative virtual surgical plan through color order ratios. We also compared the duration of surgery, enophthalmos correction, restoration of orbital volumes, and improvement of clinical symptoms in both groups systemically. Quantitative data were presented as mean ± SD. Significance was determined by the two-sample t-test using SPSS Version 19.0 A p < 0.05 was considered statistically significant. RESULTS Seventy patients with unilateral OWF were included in the study cohort. The mean difference between preoperative virtual planning and actual reconstruction outcome was (0.869 ± 0.472) mm, which means the reconstruction result could match the navigation planning accurately. The mean duration of surgery in the navigation group was shorter than it is in the control group, but not significantly. Discrepancies between the reconstructed and unaffected orbital-cavity volume and eyeball projection in the navigation group were significantly less than that in the conventional group. One patient had remnant diplopia and two patients had enophthalmos after surgery in the navigation group; two patients had postoperative diplopia and four patients had postoperative enophthalmos in the conventional group. CONCLUSION Compare with the conventional treatment for OWF, the use of CASNS can provide a significantly better surgical precision, greater improvements in orbital-cavity volume and eyeball projection, and better clinical results, without increasing the duration of surgery.
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Holmes S. Primary Orbital Fracture Repair. Atlas Oral Maxillofac Surg Clin North Am 2021; 29:51-77. [PMID: 33516540 DOI: 10.1016/j.cxom.2020.11.004] [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)
- Simon Holmes
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London, UK.
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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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17
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Jansen J, Schreurs R, Dubois L, Maal T, Gooris P, Becking A. Intraoperative imaging in orbital reconstruction: how does it affect the position of the implant? Br J Oral Maxillofac Surg 2020; 58:801-806. [DOI: 10.1016/j.bjoms.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/12/2020] [Indexed: 10/24/2022]
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18
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Azarmehr I, Stokbro K, Bell RB, Thygesen T. Contemporary Techniques in Orbital Reconstruction: A Review of the Literature and Report of a Case Combining Surgical Navigation, Computer-Aided Surgical Simulation, and a Patient-Specific Implant. J Oral Maxillofac Surg 2020; 78:594-609. [DOI: 10.1016/j.joms.2019.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 11/15/2022]
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Zeiderman MR, Pu LLQ. Contemporary reconstruction after complex facial trauma. BURNS & TRAUMA 2020; 8:tkaa003. [PMID: 32341916 PMCID: PMC7175762 DOI: 10.1093/burnst/tkaa003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/07/2020] [Indexed: 11/12/2022]
Abstract
Complex facial trauma requires complex repair and solutions. This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result. Historically, the use of pedicled flaps, and then free tissue transfer, were the primary techniques utilized. Advancements in soft-tissue reconstruction, such as perforator flaps and pre-expanded and prefabricated flaps, allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage. The advent of contemporary technologies, such as virtual surgical planning, stereolithography and customized implants and plates, facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction. When surgical and technological techniques are combined in complementary multistage reconstructions, better reconstructive and aesthetic outcomes are achievable than ever before. In this review, the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience. Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed. A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result. We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.
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Affiliation(s)
- Matthew R Zeiderman
- Division of Plastic Surgery, Department of Surgery, University of California, Davis, 2335 Stockton Boulevard, Room 6008 Sacramento, CA 95817, USA
| | - Lee L Q Pu
- Division of Plastic Surgery, Department of Surgery, University of California, Davis, 2335 Stockton Boulevard, Room 6008 Sacramento, CA 95817, USA
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Chepurnyi Y, Chernogorskyi D, Kopchak A, Petrenko O. Clinical efficacy of peek patient-specific implants in orbital reconstruction. J Oral Biol Craniofac Res 2020; 10:49-53. [PMID: 32099771 DOI: 10.1016/j.jobcr.2020.01.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022] Open
Abstract
Purpose To assess the clinical efficacy of custom made PEEK patient-specific implants in treatment of orbital wall defects. Methods Forty-five patients with unilateral post-traumatic orbital wall defects were enrolled in the study. They underwent subsequent reconstructive procedures using PEEK patient-specific implants (PSI) or pre-bent titanium plates. All the patients were examined with the standardized algorithm, including local status examination, vision assessment and computer tomography (CT) with measurements of the orbital volume. A comparative analysis of the treatment outcomes in two groups of patients (pre-bent plates/PSI) was performed. Results The study findings show an absence of any postoperative infection, inflamation or decreased visual acuity in either group. In PSI group, diplopia after surgery was absent in 82.1% of patients versus 70.6% of controls. The mean duration of surgery was 54.25 ± 16.8 min with PSI application and 82.9 ± 10.8 min with pre-bent plates. The mean difference between the intact and damaged orbital volume was 1.9 ± 1.4 cm3 in the control group versus 0.74 ± 0.6 cm3 in PSI group (р<0.05). Conclusion PEEK PSI demonstrated higher clinical efficacy in comparison to pre-bent plates in orbital wall reconstruction especially in restoring the volume and shape of the damaged orbit.
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Affiliation(s)
- Yurii Chepurnyi
- Bogomolets National Medical University, Stomatological Department, Division of Maxillofacial Surgery, 13, T. Shevchenko blvd, 01601, Kiev, Ukraine
| | - Denis Chernogorskyi
- Bogomolets National Medical University, Stomatological Department, Division of Maxillofacial Surgery, 13, T. Shevchenko blvd, 01601, Kiev, Ukraine
| | - Andrey Kopchak
- Bogomolets National Medical University, Stomatological Department, Division of Maxillofacial Surgery, 13, T. Shevchenko blvd, 01601, Kiev, Ukraine
| | - Oksana Petrenko
- Shupyk National Medical Academy of Postgraduate Education, Division of Ophtalmology, 9 Dorohozhytska Str., 04112, Kiev, Ukraine
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Chepurnyi Y, Chernogorskyi D, Petrenko O, Kopchak A. Reconstruction of Post-Traumatic Orbital Defects and Deformities with Custom-Made Patient-Specific Implants: Evaluation of the Efficacy and Clinical Outcome. ACTA ACUST UNITED AC 2020. [DOI: 10.1055/s-0039-1685505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The main purpose of this article is to evaluate the efficacy of patient-specific implants (PSI) in treatment of patients with post-traumatic orbital defects and deformities. Twenty-three patients with post-traumatic orbital defects and deformities, who underwent subsequent reconstructive procedures using PSI, were included in the study. All the patients were examined according to the standard algorithm involving the local status examination, vision assessment, and computed tomography before and after surgery. The study findings show neither postoperative infectious complications nor decreased visual acuity or loss of visual fields. Functional disorders resolved in 65.2% of cases 1 month after the surgical intervention and in 86.96% of patients within a 3-month term. Positive aesthetic outcomes were seen in 95.7% of cases. Reconstruction with computer-aided design/computer-aided manufactured PSI is an effective procedure that allows accurate restoring of the complex orbital anatomy.
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Affiliation(s)
- Yurii Chepurnyi
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Denis Chernogorskyi
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Oksana Petrenko
- Department of Ophthalmology, Pl Shupik National Medical Academy of Postgraduate Study, Kiev, Ukraine
| | - Andrii Kopchak
- Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
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22
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Nazarov VV. [Use of navigation in skull base surgery]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 83:109-118. [PMID: 31825382 DOI: 10.17116/neiro201983051109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review briefly presents the history of development of navigation systems in neurosurgery. The idea of the existing principles underlying the navigation systems used in neurosurgery is given. Currently, the basic principles of navigation are optical and electromagnetic. Studies are presented comparing the accuracy of various navigation systems. Optical navigation demonstrates greater accuracy compared to electromagnetic, but both methods demonstrate a submillimeter error in the experiment. The history of use of navigation in the surgery of the skull base is analyzed in detail, the most relevant areas of use of navigation within the surgery of the skull base are considered: craniofacial reconstruction, endoscopic endonasal surgery, surgery of common tumors of the skull base affecting the infratemporal, pterygopalatine fossa, temporomandibular joint. Indications for the use of navigation, limitations of the methodology are explained.
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Affiliation(s)
- V V Nazarov
- Burdenko Neurosurgical Center, Moscow, Russia
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23
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Kang YF, Liang J, He Z, Zhang L, Shan XF, Cai ZG. Orbital floor symmetry after maxillectomy and orbital floor reconstruction with individual titanium mesh using computer-assisted navigation. J Plast Reconstr Aesthet Surg 2019; 73:337-343. [PMID: 31477492 DOI: 10.1016/j.bjps.2019.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/24/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The present study aimed to evaluate the symmetry of the orbital floor after maxillectomy and orbital floor reconstruction with individual titanium mesh using a computer-assisted navigation system. PATIENTS AND METHODS Nineteen patients who underwent orbital floor reconstruction with individual titanium mesh were included in this study. Postoperative computed tomography scans recorded after three-dimensional (3D) reconstruction were used to evaluate the symmetry of the orbital floor, including orbital floor height, orbital floor eminence, globe projection, orbital volume, and surface deviation. RESULTS The average orbital floor height of the reconstructed and the unaffected side was 37.7 ± 2.3 and 37.8 ± 2.7 mm, respectively (P = .47). The average orbital floor eminence of the reconstructed and the unaffected side was 40.1 ± 5.5 and 39.6 ± 5.3 mm, respectively (P = .17). The average globe projection of the reconstructed and the unaffected side was 15.5 ± 3.2 and 15.3 ± 3.0 mm, respectively (P = .27). The average orbital volume of the reconstructed and the unaffected side was 25.9 ± 4.4 and 26.3 ± 4.4 cm3, respectively (P = .29). Repeatability between the reconstructed and the unaffected side was 88.3% ± 2.6% at within 1 mm and 98.6% ± 0.9% at within 2 mm. The average of maximum deviation was 2.4 ± 0.2 mm. CONCLUSION Individual titanium mesh is one of the best techniques for orbital floor reconstruction, as it can be placed precisely and helps achieve desirable esthetic outcomes through virtual surgical planning and using a computer-assisted navigation system.
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Affiliation(s)
- Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China
| | - Jie Liang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China
| | - Zheng He
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China.
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China.
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Hierl T, Kruber D, Doerfler HM, Huempfner-Hierl H, Krause M. Computer-Aided Versus Conventional Planning in Orbital Traumatology Using Preformed Meshes: Development of a New Workflow. J Oral Maxillofac Surg 2019; 77:1663-1672. [DOI: 10.1016/j.joms.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
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Franz L, Isola M, Bagatto D, Tuniz F, Robiony M. A novel approach to skull-base and orbital osteotomies through virtual planning and navigation. Laryngoscope 2018; 129:823-831. [PMID: 30151894 DOI: 10.1002/lary.27479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Computer-assisted planning of osteotomy lines, coupled with navigation-guided performance of planned osteotomies, is a highly innovative approach to skull-base and orbital surgery. The aim of this pilot study is to provide an assessment of the accuracy of this novel approach in guiding the correct positioning of osteotomy lines in frontal, temporal, and orbital regions, defining the agreement between the spatial position of the planned and performed osteotomies. METHODS Fifteen patients with orbital, frontal sinus, and lateral skull-base diseases underwent virtual surgical planning. Osteotomies to access the orbit, frontal sinus, and lateral skull base were planned on computer tomography-based three-dimensional models. The planned osteotomies were reproduced on the operating field using a navigation system. The positions of the performed and planned osteotomies were compared. The results were described as the mean positional difference between planned and performed osteotomies and as Lin's concordance coefficient, and Bland-Altman limits of agreement were also defined. RESULTS The overall mean difference was 0.719 mm (95% confidence interval [CI]: 0.472 to 0.965 mm). Overall, Lin's concordance coefficient was 0.997 (95% CI: 0.996 to 0.998), and overall Bland-Altman limits of agreement ranged from -1.407 to 2.844 mm. The smallest mean difference (0.587 mm, 95% CI: 0.244 to 0.931 mm) was calculated in the orbit group, whereas the highest mean difference (0.904 mm, 95% CI: 0.428 to 1.379 mm) was described in the lateral skull-base group. CONCLUSION This study's results support the use of this novel planning and navigation protocol for guiding osteotomy in anterior and lateral skull-base surgery, providing a clinical validation of this technique. LEVEL OF EVIDENCE 4 Laryngoscope, 00:1-9, 2018 Laryngoscope, 129:823-831, 2019.
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Affiliation(s)
- Leonardo Franz
- Department of Maxillofacial Surgery, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Miriam Isola
- Department of Maxillofacial Surgery, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.,Institute of Statistics, Department of Medicine, University of Udine
| | | | - Francesco Tuniz
- Department of Neurosurgery , Academic Hospital of Udine, Udine, Italy
| | - Massimo Robiony
- Department of Maxillofacial Surgery, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
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Jansen J, Schreurs R, Dubois L, Maal TJ, Gooris PJ, Becking AG. The advantages of advanced computer-assisted diagnostics and three-dimensional preoperative planning on implant position in orbital reconstruction. J Craniomaxillofac Surg 2018; 46:715-721. [DOI: 10.1016/j.jcms.2018.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/24/2018] [Accepted: 02/13/2018] [Indexed: 11/30/2022] Open
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Schreurs R, Dubois L, Becking A, Maal T. Implant-oriented navigation in orbital reconstruction. Part 1: technique and accuracy study. Int J Oral Maxillofac Surg 2018; 47:395-402. [DOI: 10.1016/j.ijom.2017.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/25/2017] [Accepted: 09/20/2017] [Indexed: 11/30/2022]
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Jansen J, Dubois L, Schreurs R, Gooris PJJ, Maal TJJ, Beenen LF, Becking AG. Should Virtual Mirroring Be Used in the Preoperative Planning of an Orbital Reconstruction? J Oral Maxillofac Surg 2017; 76:380-387. [PMID: 29100830 DOI: 10.1016/j.joms.2017.09.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Mirroring has been used as a diagnostic tool in orbital wall fractures for many years, but limited research is available proving the assumed symmetry of orbits. The purpose of this study was to evaluate volume and contour differences between orbital cavities in healthy humans. MATERIALS AND METHODS In this cross-sectional study, the left and right orbital cavities of a consecutive sample of patients' computed tomograms were measured. Inclusion criteria were patients with no sign of orbital or sinus pathology or fracture. Outcome variables were differences in volume and contour. Descriptive statistics and Student paired t test were used for data analysis of orbital volume and distance maps were used for analysis of orbital contour. RESULTS The sample was composed of 100 patients with a mean age of 57; 50% were men. The total mean orbital volume was 27.53 ± 3.11 mL. Mean difference between cavities was 0.44 ± 0.31 mL or 1.59% (standard deviation [SD], 1.10%). The orbital contour showed high similarity, with an absolute mean left-versus-right difference of 0.82 mm (SD, 0.23 mm). CONCLUSION The authors hypothesize that the measured differences between right and left orbital volumes and contours are clinically minor. In consequence, the use of mirroring tools as part of preoperative planning in orbital reconstruction is legitimate with the aim of simulating the pre-traumatized anatomy.
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Affiliation(s)
- Jesper Jansen
- PhD Student, Department of Oral and Maxillofacial Surgery, Orbital Unit and 3D Lab, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
| | - Leander Dubois
- Staff Member, Department of Oral and Maxillofacial Surgery, Orbital Unit and 3D Lab, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruud Schreurs
- PhD Student, Department of Oral and Maxillofacial Surgery, Orbital Unit and 3D Lab, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J J Gooris
- Staff Member and Co-Supervisor, Department of Oral and Maxillofacial Surgery, Orbital Unit and 3D Lab, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas J J Maal
- Staff Member and Co-Supervisor, Department of Oral and Maxillofacial Surgery, Orbital Unit and 3D Lab, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Ludo F Beenen
- Staff Member, Department of Radiology, Academic Medical Centre of Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Alfred G Becking
- Professor and Supervisor, Department of Oral and Maxillofacial Surgery, Orbital Unit and 3D Lab, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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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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Franz L, Isola M, Bagatto D, Calzolari F, Travan L, Robiony M. A Novel Protocol for Planning and Navigation in Craniofacial Surgery: A Preclinical Surgical Study. J Oral Maxillofac Surg 2017; 75:1971-1979. [DOI: 10.1016/j.joms.2017.04.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/20/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
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Doerfler HM, Huempfner-Hierl H, Kruber D, Schulze P, Hierl T. Template-Based Orbital Wall Fracture Treatment Using Statistical Shape Analysis. J Oral Maxillofac Surg 2017; 75:1475.e1-1475.e8. [DOI: 10.1016/j.joms.2017.03.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
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Kanno T, Karino M, Yoshino A, Koike T, Ide T, Tatsumi H, Tsunematsu K, Yoshimatsu H, Sekine J. Feasibility of Single Folded Unsintered Hydroxyapatite Particles/Poly-L-Lactide Composite Sheet in Combined Orbital Floor and Medial Wall Fracture Reconstruction. J HARD TISSUE BIOL 2017. [DOI: 10.2485/jhtb.26.237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Aya Yoshino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Takashi Koike
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Hamada Medical Center
| | - Taichi Ide
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Oki Hospital
| | - Koji Tsunematsu
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Masuda Red Cross Hospital
| | - Hideki Yoshimatsu
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
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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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Dubois L, Jansen J, Schreurs R, Habets PE, Reinartz SM, Gooris PJ, Becking AG. How reliable is the visual appraisal of a surgeon for diagnosing orbital fractures? J Craniomaxillofac Surg 2016; 44:1015-24. [DOI: 10.1016/j.jcms.2016.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 04/12/2016] [Accepted: 05/09/2016] [Indexed: 12/20/2022] Open
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Füßinger MA, Duttenhoefer F, Bittermann G, Schmelzeisen R. [Intraoperative quality management modalities in head and neck surgery]. HNO 2016; 64:650-7. [PMID: 27435274 DOI: 10.1007/s00106-016-0203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immediate intraoperative control via suitable imaging techniques is necessary to achieve the best possible surgical outcome. Intraoperative imaging increases patient safety, offers the surgeon direct support in challenging anatomic regions, and affords the possibility of direct correction with a reduced rate of corrective surgery. The procedures are based on cone beam computed tomography (CBCT), endoscopy, or navigation-assisted surgery. This article describes available intraoperative quality management modalities for fracture management and tumor treatment in the field of head and neck surgery.
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Affiliation(s)
- M A Füßinger
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
| | - F Duttenhoefer
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - G Bittermann
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - R Schmelzeisen
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
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Kanno T, Tatsumi H, Karino M, Yoshino A, Koike T, Ide T, Sekine J. Applicability of an Unsintered Hydroxyapatite Particles/Poly-L-Lactide Composite Sheet with Tack Fixation for Orbital Fracture Reconstruction. J HARD TISSUE BIOL 2016. [DOI: 10.2485/jhtb.25.329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
- Division of Oral and Maxillofacial Surgery, Oki Hospital
| | - Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Aya Yoshino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Takashi Koike
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Taichi Ide
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
| | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Maxillofacial Trauma Center, Shimane University Hospital
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