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El-Mahallawy Y, Dessoky NY, Abdelrahman HH, Al-Mahalawy H. Evaluation of the resection plane three-dimensional positional accuracy using a resection guide directional guidance slot; a randomized clinical trial. BMC Oral Health 2024; 24:736. [PMID: 38926728 PMCID: PMC11210047 DOI: 10.1186/s12903-024-04476-3] [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: 03/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
AIM The study was performed to compare the mandibular resection guide with a directional guidance slot with the conventional guide regarding three-dimensional positional accuracy. MATERIALS AND METHODS Twenty-six patients with lateral segmental mandibular defects were selected, and randomly allocated into two groups. All defects were managed with preoperative virtual surgical planning. Resection in the test group was conducted using a resection guide with a directional guidance slot, while a conventional resection guide design was utilized in the control group. The linear and angular deviation of the osteotomy planes was analyzed for both groups, along with the accuracy of the insertion of the reconstruction bone block in the resected defect. Data were documented, absolute deviation was calculated, statistical analysis was performed and significance was set at the 5% level. RESULTS The cases conducted with a directional guidance templet reported a statistically significant difference when compared to the conventional edge-cutting guide regarding the linear and angular spatial osteotomy plane position (P < 0.001). The defect span analysis reported excellent levels of agreement in both groups (ICC = 1.00, ICC = 0.995), however, the difference between the groups was statistically significant (P < 0.001). CONCLUSION The study demonstrated the enhanced positional accuracy of the resection plane and reconstruction block placement when a directional slot is incorporated in the computer-generated resection guide.
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Affiliation(s)
- Yehia El-Mahallawy
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Noha Y Dessoky
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Hams H Abdelrahman
- Dental Public Health and Pediatric Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Haytham Al-Mahalawy
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Fayoum University, Fayoum, Egypt
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Kudva A, Srikanth G, Singh A, Chitra A, Suryanarayan RK, Francis M. Reconstruction of Maxillary Defects Using Virtual Surgical Planning and Additive Manufacturing Technology: A Tertiary Care Centre Experience. J Maxillofac Oral Surg 2024; 23:644-652. [PMID: 38911428 PMCID: PMC11190103 DOI: 10.1007/s12663-023-02005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/16/2023] [Indexed: 06/25/2024] Open
Abstract
Introduction Maxillary reconstruction is often a challenging task for the surgeons because of the complex anatomy. However, with the advances in virtual surgical planning (VSP) and 3D printing technology there is a new avenue for the surgeons which offers a suitable alternative to conventional flap-based reconstructions. Patients and Methods In this article, we have described 4 case scenarios which were managed with the help of VSP and additive manufacturing technology for complex maxillary reconstruction procedures. Use of the technologies aided the clinician in achieving optimal outcomes with regards to form, function and esthetics. Discussion Virtual surgical planning (VSP) has gained a lot of impetus in past 1 decade. These aides the surgeon in determining the extent of disease and also carry out the treatment planning. In addition to VSP, the concept of additive manufacturing provides a viable alternative to the conventional reconstruction modalities for maxillary defect rehabilitation. Increased accuracy, rehabilitation of normal anatomical configuration, appropriate dental rehabilitation, decreased intra-operative time and post-operative complications are some of the advantages. In addition, patient-specific implants eliminate the need for a separate donor site. Apart from the treatment of pathologies, they also can be used for reconstruction of post-traumatic defect, where endosteal implant placement is not possible. Conclusion These modalities show promising results for reconstruction of complex maxillary defects.
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Affiliation(s)
- Adarsh Kudva
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - G. Srikanth
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Anupam Singh
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - A. Chitra
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Ramya K. Suryanarayan
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Mugdha Francis
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
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Liu Z, Zhong Y, Lyu X, Zhang J, Huang M, Liu S, Zheng L. Accuracy of the modified tooth-supported 3D printing surgical guides based on CT, CBCT, and intraoral scanning in maxillofacial region: A comparison study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101853. [PMID: 38555078 DOI: 10.1016/j.jormas.2024.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Tooth-supported surgical guides have demonstrated superior accuracy compared with bone-supported guides. This study aimed to modify the fabrication of tooth-supported guides for compatibility with tumor resection procedures and investigate their accuracy. METHODS Patients with tumors who underwent osteotomy with the assistance of modified tooth- or bone-supported surgical guides were included. Virtual surgical planning (VSP) was employed to align three dimensional (3D) models extracted from intraoperative computed tomography (CT) images. The distances and angular deviations between the actual osteotomy plane and preoperative plane were recorded. A comparative analysis of osteotomy discrepancies between tooth-supported and bone-supported guides, as well as among tooth-supported guides based on CT, cone-beam CT (CBCT), or intraoral scanner (IOS) was conducted. The factors influencing the precision of the guides were analyzed. RESULTS Sixty patients with 81 resection planes were included in this study. In the tooth-supported group, the mean deviations in the osteotomy plane and angle were 1.39 mm and 4.30°, respectively, whereas those of the bone-supported group were 2.16 mm and 4.95°. In the tooth-supported isotype guide groups, the mean deviations of the osteotomy plane were 1.39 mm, 1.47 mm, 1.23 mm across CT, CBCT, and IOS, respectively. The accuracy of the modified tooth-supported guides remained consistent regardless of number and position of the teeth supporting the guide and location of the osteotomy lines. CONCLUSIONS The findings indicate that the modified tooth-supported surgical guides demonstrated high accuracy in the maxillofacial region, contributing to a reduction in the amount of surgically detached soft tissue.
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Affiliation(s)
- Zezhao Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Yiwei Zhong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Xiaoming Lyu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Mingwei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Shuming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China.
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Morris JM, Wentworth A, Houdek MT, Karim SM, Clarke MJ, Daniels DJ, Rose PS. The Role of 3D Printing in Treatment Planning of Spine and Sacral Tumors. Neuroimaging Clin N Am 2023; 33:507-529. [PMID: 37356866 DOI: 10.1016/j.nic.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Three-dimensional (3D) printing technology has proven to have many advantages in spine and sacrum surgery. 3D printing allows the manufacturing of life-size patient-specific anatomic and pathologic models to improve preoperative understanding of patient anatomy and pathology. Additionally, virtual surgical planning using medical computer-aided design software has enabled surgeons to create patient-specific surgical plans and simulate procedures in a virtual environment. This has resulted in reduced operative times, decreased complications, and improved patient outcomes. Combined with new surgical techniques, 3D-printed custom medical devices and instruments using titanium and biocompatible resins and polyamides have allowed innovative reconstructions.
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Affiliation(s)
- Jonathan M Morris
- Division of Neuroradiology, Department of Radiology, Anatomic Modeling Unit, Biomedical and Scientific Visualization, Mayo Clinic, 200 1st Street, Southwest, Rochester, MN, 55905, USA.
| | - Adam Wentworth
- Department of Radiology, Anatomic Modeling Unit, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - S Mohammed Karim
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Peter S Rose
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Afaq S, Jain S, Sharma N, Sharma S. Acquisition of Precision and Reliability of Modalities for Facial Reconstruction and Aesthetic Surgery: A Systematic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S849-S855. [PMID: 37694018 PMCID: PMC10485431 DOI: 10.4103/jpbs.jpbs_242_23] [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: 03/12/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 09/12/2023] Open
Abstract
The foundation of reconstructive and cosmetic surgery is a confluence of advanced technologies, plethora of procedures, inventive modifications, and planned strategies. In surgical planning, the most crucial steps for treating a patient are evaluating the facial morphometry and recognizing the deviations from the baseline values of facial parameters. Various imaging and non-imaging modalities and sub-modalities contribute to diagnosis, treatment planning, and follow-up care. These techniques are an important milestone of pre-, peri-, and postoperative care in facial reconstruction. The current research aims to comprehensively explain imaging and non-imaging technologies encompassing both innovative and traditional approaches in facial reconstruction. PubMed, Scopus, and Web of Science were searched from 1990 to 2022, and systematic review was conducted in accordance with the PRISMA recommendations. Undoubtedly, various factors impact the selection of facial analysis acquisition approaches and their prospective. The surgical team must understand such modalities' potential for diagnosis and treatment. The evolution of three-dimensional imaging has been fueled because of the need for devices with high speed, small size, and several functions. Automation with more efficiency and precision is the way of the future for three-dimensional imaging. Stereophotogrammetry can clearly quantify the field of facial analysis. All the publications under consideration came to the same conclusion: Canfield's Vectra three-dimensional imaging devices can provide accurate, repeatable stereophotogrammetric pictures. Although a few minor mistakes were recorded, most examined devices are deemed reliable and accurate tools for Plastic surgeons.
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Affiliation(s)
- Shehzeen Afaq
- Department of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - S.K. Jain
- Department of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Nidhi Sharma
- Department of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Sonika Sharma
- Department of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
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An unsolved dilemma in the reliability of virtual planning in mandibular reconstruction surgery: Short communication. Oral Oncol 2023; 138:106334. [PMID: 36753905 DOI: 10.1016/j.oraloncology.2023.106334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/08/2023]
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7
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Peng X, Acero J, Yu GY. Application and prospects of computer-assisted surgery in oral and maxillofacial oncology. Sci Bull (Beijing) 2023; 68:236-239. [PMID: 36710150 DOI: 10.1016/j.scib.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Julio Acero
- Department of Oral and Maxillofacial Surgery, Ramón y Cajal and Puerta de Hierro University Hospitals, University of Alcala, Ramón y Cajal Research Institute (IRYCIS), Madrid 28034, Spain.
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
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Hu LH, Zhang WB, Yu Y, Sun ZP, Yu GY, Peng X. Factors influencing the accuracy of multimodal image fusion for oral and maxillofacial tumors: a retrospective study. BMC Oral Health 2022; 22:659. [PMID: 36585636 PMCID: PMC9805252 DOI: 10.1186/s12903-022-02679-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Ensuring high accuracy in multimodal image fusion for oral and maxillofacial tumors is crucial before further application. The aim of this study was to explore the factors influencing the accuracy of multimodal image fusion for oral and maxillofacial tumors. METHODS Pairs of single-modality images were obtained from oral and maxillofacial tumor patients, and were fused using a proprietary navigation system by using three algorithms (automatic fusion, manual fusion, and registration point-based fusion). Fusion accuracy was evaluated including two aspects-overall fusion accuracy and tumor volume fusion accuracy-and were indicated by mean deviation and fusion index, respectively. Image modality, fusion algorithm, and other characteristics of multimodal images that may have potential influence on fusion accuracy were recorded. Univariate and multivariate analysis were used to identify relevant affecting factors. RESULTS Ninety-three multimodal images were generated by fusing 31 pairs of single-modality images. The interaction effect of image modality and fusion algorithm (P = 0.02, P = 0.003) and thinner slice thickness (P = 0.006) were shown to significantly influence the overall fusion accuracy. The tumor volume (P < 0.001), tumor location (P = 0.007), and image modality (P = 0.01) were significant influencing factors for tumor volume fusion accuracy. CONCLUSIONS To ensure high overall fusion accuracy, manual fusion was not preferred in CT/MRI image fusion, and neither was automatic fusion in image fusion containing PET modality. Using image sets with thinner slice thickness could increase overall fusion accuracy. CT/MRI fusion yielded higher tumor volume fusion accuracy than fusion containing PET modality. The tumor volume fusion accuracy should be taken into consideration during image fusion when the tumor volume is small and the tumor is located in the mandible.
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Affiliation(s)
- Lei-Hao Hu
- grid.11135.370000 0001 2256 9319Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No.22, Zhongguancun South Avenue, Haidian District, Beijing, People’s Republic of China
| | - Wen-Bo Zhang
- grid.11135.370000 0001 2256 9319Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No.22, Zhongguancun South Avenue, Haidian District, Beijing, People’s Republic of China
| | - Yao Yu
- grid.11135.370000 0001 2256 9319Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No.22, Zhongguancun South Avenue, Haidian District, Beijing, People’s Republic of China
| | - Zhi-Peng Sun
- grid.11135.370000 0001 2256 9319Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Haidian District, Beijing, People’s Republic of China
| | - Guang-Yan Yu
- grid.11135.370000 0001 2256 9319Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No.22, Zhongguancun South Avenue, Haidian District, Beijing, People’s Republic of China
| | - Xin Peng
- grid.11135.370000 0001 2256 9319Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No.22, Zhongguancun South Avenue, Haidian District, Beijing, People’s Republic of China
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Establishing a Point-of-Care Virtual Planning and 3D Printing Program. Semin Plast Surg 2022; 36:133-148. [PMID: 36506280 PMCID: PMC9729064 DOI: 10.1055/s-0042-1754351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Virtual surgical planning (VSP) and three-dimensional (3D) printing have become a standard of care at our institution, transforming the surgical care of complex patients. Patient-specific, anatomic models and surgical guides are clinically used to improve multidisciplinary communication, presurgical planning, intraoperative guidance, and the patient informed consent. Recent innovations have allowed both VSP and 3D printing to become more accessible to various sized hospital systems. Insourcing such work has several advantages including quicker turnaround times and increased innovation through collaborative multidisciplinary teams. Centralizing 3D printing programs at the point-of-care provides a greater cost-efficient investment for institutions. The following article will detail capital equipment needs, institutional structure, operational personnel, and other considerations necessary in the establishment of a POC manufacturing program.
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Surgical Margins in 3D Planned Mandibular Resections for Squamous Cell Carcinomas of the Oral Cavity. J Craniofac Surg 2022; 34:e225-e228. [PMID: 36730970 DOI: 10.1097/scs.0000000000009068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/14/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Three-dimensional (3D) planned mandibular resections using cutting guides and preplanned plates are now widely used in oncological surgery. The main advantages are the gain of time, precision, and esthetic outcomes. The drawbacks include costs, time for planning, and printing the surgical tools. This time between the radiological data and the surgery may allow tumor progression, rendering the custom-made guides useless. There is no consensus regarding surgical margins that should be planned to ensure a safe oncologic outcome. The purpose of this retrospective study is to evaluate if the planned bony margins are adequate. MATERIALS AND METHODS Inclusion criteria were: Squamous cell carcinomas of the anterior and lateral floor of mouth with mandibular invasion (T4); mandibular resection using 3D planning and cutting guides. Between June 2015 to December 2019, 16 patients met the criteria. The time between the planning and the surgery was recorded. The authors decided to use a margin of at least 1 cm on the preoperative computerized tomography scans on each side of the tumors in our planning for all patients. The authors then measured the distance of the bone resection on the pathological specimen. RESULTS All 16 patients had safe bone surgical margins (R0). The average time from the scanners used for the planning to the surgery was 33 days. DISCUSSION All the cutting guides could be used. The pathology examination showed safe oncological margins and no patients required further resection. A 1 cm margin during 3D planning for mandibular resections with 3D printed cutting guides, in patients with T4 Squamous Cell Carcinomas can therefore be considered safe.
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Advances and Innovations in Ablative Head and Neck Oncologic Surgery Using Mixed Reality Technologies in Personalized Medicine. J Clin Med 2022; 11:jcm11164767. [PMID: 36013006 PMCID: PMC9410374 DOI: 10.3390/jcm11164767] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
The benefit of computer-assisted planning in head and neck ablative and reconstructive surgery has been extensively documented over the last decade. This approach has been proven to offer a more secure surgical procedure. In the treatment of cancer of the head and neck, computer-assisted surgery can be used to visualize and estimate the location and extent of the tumor mass. Nowadays, some software tools even allow the visualization of the structures of interest in a mixed reality environment. However, the precise integration of mixed reality systems into a daily clinical routine is still a challenge. To date, this technology is not yet fully integrated into clinical settings such as the tumor board, surgical planning for head and neck tumors, or medical and surgical education. As a consequence, the handling of these systems is still of an experimental nature, and decision-making based on the presented data is not yet widely used. The aim of this paper is to present a novel, user-friendly 3D planning and mixed reality software and its potential application for ablative and reconstructive head and neck surgery.
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Vosselman N, Glas HH, Merema BJ, Kraeima J, Reintsema H, Raghoebar GM, Witjes MJH, de Visscher SAHJ. Three-Dimensional Guided Zygomatic Implant Placement after Maxillectomy. J Pers Med 2022; 12:jpm12040588. [PMID: 35455704 PMCID: PMC9027393 DOI: 10.3390/jpm12040588] [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: 03/09/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 12/27/2022] Open
Abstract
Zygomatic implants are used in patients with maxillary defects to improve the retention and stability of obturator prostheses, thereby securing good oral function. Prosthetic-driven placement of zygomatic implants is even difficult for experienced surgeons, and with a free-hand approach, deviation from the preplanned implant positions is inevitable, thereby impeding immediate implant-retained obturation. A novel, digitalized workflow of surgical planning was used in 10 patients. Maxillectomy was performed with 3D-printed cutting, and drill guides were used for subsequent placement of zygomatic implants with immediate placement of implant-retained obturator prosthesis. The outcome parameters were the accuracy of implant positioning and the prosthetic fit of the obturator prosthesis in this one-stage procedure. Zygomatic implants (n = 28) were placed with good accuracy (mean deviation 1.73 ± 0.57 mm and 2.97 ± 1.38° 3D angle deviation), and in all cases, the obturator prosthesis fitted as pre-operatively planned. The 3D accuracy of the abutment positions was 1.58 ± 1.66 mm. The accuracy of the abutment position in the occlusal plane was 2.21 ± 1.33 mm, with a height accuracy of 1.32 ± 1.57 mm. This feasibility study shows that the application of these novel designed 3D-printed surgical guides results in predictable zygomatic implant placement and provides the possibility of immediate prosthetic rehabilitation in head and neck oncology patients after maxillectomy.
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Dowgierd K, Pokrowiecki R, Wolanski W, Kawlewska E, Kozakiewicz M, Wos J, Dowgierd M, Krakowczyk Ł. Analysis of the effects of mandibular reconstruction based on microvascular free flaps after oncological resections in 21 patients, using 3D planning, surgical templates and individual implants. Oral Oncol 2022; 127:105800. [DOI: 10.1016/j.oraloncology.2022.105800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/05/2022] [Accepted: 02/26/2022] [Indexed: 10/18/2022]
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Wang Y, Qu X, Jiang J, Sun J, Zhang C, He Y. Aesthetical and Accuracy Outcomes of Reconstruction of Maxillary Defect by 3D Virtual Surgical Planning. Front Oncol 2021; 11:718946. [PMID: 34737946 PMCID: PMC8560731 DOI: 10.3389/fonc.2021.718946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Reconstruction of maxillary defect resulting from trauma or oncology surgery is of great importance for patients with physical and psychological complications. The virtual surgical planning (VSP) and 3D printing technics had been used in recent years which simplified the surgical procedure and promoted success and accuracy. To assess the accuracy and outcome of VSP surgery, here we report our experience in maxillary reconstruction retrospectively. Method Patients who received maxillary defect reconstruction from 2013 to 2020 were analyzed retrospectively. These patients were divided into two groups. Group 1 received VSP and 3D printed guiding plates in the surgery, while group 2 underwent free-hand surgery (FHS). Patients with different vertical and horizontal defects were classified according to Brown and Shaw classification. Clinical information and postoperative complications of all patients were collected. For patients with unilateral maxillary defect, orbit volume, orbit height, and the contour of the reconstructed side were compared with the normal side. Result Thirty-four patients who achieved the criteria were analyzed, of which 20 patients underwent VSP surgery. There were primary and secondary reconstruction cases in both two groups. Vascularized iliac crest flap was used in three cases, and fibula flap was performed in the other cases. One flap collapse occurred in FHS group. Seven patients in VSP group received dental implants, while the number in FHS group was 0. In vertical class III cases, the differences in orbit height (ΔD) and orbit volume (ΔV) between normal side and reconstructed side were measured and compared in the two groups. The mean ΔD is 1.78 ± 1.33 mm in VSP group and 4.25 ± 0.95 mm in FHS group, while the mean ΔV is 2.04 ± 0.85 cm3 in VSP group and 3.25 ± 0.17 cm3 in FHS group. The alterations of orbit height and volume in VSP group were much smaller than that in FHS group with statistical significance. From the perspective of aesthetics, the color-gradient map indicates a more symmetric and smoother curve of post-operation appearance in VSP group. Conclusion Compared with traditional free-hand surgical technics, VSP and 3D printing guiding plates can allow for a more accurate maxillary reconstruction with improved aesthetics.
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Affiliation(s)
- Yang Wang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xingzhou Qu
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Junjian Jiang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jian Sun
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chenping Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yue He
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
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15
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Phan PK, Vo ATN, Bakhtiarydavijani A, Burch R, Smith B, Ball JE, Chander H, Knight A, Prabhu RK. In Silico Finite Element Analysis of the Foot Ankle Complex Biomechanics: A Literature Review. J Biomech Eng 2021; 143:090802. [PMID: 33764401 DOI: 10.1115/1.4050667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 11/08/2022]
Abstract
Computational approaches, especially finite element analysis (FEA), have been rapidly growing in both academia and industry during the last few decades. FEA serves as a powerful and efficient approach for simulating real-life experiments, including industrial product development, machine design, and biomedical research, particularly in biomechanics and biomaterials. Accordingly, FEA has been a "go-to" high biofidelic software tool to simulate and quantify the biomechanics of the foot-ankle complex, as well as to predict the risk of foot and ankle injuries, which are one of the most common musculoskeletal injuries among physically active individuals. This paper provides a review of the in silico FEA of the foot-ankle complex. First, a brief history of computational modeling methods and finite element (FE) simulations for foot-ankle models is introduced. Second, a general approach to build an FE foot and ankle model is presented, including a detailed procedure to accurately construct, calibrate, verify, and validate an FE model in its appropriate simulation environment. Third, current applications, as well as future improvements of the foot and ankle FE models, especially in the biomedical field, are discussed. Finally, a conclusion is made on the efficiency and development of FEA as a computational approach in investigating the biomechanics of the foot-ankle complex. Overall, this review integrates insightful information for biomedical engineers, medical professionals, and researchers to conduct more accurate research on the foot-ankle FE models in the future.
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Affiliation(s)
- P K Phan
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi, MS 39762; Center of Advanced Vehicular System (CAVS), Mississippi State University, Mississippi, MS 39762
| | - A T N Vo
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi, MS 39762; Center of Advanced Vehicular System (CAVS), Mississippi State University, Mississippi, MS 39762
| | - A Bakhtiarydavijani
- Center of Advanced Vehicular System (CAVS), Mississippi State University, Mississippi, MS 39762
| | - R Burch
- Center of Advanced Vehicular System (CAVS), Mississippi State University, Mississippi, MS 39762; Department of Industrial and Systems Engineering, Mississippi State University, Mississippi, MS 39762
| | - B Smith
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi, MS 39762
| | - J E Ball
- Department of Electrical and Computer Engineering, Mississippi State University, Mississippi, MS 39762
| | - H Chander
- Department of Kinesiology, Mississippi State University, Mississippi, MS 39762
| | - A Knight
- Department of Kinesiology, Mississippi State University, Mississippi, MS 39762
| | - R K Prabhu
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi, MS 39762; Center of Advanced Vehicular System (CAVS), Mississippi State University, Mississippi, MS 39762
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16
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Qiu B, van der Wel H, Kraeima J, Glas HH, Guo J, Borra RJH, Witjes MJH, van Ooijen PMA. Automatic Segmentation of Mandible from Conventional Methods to Deep Learning-A Review. J Pers Med 2021; 11:629. [PMID: 34357096 PMCID: PMC8307673 DOI: 10.3390/jpm11070629] [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: 05/28/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/05/2023] Open
Abstract
Medical imaging techniques, such as (cone beam) computed tomography and magnetic resonance imaging, have proven to be a valuable component for oral and maxillofacial surgery (OMFS). Accurate segmentation of the mandible from head and neck (H&N) scans is an important step in order to build a personalized 3D digital mandible model for 3D printing and treatment planning of OMFS. Segmented mandible structures are used to effectively visualize the mandible volumes and to evaluate particular mandible properties quantitatively. However, mandible segmentation is always challenging for both clinicians and researchers, due to complex structures and higher attenuation materials, such as teeth (filling) or metal implants that easily lead to high noise and strong artifacts during scanning. Moreover, the size and shape of the mandible vary to a large extent between individuals. Therefore, mandible segmentation is a tedious and time-consuming task and requires adequate training to be performed properly. With the advancement of computer vision approaches, researchers have developed several algorithms to automatically segment the mandible during the last two decades. The objective of this review was to present the available fully (semi)automatic segmentation methods of the mandible published in different scientific articles. This review provides a vivid description of the scientific advancements to clinicians and researchers in this field to help develop novel automatic methods for clinical applications.
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Affiliation(s)
- Bingjiang Qiu
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Hylke van der Wel
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Haye Hendrik Glas
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jiapan Guo
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Ronald J. H. Borra
- Medical Imaging Center (MIC), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Max Johannes Hendrikus Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Peter M. A. van Ooijen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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17
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Qiu B, Guo J, Kraeima J, Glas HH, Zhang W, Borra RJH, Witjes MJH, van Ooijen PMA. Recurrent Convolutional Neural Networks for 3D Mandible Segmentation in Computed Tomography. J Pers Med 2021; 11:jpm11060492. [PMID: 34072714 PMCID: PMC8229770 DOI: 10.3390/jpm11060492] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: Classic encoder–decoder-based convolutional neural network (EDCNN) approaches cannot accurately segment detailed anatomical structures of the mandible in computed tomography (CT), for instance, condyles and coronoids of the mandible, which are often affected by noise and metal artifacts. The main reason is that EDCNN approaches ignore the anatomical connectivity of the organs. In this paper, we propose a novel CNN-based 3D mandible segmentation approach that has the ability to accurately segment detailed anatomical structures. Methods: Different from the classic EDCNNs that need to slice or crop the whole CT scan into 2D slices or 3D patches during the segmentation process, our proposed approach can perform mandible segmentation on complete 3D CT scans. The proposed method, namely, RCNNSeg, adopts the structure of the recurrent neural networks to form a directed acyclic graph in order to enable recurrent connections between adjacent nodes to retain their connectivity. Each node then functions as a classic EDCNN to segment a single slice in the CT scan. Our proposed approach can perform 3D mandible segmentation on sequential data of any varied lengths and does not require a large computation cost. The proposed RCNNSeg was evaluated on 109 head and neck CT scans from a local dataset and 40 scans from the PDDCA public dataset. The final accuracy of the proposed RCNNSeg was evaluated by calculating the Dice similarity coefficient (DSC), average symmetric surface distance (ASD), and 95% Hausdorff distance (95HD) between the reference standard and the automated segmentation. Results: The proposed RCNNSeg outperforms the EDCNN-based approaches on both datasets and yields superior quantitative and qualitative performances when compared to the state-of-the-art approaches on the PDDCA dataset. The proposed RCNNSeg generated the most accurate segmentations with an average DSC of 97.48%, ASD of 0.2170 mm, and 95HD of 2.6562 mm on 109 CT scans, and an average DSC of 95.10%, ASD of 0.1367 mm, and 95HD of 1.3560 mm on the PDDCA dataset. Conclusions: The proposed RCNNSeg method generated more accurate automated segmentations than those of the other classic EDCNN segmentation techniques in terms of quantitative and qualitative evaluation. The proposed RCNNSeg has potential for automatic mandible segmentation by learning spatially structured information.
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Affiliation(s)
- Bingjiang Qiu
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (B.Q.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Jiapan Guo
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
- Correspondence:
| | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (B.Q.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Haye Hendrik Glas
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (B.Q.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Weichuan Zhang
- Institute for Integrated and Intelligent System, Griffith University, Nathan, QLD 4111, Australia;
- CSIRO Data61, Epping, NSW 1710, Australia
| | - Ronald J. H. Borra
- Medical Imaging Center (MIC), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
| | - Max Johannes Hendrikus Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (B.Q.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Peter M. A. van Ooijen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
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18
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Glas HH, Kraeima J, van Ooijen PMA, Spijkervet FKL, Yu L, Witjes MJH. Augmented Reality Visualization for Image-Guided Surgery: A Validation Study Using a Three-Dimensional Printed Phantom. J Oral Maxillofac Surg 2021; 79:1943.e1-1943.e10. [PMID: 34033801 DOI: 10.1016/j.joms.2021.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Oral and maxillofacial surgery currently relies on virtual surgery planning based on image data (CT, MRI). Three-dimensional (3D) visualizations are typically used to plan and predict the outcome of complex surgical procedures. To translate the virtual surgical plan to the operating room, it is either converted into physical 3D-printed guides or directly translated using real-time navigation systems. PURPOSE This study aims to improve the translation of the virtual surgery plan to a surgical procedure, such as oncologic or trauma surgery, in terms of accuracy and speed. Here we report an augmented reality visualization technique for image-guided surgery. It describes how surgeons can visualize and interact with the virtual surgery plan and navigation data while in the operating room. The user friendliness and usability is objectified by a formal user study that compared our augmented reality assisted technique to the gold standard setup of a perioperative navigation system (Brainlab). Moreover, accuracy of typical navigation tasks as reaching landmarks and following trajectories is compared. RESULTS Overall completion time of navigation tasks was 1.71 times faster using augmented reality (P = .034). Accuracy improved significantly using augmented reality (P < .001), for reaching physical landmarks a less strong correlation was found (P = .087). Although the participants were relatively unfamiliar with VR/AR (rated 2.25/5) and gesture-based interaction (rated 2/5), they reported that navigation tasks become easier to perform using augmented reality (difficulty Brainlab rated 3.25/5, HoloLens 2.4/5). CONCLUSION The proposed workflow can be used in a wide range of image-guided surgery procedures as an addition to existing verified image guidance systems. Results of this user study imply that our technique enables typical navigation tasks to be performed faster and more accurately compared to the current gold standard. In addition, qualitative feedback on our augmented reality assisted technique was more positive compared to the standard setup.?>.
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Affiliation(s)
- H H Glas
- Technical Physician, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - J Kraeima
- Technical Physician, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P M A van Ooijen
- Associate Professor Faculty of Medical Sciences, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F K L Spijkervet
- Professor, Oral and Maxillofacial Surgeon, Head of the Department, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Yu
- Lecturer in the Department of Computer Science and Software Engineering (CSSE), Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J H Witjes
- Oral and Maxillofacial Surgeon, Principal Investigator, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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19
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Barroso EM, Aaboubout Y, van der Sar LC, Mast H, Sewnaik A, Hardillo JA, Ten Hove I, Nunes Soares MR, Ottevanger L, Bakker Schut TC, Puppels GJ, Koljenović S. Performance of Intraoperative Assessment of Resection Margins in Oral Cancer Surgery: A Review of Literature. Front Oncol 2021; 11:628297. [PMID: 33869013 PMCID: PMC8044914 DOI: 10.3389/fonc.2021.628297] [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: 11/11/2020] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Achieving adequate resection margins during oral cancer surgery is important to improve patient prognosis. Surgeons have the delicate task of achieving an adequate resection and safeguarding satisfactory remaining function and acceptable physical appearance, while relying on visual inspection, palpation, and preoperative imaging. Intraoperative assessment of resection margins (IOARM) is a multidisciplinary effort, which can guide towards adequate resections. Different forms of IOARM are currently used, but it is unknown how accurate these methods are in predicting margin status. Therefore, this review aims to investigate: 1) the IOARM methods currently used during oral cancer surgery, 2) their performance, and 3) their clinical relevance. Methods A literature search was performed in the following databases: Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar (from inception to January 23, 2020). IOARM performance was assessed in terms of accuracy, sensitivity, and specificity in predicting margin status, and the reduction of inadequate margins. Clinical relevance (i.e., overall survival, local recurrence, regional recurrence, local recurrence-free survival, disease-specific survival, adjuvant therapy) was recorded if available. Results Eighteen studies were included in the review, of which 10 for soft tissue and 8 for bone. For soft tissue, defect-driven IOARM-studies showed the average accuracy, sensitivity, and specificity of 90.9%, 47.6%, and 84.4%, and specimen-driven IOARM-studies showed, 91.5%, 68.4%, and 96.7%, respectively. For bone, specimen-driven IOARM-studies performed better than defect-driven, with an average accuracy, sensitivity, and specificity of 96.6%, 81.8%, and 98%, respectively. For both, soft tissue and bone, IOARM positively impacts patient outcome. Conclusion IOARM improves margin-status, especially the specimen-driven IOARM has higher performance compared to defect-driven IOARM. However, this conclusion is limited by the low number of studies reporting performance results for defect-driven IOARM. The current methods suffer from inherent disadvantages, namely their subjective character and the fact that only a small part of the resection surface can be assessed in a short time span, causing sampling errors. Therefore, a solution should be sought in the field of objective techniques that can rapidly assess the whole resection surface.
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Affiliation(s)
- Elisa M Barroso
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Yassine Aaboubout
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lisette C van der Sar
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jose A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ivo Ten Hove
- Department of Oral and Maxillofacial Surgery, Leiden UMC, Leiden University Medical Center, Leiden, Netherlands
| | - Maria R Nunes Soares
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lars Ottevanger
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Tom C Bakker Schut
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Gerwin J Puppels
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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20
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Niu J, Qin X, Bai J, Li H. Reconstruction and optimization of the 3D geometric anatomy structure model for subject-specific human knee joint based on CT and MRI images. Technol Health Care 2021; 29:221-238. [PMID: 33682761 PMCID: PMC8150550 DOI: 10.3233/thc-218022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Nowadays, the total knee arthroplasty (TKA) technique plays an important role in surgical treatment for patients with severe knee osteoarthritis (OA). However, there are still several key issues such as promotion of osteotomy accuracy and prosthesis matching degree that need to be addressed. OBJECTIVE: It is significant to construct an accurate three-dimensional (3D) geometric anatomy structure model of subject-specific human knee joint with major bone and soft tissue structures, which greatly contributes to obtaining personalized osteotomy guide plate and suitable size of prosthesis. METHODS: Considering different soft tissue structures, magnetic resonance imaging (MRI) scanning sequences involving two-dimensional (2D) spin echo (SE) sequence T1 weighted image (T1WI) and 3D SE sequence T2 weighted image (T2WI) fat suppression (FS) are selected. A 3D modeling methodology based on computed tomography (CT) and two sets of MRI images is proposed. RESULTS: According to the proposed methods of image segmentation and 3D model registration, a novel 3D knee joint model with high accuracy is finally constructed. Furthermore, remeshing is used to optimize the established model by adjusting the relevant parameters. CONCLUSIONS: The modeling results demonstrate that reconstruction and optimization model of 3D knee joint can clearly and accurately reflect the key characteristics, including anatomical structure and geometric morphology for each component.
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Affiliation(s)
- Junlong Niu
- School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, Shaanxi 710072, China
| | - Xiansheng Qin
- School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, Shaanxi 710072, China
| | - Jing Bai
- School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, Shaanxi 710072, China
| | - Haiyan Li
- Department of Magnetic Resonance Imaging, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710054, China
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21
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Polfliet M, Hendriks MS, Guyader JM, Ten Hove I, Mast H, Vandemeulebroucke J, van der Lugt A, Wolvius EB, Klein S. Registration of magnetic resonance and computed tomography images in patients with oral squamous cell carcinoma for three-dimensional virtual planning of mandibular resection and reconstruction. Int J Oral Maxillofac Surg 2021; 50:1386-1393. [PMID: 33551174 DOI: 10.1016/j.ijom.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/29/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022]
Abstract
The aim of this study was to evaluate and present an automated method for registration of magnetic resonance imaging (MRI) and computed tomography (CT) or cone beam CT (CBCT) images of the mandibular region for patients with oral squamous cell carcinoma (OSCC). Registered MRI and (CB)CT could facilitate the three-dimensional virtual planning of surgical guides employed for resection and reconstruction in patients with OSCC with mandibular invasion. MRI and (CB)CT images were collected retrospectively from 19 patients. MRI images were aligned with (CB)CT images employing a rigid registration approach (stage 1), a rigid registration approach using a mandibular mask (stage 2), and two non-rigid registration approaches (stage 3). Registration accuracy was quantified by the mean target registration error (mTRE), calculated over a set of landmarks annotated by two observers. Stage 2 achieved the best registration result, with an mTRE of 2.5±0.7mm, which was comparable to the inter- and intra-observer variabilities of landmark placement in MRI. Stage 2 was significantly better aligned compared to all approaches in stage 3. In conclusion, this study demonstrated that rigid registration with the use of a mask is an appropriate image registration method for aligning MRI and (CB)CT images of the mandibular region in patients with OSCC.
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Affiliation(s)
- M Polfliet
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium; imec, Leuven, Belgium; Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M S Hendriks
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J-M Guyader
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands; LabISEN - Yncréa Ouest, Brest, France
| | - I Ten Hove
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Mast
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium; imec, Leuven, Belgium
| | - A van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S Klein
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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22
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Barry CP, MacDhabheid C, Tobin K, Stassen LF, Lennon P, Toner M, O'Regan E, Clark JR. 'Out of house' virtual surgical planning for mandible reconstruction after cancer resection: is it oncologically safe? Int J Oral Maxillofac Surg 2020; 50:999-1002. [PMID: 33317906 DOI: 10.1016/j.ijom.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/14/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate whether the time delay between 'out of house' proprietary virtual surgical planning (OH-VSP) of the mandibular resection for oral cancer and the actual surgery results in compromised margins and oncological disadvantage for the patient. Outcomes of patients who had OH-VSP of their mandibular resection and reconstruction were compared with those of patients who had the same surgery using a conventional non-VSP approach. The groups were similar in patient demographics, tumour stage and size, nodal status, and reconstruction complexity. VSP resulted in a significant reduction in operating time (P<0.01). VSP did not affect bony (P=0.49) or soft tissue (P=0.22) margin status. In summary, VSP reduced the operating theatre time, and despite the time interval between bony resection planning and surgery, there was no compromise to the oncological safety of the operation.
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Affiliation(s)
- C P Barry
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland; School of Dental Science, Trinity College, Dublin, Ireland.
| | - C MacDhabheid
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland
| | - K Tobin
- School of Medicine, Trinity College, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland
| | - L F Stassen
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - P Lennon
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - M Toner
- School of Dental Science, Trinity College, Dublin, Ireland; Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - E O'Regan
- School of Medicine, Trinity College, Dublin, Ireland; Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - J R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
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Tarassoli SP, Shield ME, Allen RS, Jessop ZM, Dobbs TD, Whitaker IS. Facial Reconstruction: A Systematic Review of Current Image Acquisition and Processing Techniques. Front Surg 2020; 7:537616. [PMID: 33365327 PMCID: PMC7750399 DOI: 10.3389/fsurg.2020.537616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/19/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction: Plastic and reconstructive surgery is based on a culmination of technological advances, diverse techniques, creative adaptations and strategic planning. 3D imaging is a modality that encompasses several of these criteria while encouraging the others. Imaging techniques used in facial imaging come in many different modalities and sub-modalities which is imperative for such a complex area of the body; there is a clear clinical need for hyper-specialized practice. However, with this complexity comes variability and thus there will always be an element of bias in the choices made for imaging techniques. Aims and Objectives: The aim of this review is to systematically analyse the imaging techniques used in facial reconstruction and produce a comprehensive summary and comparison of imaging techniques currently available, including both traditional and novel methods. Methods: The systematic search was performed on EMBASE, PubMed, Scopus, Web of Science and Cochrane reviews using keywords such as "image technique/acquisition/processing," "3-Dimensional," "Facial," and "Reconstruction." The PRISMA guidelines were used to carry out the systematic review. Studies were then subsequently collected and collated; followed by a screening and exclusion process with a final full-text review for further clarification in regard to the selection criteria. A risk of bias assessment was also carried out on each study systematically using the respective tool in relation to the study in question. Results: From the initial 6,147 studies, 75 were deemed to fulfill all selection criteria and selected for meta-analysis. The majority of papers involved the use of computer tomography, though the use of magnetic resonance and handheld scanners using sonography have become more common in the field. The studies ranged in patient population, clinical indication. Seminal papers were highlighted within the group of papers for further analysis. Conclusions: There are clearly many factors that affect the choice of image acquisition techniques and their potential at being ideal for a given role. Ultimately the surgical team's choice will guide much of the decision, but it is crucial to be aware of not just the diagnostic ability of such modalities, but their treatment possibilities as well.
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Affiliation(s)
- Sam P. Tarassoli
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Matthew E. Shield
- College of Medicine, Swansea University Medical School, Swansea, United Kingdom
| | - Rhian S. Allen
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Zita M. Jessop
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Thomas D. Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Iain S. Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Swansea University Medical School, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
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The use of 3D virtual surgical planning and computer aided design in reconstruction of maxillary surgical defects. Curr Opin Otolaryngol Head Neck Surg 2020; 28:122-128. [PMID: 32102008 DOI: 10.1097/moo.0000000000000618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The present review describes the latest development of 3D virtual surgical planning (VSP) and computer aided design (CAD) for reconstruction of maxillary defects with an aim of fully prosthetic rehabilitation. The purpose is to give an overview of different methods that use CAD in maxillary reconstruction in patients with head and neck cancer. RECENT FINDINGS 3D VSP enables preoperative planning of resection margins and osteotomies. The current 3D VSP workflow is expanded with multimodal imaging, merging decision supportive information. Development of more personalized implants is possible using CAD, individualized virtual muscle modelling and topology optimization. Meanwhile the translation of the 3D VSP towards surgery is improved by techniques like intraoperative imaging and augmented reality. Recent improvements of preoperative 3D VSP enables surgical reconstruction and/or prosthetic rehabilitation of the surgical defect in one combined procedure. SUMMARY With the use of 3D VSP and CAD, ablation surgery, reconstructive surgery, and prosthetic rehabilitation can be planned preoperatively. Many reconstruction possibilities exist and a choice depends on patient characteristics, tumour location and experience of the surgeon. The overall objective in patients with maxillary defects is to follow a prosthetic-driven reconstruction with the aim to restore facial form, oral function, and do so in accordance with the individual needs of the patient.
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Kraeima J, Glas HH, Merema BBJ, Vissink A, Spijkervet FKL, Witjes MJH. Three-dimensional virtual surgical planning in the oncologic treatment of the mandible. Oral Dis 2020; 27:14-20. [PMID: 32881177 DOI: 10.1111/odi.13631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/30/2020] [Accepted: 08/22/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In case of surgical removal of oral squamous cell carcinomas, a resection of mandibular bone is frequently part of the treatment. Nowadays, such resections frequently include the application of 3D virtual surgical planning (VSP) and guided surgery techniques. In this paper, current methods for 3D VSP leads for optimisation of the workflow, and patient-specific application of guides and implants are reviewed. RECENT FINDINGS Current methods for 3D VSP enable multi-modality fusion of images. This fusion of images is not restricted to a specific software package or workflow. New strategies for 3D VSP in Oral and Maxillofacial Surgery include finite element analysis, deep learning and advanced augmented reality techniques. These strategies aim to improve the treatment in terms of accuracy, predictability and safety. CONCLUSIONS Application of the discussed novel technologies and strategies will improve the accuracy and safety of mandibular resection and reconstruction planning. Accurate, easy-to-use, safe and efficient three-dimensional VSP can be applied for every patient with malignancies needing resection of the mandible.
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Affiliation(s)
- Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Haye H Glas
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bram Barteld Jan Merema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Timonen T, Iso-Mustajärvi M, Linder P, Lehtimäki A, Löppönen H, Elomaa AP, Dietz A. Virtual reality improves the accuracy of simulated preoperative planning in temporal bones: a feasibility and validation study. Eur Arch Otorhinolaryngol 2020; 278:2795-2806. [PMID: 32964264 PMCID: PMC8266780 DOI: 10.1007/s00405-020-06360-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Consumer-grade virtual reality (VR) has recently enabled various medical applications, but more evidence supporting their validity is needed. We investigated the accuracy of simulated surgical planning in a VR environment (VR) with temporal bones and compared it to conventional cross-sectional image viewing in picture archiving and communication system (PACS) interface. METHODS Five experienced otologic surgeons measured significant anatomic structures and fiducials on five fresh-frozen cadaveric temporal bones in VR and cross-sectional viewing. Primary image data were acquired by computed tomography. In total, 275 anatomical landmark measurements and 250 measurements of the distance between fiducials were obtained with both methods. Distance measurements between the fiducials were confirmed by physical measurement obtained by Vernier caliper. The experts evaluated the subjective validity of both methods on a 5-point Likert scale qualitative survey. RESULTS A strong correlation based on intraclass coefficient was found between the methods on both the anatomical (r > 0.900) and fiducial measurements (r > 0.916). Two-tailed paired t-test and Bland-Altman plots demonstrated high equivalences between the VR and cross-sectional viewing with mean differences of 1.9% (p = 0.396) and 0.472 mm (p = 0.065) for anatomical and fiducial measurements, respectively. Gross measurement errors due to the misidentification of fiducials occurred more frequently in the cross-sectional viewing. The mean face and content validity rating for VR were significantly better compared to cross-sectional viewing (total mean score 4.11 vs 3.39, p < 0.001). CONCLUSION Our study supports good accuracy and reliability of VR environment for simulated surgical planning in temporal bones compared to conventional cross-sectional visualization.
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Affiliation(s)
- Tomi Timonen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland.
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Matti Iso-Mustajärvi
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland
- Microsurgery Centre of Eastern Finland, Kuopio, Finland
| | - Pia Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland
| | - Antti Lehtimäki
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Löppönen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 70210, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Alternative technique to repair damaged inferior alveolar nerve using data fusion from computed tomographic and magnetic resonance imaging. Br J Oral Maxillofac Surg 2020; 60:207-208. [PMID: 34930645 DOI: 10.1016/j.bjoms.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/04/2020] [Indexed: 11/20/2022]
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Lindenberg M, Retèl V, van Til J, Kuhlmann K, Ruers T, van Harten W. Selecting Image-Guided Surgical Technologies in Oncology: A Surgeon's Perspective. J Surg Res 2020; 257:333-343. [PMID: 32892128 DOI: 10.1016/j.jss.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To improve surgical performance, image-guided (IG) technologies are increasingly introduced. Yet, it is unknown which oncological procedures yield most value from these technologies. This study aimed to select the most promising IG technology per oncologic indication. METHODS An Analytic Hierarchical Process was used to evaluate three IG technologies: navigation, optical imaging, and augmented reality, in five oncologic indications compared with usual care. Sixteen decision criteria were selected. The relative importance of the criteria and the expected performance of the technologies were evaluated among surgeons. The combination of these scores gives the expected value per technology. RESULTS On criteria level, sparing critical tissue (9%-18%) and reducing the risk of local recurrence (11%-27%) were most important. Navigation was preferred in three indications-removal of lymph nodes (42%), liver (47%), and rectal tumors (33%). In removing rectal tumors, optical imaging was equally preferred (34%). In removing breast and tongue tumors, no technology was clearly preferred. CONCLUSIONS In selecting IG technologies, especially optical and navigation technologies are expected to add value in addition to usual care. Further development of those technologies for the preferred indications seems valuable. Multi-attribute analysis showed to be useful in prioritization of conducting clinical studies and steer research and development initiatives.
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Affiliation(s)
- Melanie Lindenberg
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Valesca Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Janine van Til
- Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Koert Kuhlmann
- Division of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Theo Ruers
- Division of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Wim van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands.
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Merema BBJ, Kraeima J, de Visscher SAHJ, van Minnen B, Spijkervet FKL, Schepman K, Witjes MJH. Novel finite element-based plate design for bridging mandibular defects: Reducing mechanical failure. Oral Dis 2020; 26:1265-1274. [PMID: 32176821 PMCID: PMC7507837 DOI: 10.1111/odi.13331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION When the application of a free vascularised flap is not possible, a segmental mandibular defect is often reconstructed using a conventional reconstruction plate. Mechanical failure of such reconstructions is mostly caused by plate fracture and screw pull-out. This study aims to develop a reliable, mechanically superior, yet slender patient-specific reconstruction plate that reduces failure due to these causes. PATIENTS AND METHODS Eight patients were included in the study. Indications were as follows: fractured reconstruction plate (2), loosened screws (1) and primary reconstruction of a mandibular continuity defect (5). Failed conventional reconstructions were studied using finite element analysis (FEA). A 3D virtual surgical plan (3D-VSP) with a novel patient-specific (PS) titanium plate was developed for each patient. Postoperative CBCT scanning was performed to validate reconstruction accuracy. RESULTS All PS plates were placed accurately according to the 3D-VSP. Mean 3D screw entry point deviation was 1.54 mm (SD: 0.85, R: 0.10-3.19), and mean screw angular deviation was 5.76° (SD: 3.27, R: 1.26-16.62). FEA indicated decreased stress and screw pull-out inducing forces. No mechanical failures appeared (mean follow-up: 16 months, R: 7-29). CONCLUSION Reconstructing mandibular continuity defects with bookshelf-reconstruction plates with FEA underpinning the design seems to reduce the risk of screw pull-out and plate fractures.
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Affiliation(s)
- Bram B. J. Merema
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Baucke van Minnen
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Fred K. L. Spijkervet
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Kees‐Pieter Schepman
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Max J. H. Witjes
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
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Pu JJ, Choi WS, Yu P, Wong MCM, Lo AWI, Su YX. Do predetermined surgical margins compromise oncological safety in computer-assisted head and neck reconstruction? Oral Oncol 2020; 111:104914. [PMID: 32712577 DOI: 10.1016/j.oraloncology.2020.104914] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Computer assisted head and neck reconstruction has gained popularity over the past few years. In computer assisted surgery (CAS), surgical margins are predetermined in virtual surgery and resection guides are designed to be fitted intra-operatively. However, concerns have been raised regarding the oncological safety of predetermined surgical margins. Therefore, the aim of this study was to compare surgical margins, recurrence and survival outcomes in patients underwent CAS and non-CAS in head and neck reconstruction. METHODS We retrospectively reviewed the patients underwent oral and maxillofacial malignancies surgical excision and free flap reconstruction from October 2014 to December 2019 by the same chief surgeon. Patients were divided into two groups depending on whether CAS and predetermined surgical margins were adopted. The primary outcome was surgical resection margin and the secondary outcomes included recurrence and survival. RESULTS A total of 66 subjects were recruited with 37 in the CAS group and 29 in the non-CAS group. The follow-up rate was 100%. The average follow-up time was 24.5 months. No significant difference in resection margin was identified between the groups (p = 0.387). Tumor staging, margin status, perineural invasion, lymphovascular invasion and extranodal extension were identified as significant factors influencing survival. Both before and after adjustment for these prognostic factors identified, CAS and non-CAS group showed no significant difference in survival outcome. CONCLUSION Predetermined surgical margins do not compromise oncological safety in terms of resection margin, disease recurrence and patient survival.
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Affiliation(s)
- Jingya Jane Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Wing Shan Choi
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Peirong Yu
- Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - May Chun Mei Wong
- Division of Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Anthony W I Lo
- Anatomical Pathology Division, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region.
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Evaluating the accuracy of resection planes in mandibular surgery using a preoperative, intraoperative, and postoperative approach. Int J Oral Maxillofac Surg 2020; 50:287-293. [PMID: 32682645 DOI: 10.1016/j.ijom.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/17/2020] [Accepted: 06/25/2020] [Indexed: 11/20/2022]
Abstract
In mandibular surgery, three-dimensionally printed patient-specific cutting guides are used to translate the preoperative virtually planned resection planes to the operating room. This study was performed to determine whether cutting guides are positioned according to the virtual plan and to compare the intraoperative position of the cutting guide with the resection performed. Nine patients were included. The exact positions of the resection planes were planned virtually and a patient-specific cutting guide was designed and printed. After surgical placement of the cutting guide, intraoperative cone beam computed tomography (CBCT) was performed. Postoperative CT was used to obtain the final resection planes. Distances and yaw and pitch angles between the preoperative, intraoperative, and postoperative resection planes were calculated. Cutting guides were positioned on the mandible with millimetre accuracy. Anterior osteotomies were performed more accurately than posterior osteotomies (intraoperatively positioned and final resection planes differed by 1.2±1.0mm, 4.9±6.6°, and 1.8±1.5°, respectively, and by 2.2±0.9mm, 9.3±9°, and 8.3±6.5° respectively). Differences between intraoperatively planned and final resection planes imply a directional freedom of the saw through the saw slots. Since cutting guides are positioned with millimetre accuracy compared to the virtual plan, the design of the saw slots in the cutting guides needs improvement to allow more accurate resections.
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Hu LH, Zhang WB, Yu Y, Peng X. Accuracy of multimodal image fusion for oral and maxillofacial tumors: A revised evaluation method and its application. J Craniomaxillofac Surg 2020; 48:741-750. [PMID: 32536539 DOI: 10.1016/j.jcms.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/14/2020] [Accepted: 05/28/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To develop a revised evaluation method for accuracy of multimodal image fusion for oral and maxillofacial tumors and explore its application for comparing the accuracy of three commonly used fusion algorithms, automatic fusion, manual fusion, and registration point-based fusion. MATERIALS AND METHODS Image sets of patients with oral and maxillofacial tumor were fused using the iPlan 3.0 navigation system. Fusion accuracy included two aspects: (1) overall fusion accuracy: represented by the mean value of the coordinate differences along the x-, y-, and z- axes (Δx, Δy, and Δz), mean deviation (MD), and root mean square (RMS) of six pairs of landmarks on the two image sets; (2) tumor volume fusion accuracy: represented by Fusion Index (FI), which was calculated based on the volume of tumor delineated on the two image sets. RESULTS Eighteen pairs of image sets of 17 patients were enrolled in this study. The Δx and Δy values for the three algorithms were less than 1.5 mm. The Δz values for automatic fusion, manual fusion and registration point-based fusion was 1.049 mm, 1.864 mm and 1.254 mm. The MD for automatic fusion, manual fusion and registration point-based fusion was 1.978 mm, 2.788 mm and 1.926 mm. Significant differences existed in Δz for manual fusion and that for automatic fusion (P = 0.058), in MD for manual fusion and that for automatic fusion (P = 0.087), and in MD for manual fusion and that for registration point-based fusion (P = 0.069). The FI for automatic fusion, manual fusion, and registration point-based fusion was 0.594, 0.520, and 0.549; the inter-algorithm differences were not significant (P = 0.290). CONCLUSION The automatic fusion and the registration point-based fusion were more accurate than manual fusion, and therefore were recommended to be used in multimodal image fusion for oral and maxillofacial tumors.
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Affiliation(s)
- Lei-Hao Hu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing 100081, China.
| | - Wen-Bo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing 100081, China.
| | - Yao Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing 100081, China.
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing 100081, China.
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Vosselman N, Alberga J, Witjes MHJ, Raghoebar GM, Reintsema H, Vissink A, Korfage A. Prosthodontic rehabilitation of head and neck cancer patients-Challenges and new developments. Oral Dis 2020; 27:64-72. [PMID: 32343862 PMCID: PMC7818410 DOI: 10.1111/odi.13374] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 01/23/2023]
Abstract
Head and neck cancer treatment can severely alter oral function and aesthetics, and reduce quality of life. The role of maxillofacial prosthodontists in multidisciplinary treatment of head and neck cancer patients is essential when it comes to oral rehabilitation and its planning. This role should preferably start on the day of first intake. Maxillofacial prosthodontists should be involved in the care pathway to shape and outline the prosthetic and dental rehabilitation in line with the reconstructive surgical options. With the progress of three‐dimensional technology, the pretreatment insight in overall prognosis and possibilities of surgical and/or prosthetic rehabilitation has tremendously increased. This increased insight has helped to improve quality of cancer care. This expert review addresses the involvement of maxillofacial prosthodontists in treatment planning, highlighting prosthodontic rehabilitation of head and neck cancer patients from start to finish.
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Affiliation(s)
- Nathalie Vosselman
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Jamie Alberga
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Max H J Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Harry Reintsema
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Anke Korfage
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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Yang R, Lu H, Wang Y, Peng X, Mao C, Yi Z, Guo Y, Guo C. CT-MRI Image Fusion-Based Computer-Assisted Navigation Management of Communicative Tumors Involved the Infratemporal-Middle Cranial Fossa. J Neurol Surg B Skull Base 2020; 82:e321-e329. [PMID: 34306956 DOI: 10.1055/s-0040-1701603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/24/2019] [Indexed: 01/02/2023] Open
Abstract
Objective Computed tomography (CT) and magnetic resonance imaging (MRI) are crucial for preoperative assessment of the three-dimensional (3D) spatial position relationships of tumor, vital vessels, brain tissue, and craniomaxillofacial bones precisely. The value of CT-MRI-based image fusion was explored for the preoperative assessment, virtual planning, and navigation surgery application during the treatment of communicative tumors involved the infratemporal fossa (ITF) and middle cranial fossa. Methods Eight patients with infratemporal-middle cranial fossa communicative tumors (ICFCTs) were enrolled in this retrospective study. Plain CT, contrast CT, and MRI image data were imported into a workstation for image fusion, which were used for 3D image reconstruction, virtual surgical planning, and intraoperative navigation sequentially. Therapeutic effect was evaluated through the clinical data analysis of ICFCT patients after CT-MRI image fusion-based navigation-guided biopsy or surgery. Results High-quality CT-MRI image fusion and 3D reconstruction were obtained in all eight cases. Image fusion combined with 3D image reconstruction enhanced the preoperative assessment of ICFCT, and improved the surgical performance via virtual planning. Definite pathological diagnosis was obtained in all four navigation-guided core needle biopsies. Complete removal of the tumor was achieved with one exception among the seven navigation-guided operations. Postoperative cerebrospinal fluid leakage occurred in one patient with recurrent meningioma. Conclusion CT-MRI image fusion combined with computer-assisted navigation management, optimized the accuracy, safety, and surgical results for core needle biopsy and surgery of ICFCTs.
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Affiliation(s)
- Rong Yang
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Han Lu
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Yang Wang
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Xin Peng
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Chi Mao
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Zhiqiang Yi
- Department of Neurosurgery, Peking University First Hospital, Beijing, P.R. China
| | - Yuxing Guo
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Chuanbin Guo
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
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Spijkervet FKL, Brennan MT, Peterson DE, Witjes MJH, Vissink A. Research Frontiers in Oral Toxicities of Cancer Therapies: Osteoradionecrosis of the Jaws. J Natl Cancer Inst Monogr 2019; 2019:5551359. [DOI: 10.1093/jncimonographs/lgz006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/13/2019] [Indexed: 01/28/2023] Open
Abstract
AbstractThe deleterious effects of head and neck radiation on bone, with osteoradionecrosis (ORN) as the major disabling side effect of head and neck cancer treatment, are difficult to prevent and hard to treat. This review focuses on the current state of the science regarding the pathobiology, clinical impact, and management of ORN. With regard to the pathobiology underlying ORN, it is not yet confirmed whether the current radiation schedules by 3-dimensional conformal radiotherapy and intensity modified radiotherapy result in an unchanged, decreased, or increased risk of developing ORN when compared with conventional radiation treatment, the main risk factor being the total radiation dose delivered on any clinically significant surface of the mandible.With regard to the prevention of ORN, a thorough, early pre-irradiation dental assessment is still considered the first step to reduce the hazard of developing ORN post-radiotherapy, and hyperbaric oxygen (HBO) treatment reduces the risk of developing ORN in case of dental surgery in an irradiated field.With regard to the treatment of ORN, the focus is bidirectional: elimination of the necrotic bone and improving the vascularity of the normal tissues that were included in the radiation portal. The cure rate of limited ORN by conservative therapy is approximately 50%, and the cure rate of surgical approaches when conservative therapy has failed is approximately 40%.Whether it is effective to support conservative or surgical treatment with HBO as an adjuvant is not set. HBO treatment is shown to increase the vascularity of hard and soft tissues and has been reported to be beneficial in selected cases. However, in randomized clinical trials comparing the preventive effect of HBO on developing ORN with, eg, antibiotic coverage in patients needing dental surgery, the preventive effect of HBO was not shown to surpass that of a more conservative approach.More recently, pharmacologic management was introduced in the treatment of ORN with success, but its efficacy has to be confirmed in randomized clinical trials. The major problem of performing well-designed randomized clinical trials in ORN is having access to large numbers of patients with well-defined, comparable cases of ORN. Because many institutions will not have large numbers of such ORN cases, national and international scientific societies must be approached to join multicenter trials. Fortunately, the interest of funding organizations and the number researchers with an interest in healthy aging is growing. Research aimed at prevention and reduction of the morbidity of cancer treatment fits well within these programs.
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Affiliation(s)
- Frederik K L Spijkervet
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC
| | - Douglas E Peterson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, Neag Comprehensive Cancer Center, UConn Health, Farmington, CT
| | - Max J H Witjes
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Battaglia S, Ricotta F, Maiolo V, Savastio G, Contedini F, Cipriani R, Bortolani B, Cercenelli L, Marcelli E, Marchetti C, Tarsitano A. Computer-assisted surgery for reconstruction of complex mandibular defects using osteomyocutaneous microvascular fibular free flaps: Use of a skin paddle-outlining guide for soft-tissue reconstruction. A technical report. J Craniomaxillofac Surg 2018; 47:293-299. [PMID: 30558999 DOI: 10.1016/j.jcms.2018.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/29/2018] [Accepted: 11/20/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION We present our pre-operative virtual planning of complex mandibular reconstruction with a microvascular fibular composite free flap and its harvesting using our novel cutaneous positioning guide based on the perforator vessels for our soft tissue reconstructive surgery. TECHNICAL REPORT We applied our protocol to 42 consecutive patients needing mandibular composite reconstruction. All patients were preoperatively studied with a CTA scan to evaluate the fibular pattern of vascularization and the perforator vessels three-dimensional path and position. Computer assisted surgery (CAS) was performed: a skin paddle outlining guide (SPOG) was designed to reproduce the shape and area of the planned soft tissue resection. CTA measurements and in vivo findings were compared. After performing the CTA, we classified the viable perforators in High Perforators, Medium Perforators and Low Perforators. The average diameter of the perforator vessels was 3 mm. The average difference between the measurements performed on the CTA and the intra-operative measures was 1, 4 mm. The SPOG was based on calf proximal and distal diameters. The anatomical fitting of the guide was obtained thanks to two customized flanges that embrace circumferentially the proximal and distal portions of the leg. The SPOG encompassed appropriate skin/leg regions, allowing the surgeon to localise the required perforator vessel. CONCLUSIONS CTA protocol appears to be a valuable approach to asses and virtually simulate composite mandibular reconstructions. The SPOG seems to be a valuable tool to reproduce intra-operatively the planned soft tissue area to be reconstructed.
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Affiliation(s)
- Salvatore Battaglia
- Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences, (Head Prof. Claudio Marchetti), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Ricotta
- Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences, (Head Prof. Claudio Marchetti), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Vincenzo Maiolo
- Radiology Department, (Head Prof. Alessio Giuseppe Morganti), S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Italy
| | - Gabriella Savastio
- Radiology Department, (Head Prof. Alessio Giuseppe Morganti), S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Italy
| | - Federico Contedini
- Plastic and Reconstructive Surgery Unit, (Head Dr. Riccardo Cipriani), Policlinico S. Orsola, Bologna, Italy
| | - Riccardo Cipriani
- Plastic and Reconstructive Surgery Unit, (Head Dr. Riccardo Cipriani), Policlinico S. Orsola, Bologna, Italy
| | - Barbara Bortolani
- Department of Experimental, Diagnostic and Specialty Medicine, Bioengineering Laboratory (Head Prof. Emanuela Marcelli), S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Laura Cercenelli
- Department of Experimental, Diagnostic and Specialty Medicine, Bioengineering Laboratory (Head Prof. Emanuela Marcelli), S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine, Bioengineering Laboratory (Head Prof. Emanuela Marcelli), S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Claudio Marchetti
- Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences, (Head Prof. Claudio Marchetti), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Achille Tarsitano
- Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences, (Head Prof. Claudio Marchetti), Alma Mater Studiorum University of Bologna, Bologna, Italy.
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