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Oley MH, Oley MC, Sukarno V, Faruk M. Advances in Three-Dimensional Printing for Craniomaxillofacial Trauma Reconstruction: A Systematic Review. J Craniofac Surg 2024:00001665-990000000-01748. [PMID: 38958985 DOI: 10.1097/scs.0000000000010451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
Craniomaxillofacial (CMF) fractures present significant challenges for plastic surgeons due to their intricate nature. Conventional methods such as autologous bone grafts have limitations, necessitating advancements in reconstructive surgery techniques. This study reviewed the use of three-dimensional printing for CMF trauma reconstruction using human studies. A systematic search of PubMed, EMBASE, and Google Scholar was conducted in February 2024 for case reports, case series, and clinical trials related to CMF trauma reconstruction using three-dimensional printing technology. The authors' systematic review included 20 studies and a total of 170 participants with CMF bone defects. In general, the authors observed low bias risk in analyzed case reports and series, serious bias risk in nonrandomized controlled trials, and moderate bias risk in randomized controlled trials. The printed objects included CMF structure model prototypes, patient-specific implants, and other custom surgical devices. Studies reveal successful outcomes, including restored facial symmetry and function, restored orbital occlusion, resolved enophthalmos and diplopia, achieved cosmetically symmetrical lower face reconstruction, and precise fitting of surgical devices, enhancing patient and surgeon comfort. However, complications such as local infection, implant exposure, and persistent diplopia were reported. Three-dimensional printed devices reduced surgery time but increased preparation time and production costs. In-house production options could mitigate these time and cost expenditures. Three-dimensional printing holds potential in CMF trauma reconstruction, addressing both functional and esthetic restoration. Nevertheless, challenges persist in implementing this advanced technology in resource-limited environments.
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Affiliation(s)
- Mendy Hatibie Oley
- Division of Plastic Reconstructive and Esthetic Surgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University
- Division of Plastic Reconstructive and Esthetic Surgery, Department of Surgery, Kandou Hospital
- Hyperbaric Centre Siloam Hospital
| | - Maximillian Christian Oley
- Hyperbaric Centre Siloam Hospital
- Division of Neurosurgery, Faculty of Medicine, Department of Surgery, Sam Ratulangi University
- Division of Neurosurgery, Department of Surgery, Kandou Hospital, Manado
| | | | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Zhou T, Li J, Chen S, Ren J, Geng N. Application of Computer-Aided Design and Individualized Templates for Bilateral Zygomaticomaxillary Complex Fractures. J Craniofac Surg 2022; 33:1230-1235. [PMID: 34907945 DOI: 10.1097/scs.0000000000008418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Reduction of the bilateral zygomaticomaxillary complex (ZMC) fracture with individualized templates based on computer- aided surgical simulation system. To evaluate the practicality and accuracy of this approach in the treatment of bilateral ZMC fracture. METHODS Sixteen patients with bilateral ZMC fractures were collected to create a study model. The authors reconstruct the ZMC on one side via the three-dimensional (3D) model, and then mirrored to the opposite side. Multiple individualized templates were made based on the 3D model, and used as intraoperative guidance to reduce fractures. After surgery, the facial symmetry and the position of zygoma were observed. The mouth opening, pupil level, and sensation of infraorbital nerve were evaluated. Some mark points on zygoma were measured and the postoperative horizontal asymmetry rate (H) was calculated. Besides, orbital height and width were measured. RESULTS For all patients, the position of bilateral ZMC was basically restored. The patients with restriction of mouth opening all recovered to normal. The H values were less than 3.0% at all mark points. There was almost no difference in bilateral orbital width and height. Meanwhile, there was no significant difference between the preoperative measurements of the ideal virtual 3D model and the postoperative measurements of patients. CONCLUSIONS The study proves that application of computer-aided design and individualized templates can accurately guide the reduction operation of ZMC fracture, restore the ideal shape of ZMC, and obtain good facial symmetry.
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Affiliation(s)
- Tianren Zhou
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Jianping Li
- Stomatology Clinical Center of Zhongshan City People' s Hospital, Zhongshan, Guangdong, China
| | - Songling Chen
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Jing Ren
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Ningbo Geng
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou
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Han C, Zhang X, Li K, Huang D, Liu L. Application of customized integration titanium mesh in the treatment of complicated zygomatic complex fractures: A prospective randomized clinical study. J Craniomaxillofac Surg 2022; 50:304-309. [PMID: 35341692 DOI: 10.1016/j.jcms.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 01/11/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to quantitatively evaluate the outcomes of the application of customized integration titanium mesh (CITM) in treating unilateral complicated zygomatic complex fractures. A prospective, randomized, controlled clinical study was conducted. Patients were randomly divided into the experimental group who underwent treatment with CITM, and the control group who underwent treatment just with traditional titanium plates. The X2 test and student t-test were used for statistical analyses. Twenty patients who required surgery for unilateral complicated zygomatic complex fracture were included in this study. The results showed that the mean of average distance (AD) between pre- and postoperative CT measurements was 0.487 mm in the experimental group and 1.173 mm in the control group (P < 0.001). Compared with the control group, the experimental group had superior zygomatico-facial symmetry (P<0.05), a shorter average operation time (150 min versus 229 min; P < 0.001), and a higher rate of anatomic reduction (80.0% versus 30.0%; P<0.05). In conclusion, CITM deserves to be promoted for the treatment of complicated zygomatic complex fractures. TRIAL REGISTRATION: www.chictr.org.cn (ChiCTR1800016818).
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Affiliation(s)
- Chaoying Han
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China; The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, PR China
| | - Xiao Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China
| | - Kaide Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China
| | - Dou Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China
| | - Lei Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China.
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Reduction Malarplasty Using Customized Surgical Stent Based on 3D Virtual Surgery, CAD/CAM, and 3D Printing Technology: Case Series. J Craniofac Surg 2021; 33:1578-1582. [PMID: 34907946 DOI: 10.1097/scs.0000000000008430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The zygomatic bone is a structure that protrudes symmetrically on both sides of the midface and plays an important role in the overall aesthetic appearance of the face. Unlike Caucasians, the mesocephalic facial shape is predominant in Asians, and therefore, many people have a relatively laterally developed zygomatic bone. In Asians, when the zygomatic bone is excessively developed, it gives a strong and stubborn image, and aesthetically, many people want to reduce the zygomatic bone because they prefer an oval and slim face.To reduce the excessive zygomatic bone, a reduction malarplasty through an intraoral and preauricular approach has been performed. Although reducing the zygomatic bone is not a big problem in most cases of symmetric reduction malarplasty, it is not easy to produce surgical results as intended by the surgeon in asymmetric malar patients or patients requiring a three-dimensional (3D) change of zygoma. In addition, because of the mobility of the zygoma segment, it may be difficult to drill holes and fix plate after osteotomy. Moreover, these factors can increase the possibility of malunion or nonunion.In this study, cutting guides made with the aid of 3D virtual surgery, 3D printing, and customized titanium plates manufactured with the computer-aided design/computer-aided manufacturing technology are used for 8 patients to maximize the recovery of 3D symmetry and minimize complications through accurate fixation after surgery. During the surgical procedures, screw hole drilling and osteotomy were performed using a cutting guide, and then, the malar segment was fixed by matching the premade customized plates with the predrilled holes. As a result of checking the accuracy of the surgery by superimposing the postoperative 3D cone beam computed tomography image and virtual surgery data based on the skull base, the 2 images almost overlapped and no significant differences were observed, so it was confirmed that the operation was performed exactly as plannedWhen using the 3D technology, it is possible to perform a more accurate surgery in patients with asymmetry due to congenital anomalies or trauma as well as simple asymmetry, so it can be concluded that using the 3D technology can overcome the limitations and disadvantages of the conventional method as in the cases in this study. The accurate prediction of soft tissue is still insufficient, and further research is needed to overcome this limitation.
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Zhao L, Zhang X, Guo Z, Long J. Use of modified 3D digital surgical guides in the treatment of complex mandibular fractures. J Craniomaxillofac Surg 2021; 49:282-291. [PMID: 33581958 DOI: 10.1016/j.jcms.2021.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 01/31/2021] [Indexed: 11/27/2022] Open
Abstract
The objective of this study was to evaluate the use of 3D modified digital surgical guide plates combined with preformed titanium plates in the treatment of complex mandibular fractures. Patients with complex mandibular fractures were randomized into three groups. Group A was treated with a combination of 3D modified digital surgical guide plates and preformed titanium plates, Group B was treated with preformed titanium plates only, and Group C was treated conventionally. The key design point of the guide plates is the "slot" structure, which is crucial for accurately locating the preformed titanium plate. Clinical outcomes, including facial symmetry, surgical accuracy, and maximum deviation were quantitatively assessed postoperatively. Twenty-two patients were recruited for this study, eight for Group A, six for Group B, and eight for Group C. Group A exhibited better postoperative clinical outcomes. Among three groups, significant improvements were found in Group A for facial symmetry (S1 [0.74 ± 0.17 mm, P < 0.001], S2 [0.86 ± 0.21 mm, P = 0.004], S3 [0.92 ± 0.26 mm, P < 0.001], S4 [0.32 ± 0.09 mm, P < 0.001], S5 [0.47 ± 0.16 mm, P = 0.042], S6 [0.35 ± 0.04 mm, P = 0.001], S10 [0.50 ± 0.31 mm, P = 0.048], S11 [0.97 ± 0.29 mm, P = 0.018]) and surgical accuracy (T1 [R, 0.56 ± 0.18 mm, P = 0.021], T1 [L, 0.60 ± 0.30 mm, P = 0.022], T2 [L, 0.76 ± 0.21 mm, P = 0.006], T4 [R, 0.37 ± 0.15 mm, P < 0.001], T4 [L, 0.40 ± 0.15 mm, P = 0.001], T8 [R, 0.40 ± 0.15 mm, P = 0.007], T8 [L, 0.31 ± 0.29 mm, P = 0.001], T9 [L, 0.51 ± 0.33 mm, P = 0.042], T10 [R, 0.58 ± 0.28 mm, P = 0.049], T10 [L, 0.53 ± 0.34 mm, P = 0.046], T11 [R, 0.54 ± 0.13 mm, P = 0.021], T12 [0.45 ± 0.16 mm, P = 0.003]). The ideal postoperative effect was found in Group A with maximum deviation analysis. 3D printed modified digital surgical guide plates can effectively improve treatment outcomes in complex mandibular fractures.
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Affiliation(s)
- Luyang Zhao
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, PR China; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, PR China; National Engineering Laboratory for Oral Regenerative Medicine, Chengdu, 610041, PR China
| | - Xiaojie Zhang
- Stomatology Hospital, Zhejiang University School of Medicine, 310000, PR China
| | - Zeyou Guo
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, PR China; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, PR China; National Engineering Laboratory for Oral Regenerative Medicine, Chengdu, 610041, PR China
| | - Jie Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, PR China; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, PR China; Engineering Research Center of Oral Translational Medicine, Ministry of Education, Chengdu, 610041, PR China.
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Cost Analysis for In-house versus Industry-printed Skull Models for Acute Midfacial Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2831. [PMID: 33154873 PMCID: PMC7605867 DOI: 10.1097/gox.0000000000002831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/18/2020] [Indexed: 12/29/2022]
Abstract
Industry-printed (IP) 3-dimensional (3D) models are commonly used for secondary midfacial reconstructive cases but not for acute cases due to their high cost and long turnaround time. We have begun using in-house (IH) printed models for complex unilateral midface trauma. We hypothesized that IH models would decrease cost and turnaround time, compared with IP models.
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Lehtinen V, Pyötsiä K, Snäll J, Toivari M. Zygomatico-Orbital Fracture-Dislocation in Surgical Treatment: Novel 3-Dimensional Software Automated Analysis. J Oral Maxillofac Surg 2020; 78:1372-1381. [PMID: 32304659 DOI: 10.1016/j.joms.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The human capability to detect the degree of zygomatico-orbital (ZMO) fracture-dislocation in surgical treatment is unknown. The aim of this study was to examine the association between ZMO fracture-dislocation and injury etiology and treatment. MATERIALS AND METHODS We implemented a retrospective cross-sectional study, enrolled a sample composed of patients with an isolated unilateral ZMO fracture, and analyzed fracture-dislocation from computed tomography images with an automatic algorithm. The primary predictor variable was mean surface point-to-point dislocation (the mean distance of dislocation for all surface points in isolated ZMO fracture segments between the original position and after virtual repositioning). The primary outcome was the treatment choice (operative vs nonoperative). Other studied variables were gender, age group, injury mechanism, clinical asymmetry, and human-evaluated dislocation on computed tomography images. Descriptive and bivariate statistics were computed, and the threshold for statistical significance was set at P < .05. RESULTS The sample consisted of 115 patients with a mean age of 66.3 years, 66.1% of whom were male patients, and the most common cause of injury was falling on the ground (49.6%). Operative treatment was required in 58 patients (50.4%). A significant association was found between mean dislocation and operative treatment. Mean dislocation of operatively versus nonoperatively treated fractures was 2.39 mm versus 1.05 mm (P < .001). Mean fracture-dislocation was greatest in injuries caused by assault (2.41 mm) and smallest in motor vehicle accidents (1.08 mm) and ground-level falls (1.25 mm). The threshold of human-eye detection for ZMO fracture-dislocation was 1.97 mm. CONCLUSIONS The results of this study demonstrate that the threshold for operative treatment of ZMO fracture-dislocation is over 2 mm, which the human eye is able to detect. True dislocation is greater in younger patients than elderly patients and in injuries caused by assault compared with falling.
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Affiliation(s)
- Valtteri Lehtinen
- Dental Student and Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Krista Pyötsiä
- Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Head of Department, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miika Toivari
- Resident, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Zhang X, Han CY, Dai MJ, Chen JL, Zheng XH, Long J, Tang W, Tian WD, Liu L. Application of computer-assisted surgery techniques in the management of zygomatic complex fractures. Chin J Traumatol 2018; 21:281-286. [PMID: 30342986 PMCID: PMC6235788 DOI: 10.1016/j.cjtee.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/28/2018] [Accepted: 04/05/2018] [Indexed: 02/07/2023] Open
Abstract
Patients suffering from zygomatic complex fractures always present facial deformity and dysfunctions, and thereafter develop psychological and physiological problems. It is really hard to get an ideal prognosis for the zygomatic complex fractures because of the complicated anatomical structures. Computer-assisted surgery techniques, as the new emerging auxiliary methods, can optimize the surgical protocol, predict operation outcomes, and improve the accuracy and quality of the operation. Meanwhile the postoperative complications can be reduced effectively. This review aims to provide a comprehensive overview of the application of computer-assisted surgery techniques in the management of zygomatic complex fractures.
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Affiliation(s)
- Xiao Zhang
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chao-Ying Han
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Min-Jia Dai
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jin-Long Chen
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xiao-Hui Zheng
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jie Long
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wei Tang
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wei-Dong Tian
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Lei Liu
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Sigaux N, Mojallal A, Breton P, Giai J, Louvrier A, Bouletreau P. Mandibular Advancement Means Lower Facial Enlargement: A 2-Dimensional and 3-Dimensional Analysis. J Oral Maxillofac Surg 2018; 76:2646.e1-2646.e8. [PMID: 30193119 DOI: 10.1016/j.joms.2018.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Bilateral sagittal split osteotomy (BSSO) is frequently used to treat Class II malocclusion for functional and esthetic purposes, with expected changes in the profile. The goal of this study was to assess transversal changes in mandibular advancement by comparing 3-dimensional (3D) photogrammetric modifications and 2-dimensional (2D) radiographic enlargement. MATERIALS AND METHODS A cohort study was conducted of patients who underwent an isolated advancement BSSO (Obwegeser-Dal Pont II type) for a Class II malocclusion. All patients had 3D photogrammetric and 2D radiographic evaluations before and after surgery. Frontal cephalograms were used to measure the evolution of bigonial distance (BGD) and 3D photographs were used to measure the evolution of cutaneous BGD (CBGD). RESULTS Fourteen patients were included. Mean mandibular advancement was 6 mm. BGD (+6.1 mm; P < 10-3) and CBGD (+4.2 mm; P = .0017) were significantly increased. The mean ratio of soft tissue response to transversal skeletal changes was 0.81. CONCLUSION This 2D and 3D analysis of transversal modifications shows that advancement with the BSSO is responsible for marked lower third facial enlargement. This parameter must be taken into account during the preoperative esthetic assessment to ensure the provision of pertinent information to the patient and the consideration of complementary surgical correction.
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Affiliation(s)
- Nicolas Sigaux
- Doctor, Department of Maxillofacial Surgery and Plastic Facial Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Pierre-Bénite, France.
| | - Ali Mojallal
- Professor, Department of Plastic, Reconstructive and Esthetic Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Pierre-Bénite, France
| | - Pierre Breton
- Professor and Department Head, Department of Maxillofacial Surgery and Plastic Facial Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Pierre-Bénite, France
| | - Joris Giai
- Doctor, Department of Biostatistics, Lyon Sud Hospital, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Pierre-Bénite, France
| | - Aurélien Louvrier
- Doctor, Department of Maxillofacial Surgery and Stomatology, Jean Minjoz Hospital, Besançon, France
| | - Pierre Bouletreau
- Professor, Department of Maxillofacial Surgery and Plastic Facial Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Pierre-Bénite, France
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De Souza N, Kamat S, Chalakkal P, Khandeparker RV. Use of 3D printed model as an aid in surgical removal of a rare occurrence of a compound odontome in the anterior mandible associated with impacted teeth. J Clin Exp Dent 2018; 10:e721-e725. [PMID: 30057718 PMCID: PMC6057080 DOI: 10.4317/jced.54654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022] Open
Abstract
The use of 3D printing in the medical field has been well documented, with significant developments in fabrication of tissues, organs, customized prosthetics, implants, and anatomical models as well as pharmaceutical research. Its use in dentistry, however has been limited mainly to maxillofacial surgery and reconstruction, orthognathic surgery and trauma. Compound odontomes are usually prevalent in the anterior maxilla, however, their occurrence in the anterior mandibular region is rare. This case report highlights the effective usage of 3D printing as an aid in the surgical removal of a compound odontome and impacted incisors in the mandibular anterior region. The surgery was carried out under general anesthesia. A full thickness muco-periosteal flap was reflected and the compound odontome along with the impacted incisors were removed. The defect was restored using a mixture of autogenous scrapes harvested from the chin, xenograft and platelet-rich fibrin. Wound closure was done using 4-0 vicryl. A CBCT scan taken 1 year later confirmed uneventful healing and complete bone regeneration of the surgical defect.
Key words:3D printing, model, compound odontome, impacted, incisors.
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Affiliation(s)
- Neil De Souza
- MDS, Lecturer, Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Bambolim, Goa
| | - Saurabh Kamat
- MDS, Lecturer, Department of Oral surgery, Government dental college, Bambo-lim Goa
| | - Paul Chalakkal
- MDS, Associate Professor, Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Bambolim, Goa
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Southerden P, Haydock RM, Barnes DM. Three Dimensional Osteometric Analysis of Mandibular Symmetry and Morphological Consistency in Cats. Front Vet Sci 2018; 5:157. [PMID: 30050911 PMCID: PMC6052099 DOI: 10.3389/fvets.2018.00157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/21/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives: The aim of this study was to describe a number of anatomical reference points which can be used to measure mandibular morphology and assess the degree of mandibular symmetry in a group of normal cats. Comparisons were then made between cats to evaluate correlations between morphological measurements and degree of inter-cat variation. This will provide data valuable evaluating and developing techniques for caudal mandibular fracture repair. Methods: Twenty-seven mixed breed cats (26 Domestic Shorthaired and 1 Domestic Longhaired) with no history of head trauma, intact undamaged mandibles, both mandibular fourth premolars and first molars present which had a full skull CT scan were included in this study. Anatomical reference points were defined on maximum intensity projections of multiplanar reconstruction of the mandibles and measurements taken. The ratios between paired right and left measurements, and the ratio of jaw widths at the coronoid process and mandibular foramen were calculated. All analyses were performed using R version 3.3.3 and the multcomp library. Results: None of the right:left ratios were detected as being significantly different from 1 and the coefficient of variation values were all very small showing that when cats deviate from the mean ratio they do so by only a small amount. Measurements analyzed to determine how consistent individual measurements were between cats showed that the most consistent measurement was the lateral ramus inclination angle. The least consistent measurements were ramus height and jaw width at the mental foramen. The correlation between pairs of measurements of the right and left ramus was analyzed and demonstrated a strong correlation between the height, width and length of the ramus. Conclusions: This study has demonstrated a low level of asymmetry between contralateral mandibles in cats, a high level of consistency in the dimensions of mandibles between cats and a strong correlation between the height, width and length of the ramus.
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Affiliation(s)
- Peter Southerden
- Department of Dentistry and Oral Surgery, Eastcott Veterinary Referrals, Swindon, United Kingdom
| | - Richard M Haydock
- The WALTHAM Centre for Pet Nutrition, Melton Mowbray, United Kingdom
| | - Duncan M Barnes
- Department of Orthopaedic Surgery, Eastcott Veterinary Referrals, Swindon, United Kingdom
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Zhang X, Ye L, Li H, Wang Y, Dilxat D, Liu W, Chen Y, Liu L. Surgical navigation improves reductions accuracy of unilateral complicated zygomaticomaxillary complex fractures: a randomized controlled trial. Sci Rep 2018; 8:6890. [PMID: 29720719 PMCID: PMC5932064 DOI: 10.1038/s41598-018-25053-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 04/05/2018] [Indexed: 02/07/2023] Open
Abstract
Accurate reduction is the key to successful treatment of bone fractures. Complicated zygomaticomaxillary complex fracture, known as one of the most challenging facial bone fractures, is often hard to achieve an accurate reduction, thus leading to facial deformity. In this study, twenty patients with unilateral complicated zygomaticomaxillary complex fractures were included and randomly divided into experimental and control groups, which is with and without the aid of surgical navigation, respectively. The pre- and postoperative imaging data were collected and then analysed using Geomagic Studio 11 software and Brainlab iPlan CMF 3.0. A more precise reduction was showed in the experimental group according to the measurement results of both software programmes than in the control group. In conclusion, surgical navigation showed great value in performing accurate reductions of complicated zygomaticomaxillary complex fractures and restoring facial contour.
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Affiliation(s)
- Xiao Zhang
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P.R. China
| | - Lanfeng Ye
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P.R. China
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, 510140, China
| | - Hui Li
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P.R. China
| | - Yi Wang
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P.R. China
| | - Dilnur Dilxat
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P.R. China
| | - Weilong Liu
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P.R. China
| | - Yuanwei Chen
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P.R. China
| | - Lei Liu
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P.R. China.
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Multimaterial 3D printing preoperative planning for frontoethmoidal meningoencephalocele surgery. Childs Nerv Syst 2018; 34:749-756. [PMID: 29067504 DOI: 10.1007/s00381-017-3616-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Surgical correction of frontoethmoidal meningoencephalocele, although rare, is still challenging to neurosurgeons and plastic reconstructive surgeons. It is fundamental to establish reliable and safe surgical techniques. The twenty-first century has brought great advances in medical technology, and the 3D models can mimic the correct tridimensional anatomical relation of a tissue organ or body part. They allow both tactile and spatial understanding of the lesion and organ involved. The 3D printing technology allows the preparation for specific surgery ahead of time, planning the surgical approach and developing plans to deal with uncommon and high-risk intraoperative scenarios. CASE PRESENTATION The present report describes a case of frontoethmoidal encephalocele, (nasofrontal subtype) of a 19-month-old girl, whose surgical correction was planned using 3D printing modeling. CONCLUSION The 3D model allowed a detailed discussion of the aspects of the surgical approach by having tissues of different consistencies and resistances, and also predicting with millimetric precision the bilateral orbitotomy measurements. Moreover, it was a fundamental and valuable factor in the multidisciplinary preoperative discussion. This approach allowed reducing the time of surgery, accurately planning the location of the osteotomies and precontouring the osteosynthesis material. 3D models can be very helpful tools in planning complex craniofacial operative procedures.
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Assessing symmetry of zygomatic bone through three-dimensional segmentation on computed tomography scan and "mirroring" procedure: A contribution for reconstructive maxillofacial surgery. J Craniomaxillofac Surg 2018; 46:600-604. [PMID: 29548881 DOI: 10.1016/j.jcms.2018.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/29/2018] [Accepted: 02/13/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Surgical reconstruction of zygomatic bones in cases of traumatic injuries is a frequent event: assessment of symmetry is mandatory for a correct restoration of zygomatic shape, but the literature is discordant about its quantification. The purpose of this study is to show a novel method for assessing symmetry of zygomatic bone through mirroring of 3D models segmented on CT-scan. MATERIALS AND METHODS A total of 100 patients (50 male and 50 female), divided into two age groups (18-49 years and 50-92 years) were selected from the computed tomography (CT) scan database of a hospital in northern Italy. Zygomatic bones from each patient were segmented, and the left bone was automatically mirrored and registered on the right one according to the least point-to-point distance between the two surfaces. The mean and root mean square (RMS) distance between the two models was then calculated. Statistically significant differences according to sex and age groups were assessed through two-way analysis of variance (p < 0.05). In addition, the effect size of differences was calculated. RESULTS The method proved to be repeatable, with inter- and intraoperator errors lower than 5%. Overall, mean and RMS point-to-point distances were respectively 0.01 mm and 0.84 mm, without statistically significant differences according to sex or age (p > 0.05), and with negligible effect size. CONCLUSION This study provides an innovative method for assessing the symmetry of the zygomatic bone based on surface analysis. Results may provide useful indications for the reconstruction of zygomatic bones in maxillofacial surgery.
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do Ó Silva AL, Dias IJ, Grempel RG, de Morais HHA, da Silva Oliveira Brito NM, de Castro Gomes DQ. Prototyping for the treatment of late zygomatic-orbital fracture: A case report. Int J Surg Case Rep 2017; 38:91-94. [PMID: 28746906 PMCID: PMC5526466 DOI: 10.1016/j.ijscr.2017.06.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/20/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Zygomatic-orbital complex fractures are the most common facial traumas that can result in severe esthetic and functional sequelae. Surgical correction of these fractures is a delicate approach and prototyping is an excellent tool to facilitate this procedure. PRESENTATION OF CASE A 27-year-old man, a motorcycle accident victim, was hospitalized in the intensive care unit for 30days. After this period, facial fractures were treated surgically, leaving sequelae such as enophthalmos, dystopia and loss of projection of the zygomatic arch. A second intervention was planned after one year for reconstruction of the orbit with the help of prototyping. Better outcomes were achieved than in the first intervention. DISCUSSION This report permits to compare the result of conventional surgery and the use of a prototype in the same patient. Noticeably better outcomes were achieved with the second approach. Prototyping made the surgical procedure more predictable and reduced operative time because of the possibility of using preshaped titanium plates. CONCLUSIONS Prototyping was found to be an excellent option to overcome the deficiencies of the conventional technique, recovering the functional and esthetic characteristics of the patient's face and ensuring a markedly satisfactory outcome.
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Affiliation(s)
| | | | - Rafael Grotta Grempel
- Department of Dentistry, State University of Paraíba, Campina Grande, PB, Brazil; Nucleus for Strategic Technologies Applied to Health, State University of Paraíba, Campina Grande, PB, Brazil; Department of Surgery, Dom Luiz Gonzaga Fernandes Emergency and Trauma Hospital, Campina Grande, PB, Brazil
| | - Hécio Henrique Araújo de Morais
- Department of Surgery, Dom Luiz Gonzaga Fernandes Emergency and Trauma Hospital, Campina Grande, PB, Brazil; Department of Dentistry, State University of Rio Grande do Norte, Caicó, RN, Brazil
| | - Nadja Maria da Silva Oliveira Brito
- Department of Dentistry, State University of Paraíba, Campina Grande, PB, Brazil; Nucleus for Strategic Technologies Applied to Health, State University of Paraíba, Campina Grande, PB, Brazil; Department of Surgery, Dom Luiz Gonzaga Fernandes Emergency and Trauma Hospital, Campina Grande, PB, Brazil
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Ma J, Ma L, Wang Z, Zhu X, Wang W. The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures: A case report. Medicine (Baltimore) 2017; 96:e7250. [PMID: 28682875 PMCID: PMC5502148 DOI: 10.1097/md.0000000000007250] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Precise bony reduction and reconstruction of optimal contour in treating comminuted mandibular fractures is very difficult using traditional techniques and devices. The aim of this report is to introduce our experiences in using virtual surgery and three-dimensional (3D) printing technique in treating this clinical challenge. PATIENT CONCERNS A 26-year-old man presented with severe trauma in the maxillofacial area due to fall from height. DIAGNOSIS Computed tomography images revealed middle face fractures and comminuted mandibular fracture including bilateral condyles. INTERVENTIONS AND OUTCOMES The computed tomography data was used to construct the 3D cranio-maxillofacial models; then the displaced bone fragments were virtually reduced. On the basis of the finalized model, a customized titanium mesh tray was designed and fabricated using selective laser melting technology. During the surgery, a submandibular approach was adopted to repair the mandibular fracture. The reduction and fixation were performed according to preoperative plan, the bone defects in the mental area were reconstructed with iliac bone graft. The 3D-printed mesh tray served as an intraoperative template and carrier of bone graft. The healing process was uneventful, and the patient was satisfied with the mandible contour. LESSONS Virtual surgical planning combined with 3D printing technology enables surgeon to visualize the reduction process preoperatively and guide intraoperative reduction, making the reduction less time consuming and more precise. 3D-printed titanium mesh tray can provide more satisfactory esthetic outcomes in treating complex comminuted mandibular fractures.
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Affiliation(s)
| | - Limin Ma
- Department of Orthopedics, Guangdong Key Laboratory of Orthopedic Technology and Implant Materials, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
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Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 2016; 15:115. [PMID: 27769304 PMCID: PMC5073919 DOI: 10.1186/s12938-016-0236-4] [Citation(s) in RCA: 535] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/09/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. METHODS Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. RESULTS 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. CONCLUSION 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis.
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Affiliation(s)
- Philip Tack
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Jan Victor
- Ghent University Hospital, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Paul Gemmel
- Departement of Economics & Business Administration, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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Autologous Fat Grafting With Combined Three-Dimensional and Mirror-Image Analyses for Progressive Hemifacial Atrophy. Ann Plast Surg 2016; 77:308-13. [DOI: 10.1097/sap.0000000000000641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martelli N, Serrano C, van den Brink H, Pineau J, Prognon P, Borget I, El Batti S. Advantages and disadvantages of 3-dimensional printing in surgery: A systematic review. Surgery 2016; 159:1485-1500. [PMID: 26832986 DOI: 10.1016/j.surg.2015.12.017] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/02/2015] [Accepted: 12/11/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Three-dimensional (3D) printing is becoming increasingly important in medicine and especially in surgery. The aim of the present work was to identify the advantages and disadvantages of 3D printing applied in surgery. METHODS We conducted a systematic review of articles on 3D printing applications in surgery published between 2005 and 2015 and identified using a PubMed and EMBASE search. Studies dealing with bioprinting, dentistry, and limb prosthesis or those not conducted in a hospital setting were excluded. RESULTS A total of 158 studies met the inclusion criteria. Three-dimensional printing was used to produce anatomic models (n = 113, 71.5%), surgical guides and templates (n = 40, 25.3%), implants (n = 15, 9.5%) and molds (n = 10, 6.3%), and primarily in maxillofacial (n = 79, 50.0%) and orthopedic (n = 39, 24.7%) operations. The main advantages reported were the possibilities for preoperative planning (n = 77, 48.7%), the accuracy of the process used (n = 53, 33.5%), and the time saved in the operating room (n = 52, 32.9%); 34 studies (21.5%) stressed that the accuracy was not satisfactory. The time needed to prepare the object (n = 31, 19.6%) and the additional costs (n = 30, 19.0%) were also seen as important limitations for routine use of 3D printing. CONCLUSION The additional cost and the time needed to produce devices by current 3D technology still limit its widespread use in hospitals. The development of guidelines to improve the reporting of experience with 3D printing in surgery is highly desirable.
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Affiliation(s)
- Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France; University Paris-Sud, GRADES, Faculty of Pharmacy, Châtenay-Malabry, France.
| | - Carole Serrano
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | | | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Isabelle Borget
- University Paris-Sud, GRADES, Faculty of Pharmacy, Châtenay-Malabry, France; Department of Health Economics, Gustave Roussy Institute, Villejuif, France
| | - Salma El Batti
- Department of Cardiac and Vascular Surgery, Georges Pompidou European Hospital, Paris, France; URDIA - Unité de Recherche en Développement, Imagerie et Anatomie - EA 4465, Université Paris Descartes, Paris, France
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Abstract
Rapid prototyping (RP) technologies have found many uses in dentistry, and especially oral and maxillofacial surgery, due to its ability to promote product development while at the same time reducing cost and depositing a part of any degree of complexity theoretically. This paper provides an overview of RP technologies for maxillofacial reconstruction covering both fundamentals and applications of the technologies. Key fundamentals of RP technologies involving the history, characteristics, and principles are reviewed. A number of RP applications to the main fields of oral and maxillofacial surgery, including restoration of maxillofacial deformities and defects, reduction of functional bone tissues, correction of dento-maxillofacial deformities, and fabrication of maxillofacial prostheses, are discussed. The most remarkable challenges for development of RP-assisted maxillofacial surgery and promising solutions are also elaborated.
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Affiliation(s)
- Qian Peng
- Xiangya Stomatological Hospital, Central South University , Changsha, Hunan 410008 , China
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Shu DL, Liu XZ, Guo B, Ran W, Liao X, Zhang YY. Accuracy of using computer-aided rapid prototyping templates for mandible reconstruction with an iliac crest graft. World J Surg Oncol 2014; 12:190. [PMID: 24957053 PMCID: PMC4101797 DOI: 10.1186/1477-7819-12-190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate the accuracy of surgical outcomes in free iliac crest mandibular reconstructions that were carried out with virtual surgical plans and rapid prototyping templates. Methods This study evaluated eight patients who underwent mandibular osteotomy and reconstruction with free iliac crest grafts using virtual surgical planning and designed guiding templates. Operations were performed using the prefabricated guiding templates. Postoperative three-dimensional computer models were overlaid and compared with the preoperatively designed models in the same coordinate system. Results Compared to the virtual osteotomy, the mean error of distance of the actual mandibular osteotomy was 2.06 ± 0.86 mm. When compared to the virtual harvested grafts, the mean error volume of the actual harvested grafts was 1412.22 ± 439.24 mm3 (9.12% ± 2.84%). The mean error between the volume of the actual harvested grafts and the shaped grafts was 2094.35 ± 929.12 mm3 (12.40% ± 5.50%). Conclusions The use of computer-aided rapid prototyping templates for virtual surgical planning appears to positively influence the accuracy of mandibular reconstruction.
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Affiliation(s)
| | | | | | - Wei Ran
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Sun Yat-sen University, No, 58 Zhongshan Er Road, Guangzhou 510080, China.
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Cui J, Chen L, Guan X, Ye L, Wang H, Liu L. Surgical planning, three-dimensional model surgery and preshaped implants in treatment of bilateral craniomaxillofacial post-traumatic deformities. J Oral Maxillofac Surg 2014; 72:1138.e1-14. [PMID: 24679954 DOI: 10.1016/j.joms.2014.02.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 02/08/2014] [Accepted: 02/13/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of the present study was to explore the treatment and outcomes of bilateral craniomaxillofacial post-traumatic deformities with surgical planning, 3-dimensional (3D) model surgery, and preshaped implants. MATERIALS AND METHODS We analyzed the preoperative computed tomography (CT) data and designed preliminary surgical plans for 3 patients with bilateral craniomaxillofacial post-traumatic deformities. 3D resin skull models were produced using rapid prototyping technology, and 3D model surgery was performed to determine the location, reduction direction, and shift distance of the osteotomy and to optimize the surgical plans. Titanium plates or mesh were preshaped on the models and then implanted into the patients. The complications, symmetry of the maxillofacial regions, mouth opening, and occlusion were observed 1 month postoperatively. RESULTS The patients had good recovery of their facial contour, occlusion, and mouth opening and acceptable symmetry of the bilateral maxillofacial regions. No complications were observed. CONCLUSIONS The combination of surgical planning, 3D model surgery, and preshaped implants can provide surgical accuracy and efficiency and good therapeutic outcomes in the treatment of bilateral craniomaxillofacial post-traumatic deformities.
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Affiliation(s)
- Junhui Cui
- Resident, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Chen
- Resident, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoguang Guan
- Resident, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lanfeng Ye
- Resident, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hang Wang
- Associate Professor, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Liu
- Professor, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Niikura T, Sugimoto M, Lee SY, Sakai Y, Nishida K, Kuroda R, Kurosaka M. Tactile surgical navigation system for complex acetabular fracture surgery. Orthopedics 2014; 37:237-42. [PMID: 24762831 DOI: 10.3928/01477447-20140401-05] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 09/05/2013] [Indexed: 02/03/2023]
Abstract
The authors describe a tactile surgical navigation system using custom 3-dimensional (3D) models of the bony pelvis for complex acetabular fracture surgery. The bone area of interest was extracted from the Digital Imaging and Communications in Medicine (DICOM) data of computed tomography scans. A standard triangulated language file was used to create 3D models of the bony pelvis by layered manufacturing using a 3D printer and non-cytotoxic, sterilizable, acrylic-based photopolymers. No infections and no toxic or other adverse events were observed. The models were useful for preoperative assessment, planning, and simulation; intraoperative assessment; obtaining informed consent; and education.
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Modabber A, Gerressen M, Ayoub N, Elvers D, Stromps JP, Riediger D, Hölzle F, Ghassemi A. Computer-assisted zygoma reconstruction with vascularized iliac crest bone graft. Int J Med Robot 2013; 9:497-502. [PMID: 24338854 DOI: 10.1002/rcs.1557] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 09/19/2013] [Accepted: 10/10/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND The reconstruction of zygoma is a challenge with regard to aesthetic and reconstructive demands. METHODS Pre-operative CT data were imported into specific surgical planning software. The mirror-imaging technique was used. A surgical guide transferred the virtual surgery plan to the operation site, whereby it fitted uniquely to the iliac donor site. A postoperative CT scan was obtained for comparing the actual postoperative graft position and shape with the pre-operative virtual simulation. RESULTS A mean difference of 0.71 mm (SD ± 1.42) for the shape analysis and 3.53 mm (SD ± 3.14) for the graft position was determined. The calculation of the closest point distance showed a surface deviation of < 2 mm for the shape analysis with 83.6% of values and for the graft position with 35.7% of values. CONCLUSION Virtual surgical planning is a suitable method for zygoma reconstruction with vascularized iliac crest bone graft, with good accuracy for restoring the three-dimensional anatomy.
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Affiliation(s)
- Ali Modabber
- Department of Oral, Maxillofacial and Plastic Facial Surgery, RWTH Aachen University Hospital, Germany
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Liu XZ, Shu DL, Ran W, Guo B, Liao X. Digital surgical templates for managing high-energy zygomaticomaxillary complex injuries associated with orbital volume change: a quantitative assessment. J Oral Maxillofac Surg 2013; 71:1712-23. [PMID: 23911146 DOI: 10.1016/j.joms.2013.06.197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/26/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study sought to introduce 3-dimensional (3D) virtual surgical planning and digital rapid-prototyping templates for zygomaticomaxillary complex (ZMC) injuries associated with orbital volume change and to evaluate the surgical outcomes quantitatively. PATIENTS AND METHODS Eight patients who underwent open reduction and fixation for a ZMC injury with orbital volume change were studied. Computed tomographic (CT) scan of the zygomaticomaxillary area was performed before the operation in each case. Scanned data were converted into 3D models using Mimics software (Materialise, Brussels, Belgium) for surgical designs. Virtual surgical reductions and correlated guiding templates were designed using Mimics and Magics software (Materialise). The operations were performed with the help of prefabricated templates to reduce the fractures. A postoperative CT scan of each patient was obtained within 2 weeks after surgery, and quantitative measurements were made to assess the surgical outcomes. Preoperative volumes of the bilateral orbits were compared, and concordance with postoperative volumes of the bilateral orbits was assessed. Twenty-one pairs of distances from 7 marker points to 3 reference planes were measured to assess postoperative facial symmetry. RESULTS Volumes of the injured orbits were significantly different from volumes of the uninjured orbits preoperatively (P < .05), whereas bilateral orbital volumes showed no statistically significant difference postoperatively (P > .05). In addition, 19 of the 21 pairs of bilateral distances showed no significant difference postoperatively (P > .05). CONCLUSIONS Quantitative assessment showed that digitally designed, rapid-prototyping templates for ZMC fractures have a positive impact on restoring facial symmetry and concordance of bilateral orbital volumes.
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Affiliation(s)
- Xiang-Zhen Liu
- Attending, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Toriumi M, Nagasao T, Itamiya T, Shimizu Y, Yasudo H, Sakamoto Y, Ogata H, Kishi K. 3-D analysis of dislocation in zygoma fractures. J Craniomaxillofac Surg 2013; 42:397-402. [PMID: 23891273 DOI: 10.1016/j.jcms.2013.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/02/2013] [Accepted: 06/03/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE When fractured, zygomas rotate and dislocate. The present study quantitatively elucidates the pattern of the rotation. METHODS 50 patients with tri-pod-type zygoma fractures were involved in this study. After defining a 3-dimensional coordinate system--consisting of the M-L axis (the axis directed from the medial to lateral side of the skull), I-S axis (directed from the inferior to superior side), and P-A axis (directed from the posterior to anterior side), the degree with which the fractured zygomas rotated around each of these axes was measured using 3-dimensional graphic software. Thereafter, the tendency of the rotation was compared between the three rotational axes. RESULTS Rotation around the I-S axis was the most frequent with a 96% incidence, followed by a substantial margin by rotation around the M-L axis with a 26% incidence; rotation around the P-A axis was rare, with an incidence of 10%. Furthermore, the degree of P-A axis rotation was minor compared to I-S and M-L axis rotations. CONCLUSION The main factor of zygoma dislocation in zygoma fracture is rotation around the I-S axis. This finding is helpful for effective performance to reposition fractured zygomas.
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Affiliation(s)
- Masahiro Toriumi
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Tomohisa Nagasao
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan.
| | - Tomoki Itamiya
- Design Faculty, Tokyo University of Technology, Tokyo, Japan
| | - Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Hiroki Yasudo
- Department of Pediatrics, Tokyo University, Tokyo, Japan
| | - Yoshiaki Sakamoto
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Hisao Ogata
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
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Guibert M, Franchi G, Ansari E, Billotet B, Diner PA, Cassier S, Vazquez MP, Picard A, Kadlub N. Fat graft transfer in children's facial malformations: a prospective three-dimensional evaluation. J Plast Reconstr Aesthet Surg 2013; 66:799-804. [PMID: 23535268 DOI: 10.1016/j.bjps.2013.02.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 02/17/2013] [Accepted: 02/21/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Autologous fat grafting for volume augmentation in soft tissues has grown in popularity in the paediatric plastic surgery community, despite a lack of quantifiable evidence of graft survival and predictable outcomes for child patients. The objective of this study is to quantify, through an objective method, the rate of survival of fat grafting in children's reconstructive surgery. METHODS Clinical evaluation of all children was performed under standardised conditions in a prospective fashion with a 1-year follow-up. All patients, under 18 years of age, were photographed with a three-dimensional imaging system. Data were analysed with three-dimensional analysing software to quantify the volume improvements postoperatively and during the follow-up. RESULTS Eleven children were included and followed up for 12 months. The mean age was 7.4 years. The mean amount of fat grafted was 13 cm3. At the end of the follow-up, the mean survival rate of the fat grafted was 40%. Complementary fat grafts were needed in 27% of the cases. No significant complications occurred. CONCLUSION Until now, the literature has failed to provide objective evidence of fat survival in children. This study, using three-dimensional data, showed a 40% survival of grafted fat. The use of three-dimensional photographs and analysis has great clinical potential for surgical planning and follow-up.
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Affiliation(s)
- Marc Guibert
- APHP, Hôpital Necker Enfants Malades, Université Paris 6, Faculté de médecine Pierre et Marie Curie,75015 Paris, France
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Modabber A, Legros C, Rana M, Gerressen M, Riediger D, Ghassemi A. Evaluation of computer-assisted jaw reconstruction with free vascularized fibular flap compared to conventional surgery: a clinical pilot study. Int J Med Robot 2011; 8:215-20. [PMID: 22213406 DOI: 10.1002/rcs.456] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND The introduction of computer-assisted surgery was a milestone in functional reconstructions of facial skeletal defects. PATIENTS AND METHODS We compared five computer-assisted and five conventional reconstructions with fibular grafts in the course of a pilot study. A rapid prototyping guide translated the computer-assisted surgery plan into intraoperative utilizable models. We intraoperatively measured the time needed for shaping the graft to the recipient site and the ischaemic time. Furthermore, the size of donor site defect compared to the required transplant length was evaluated. RESULTS Shaping procedure and ischaemic time turned out significantly shorter when compared to conventional surgery without cutting guide (p = 0.014). Using surgical guides, there was no change between the defect size of the fibula and the necessary transplant size. In conventional surgery, a mean change of 1.92 cm occurred (p = 0.001). CONCLUSION The surgical guide significantly reduced shaping time and consequently ischaemic time. These factors can influence flap survival. The fibular donor site defect was downsized.
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Affiliation(s)
- Ali Modabber
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Aachen, Germany.
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