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Li X, Xia S, Li Z, Zhang Z. Evaluation of post-activation mandibular remodelling in children with craniofacial microsomia treated with distraction osteogenesis. Orthod Craniofac Res 2024. [PMID: 38899587 DOI: 10.1111/ocr.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Patients with type IIA craniofacial microsomia (CFM) may benefit from mandibular distraction osteogenesis (MDO) treatment during childhood; however, remodelling of the mandible during the consolidation phase, which may affect the short-term outcomes of MDO, has not yet been quantitatively analysed using computed tomography. Therefore, we aimed to investigate bone remodelling of the mandible in children with type IIA CFM treated with MDO before distractor removal and the factors that influence ramus vertical elongation efficiency. MATERIALS AND METHODS Twenty-three children with unilateral CFM were studied between 2020 and 2024. Longitudinal computed tomography data (preoperative, end of active phase and at pre-distractor removal) were analysed. Condyle positions and the mandibular cant were analysed using a paired-sample t test. The relapse rates of vertical lengthening and mandibular cant were calculated. The correlation between distraction efficiency and preoperative craniofacial morphology was analysed. RESULTS The condyle on the affected side moved upwards and backwards by 28.84 ± 4.08 and 2.85 ± 4.33 mm, respectively during the active phase but lost 7.66 ± 2.64 mm of vertical extension during the consolidation phase. The relapse rates for vertical extension of the condyle and occlusal plane were 27% and 35%, respectively. The ratio of mandibular ramus height was positively related to EV. CONCLUSIONS In children with CFM, attention should be paid to vertical elongation instability and relapse of mandibular inclination during consolidation. Severe mandibular ramus hypoplasia is a preoperative risk factor for vertical skeletal relapse during consolidation. Further efforts are required to reduce the stress that leads to relapse.
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Affiliation(s)
- Xiyuan Li
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Songxia Xia
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhifeng Li
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhiyong Zhang
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Hattori Y, Pai BCJ, Lo CC, Chou PY, Lo LJ. Comparison between one-jaw and two-jaw designs in virtual surgery planning for patients with class III malocclusion. J Craniomaxillofac Surg 2024; 52:612-618. [PMID: 38448337 DOI: 10.1016/j.jcms.2024.02.023] [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: 07/29/2023] [Revised: 10/19/2023] [Accepted: 02/11/2024] [Indexed: 03/08/2024] Open
Abstract
Orthognathic surgery is highly effective for treating maxillomandibular discrepancies in patients with class III malocclusion. However, whether one- or two-jaw surgery should be selected remains controversial. Our study aimed to evaluate quantitative differences between one-jaw and two-jaw surgical designs. In total, 100 consecutive patients with skeletal class III malocclusion who underwent orthognathic surgery with preoperative three-dimensional simulation between August 2016 and November 2021 were recruited. Based on the same final occlusal setup, a two-jaw surgery design and two types of one-jaw design were created. In total, 400 image sets, including preoperative images and three types of surgical simulation, were measured and compared. The one-jaw mandibular setback design led to improvement in most cephalometric measurements and facial symmetry. Although the one-jaw maxillary advancement design improved the ANB angle and facial convexity, it induced maxillary protrusion and reduced facial symmetry. Compared with the other designs, the two-jaw design provided significantly closer cephalometric measurements to the normative values, better symmetry, and less occlusal cant. Overall, the two-jaw design provided a quantitatively better facial appearance in terms of symmetry, proportion, and profile. Although an optimal surgical design necessitates thorough preoperative evaluation and a shared decision-making process, two-jaw surgery can be considered for improving overall facial esthetics and harmony.
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Affiliation(s)
- Yoshitsugu Hattori
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Betty Chien-Jung Pai
- Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Chin Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan.
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Taylor EM, Vorstenbosch J, Morrison E, Janssen PL, Kronstadt KL, Randazzo J, Rosen EB, Cordeiro PG, Shahzad F, Ganly I, Matros E. Making the Case for Virtual Surgical Planning: Bilateral Sequential Fibula Flaps with Immediate Dental Implants for Maxillectomy. Plast Reconstr Surg 2023; 152:707e-711e. [PMID: 36780347 PMCID: PMC11305406 DOI: 10.1097/prs.0000000000010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
SUMMARY Oncologic maxillectomy defects requiring bony reconstruction are among the most challenging head and neck cases because of the complex three-dimensional geometry of the midface. Virtual surgical planning technology is advantageous in these cases because it provides superior positional precision and accuracy compared with traditional techniques and facilitates prosthodontic rehabilitation. Maxillary cancer recurrence after an initial fibula flap reconstruction presents a unique challenge. The authors report the first two cases of sequential fibula flaps after second or recurrent cancer of the maxilla. Virtual surgical planning facilitated resection with adequate tumor margins, optimized anatomic positioning of the fibula construct with three-dimensional printed plates, and enabled immediate functional dental implant placement.
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Affiliation(s)
- Erin M. Taylor
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Joshua Vorstenbosch
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Edwin Morrison
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pierce L. Janssen
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kenneth L. Kronstadt
- Division of Maxillofacial Prosthetics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph Randazzo
- Division of Maxillofacial Prosthetics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Evan B. Rosen
- Dental Oncology and Maxillofacial Prosthetics, Miami Cancer Institute, Miami, FL
| | - Peter G Cordeiro
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Farooq Shahzad
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ian Ganly
- Division of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Evan Matros
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Liu R, Su Y, Pu J, Zhang C, Yang W. Cutting-edge patient-specific surgical plates for computer-assisted mandibular reconstruction: The art of matching structures and holes in precise surgery. Front Surg 2023; 10:1132669. [PMID: 36969756 PMCID: PMC10033664 DOI: 10.3389/fsurg.2023.1132669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesCutting-edge patient-specific surgical plates (PSSPs) are supposed to improve the efficiency, precision, and functional outcomes of mandibular reconstruction. This study characterized the premium role of PSSPs in precise surgery and explored their working principles in computer-assisted mandibular reconstruction (CAMR).MethodsThe PSSPs-enhanced surgical precision was investigated through the model surgery and representative cases. Spatial deviations of reconstruction were characterized by comparing the reconstructed mandible with the virtually designed mandible. Working principles of PSSPs were distinguished by a review of evolving surgical techniques in CAMR.ResultsIn the model surgery, spatial deviations between the virtually planned mandible and the reconstructed mandible were 1.03 ± 0.43 mm in absolute distance deviation, 1.70 ± 1.26 mm in intercondylar length, and 1.86 ± 0.91 mm in intergonial length in the study group of PSSPs, significantly smaller than in the control group of conventional prebent surgical plates. Meanwhile, in the study group, distance deviations were 0.51 ± 0.19 mm in bone-plate distance and 0.56 ± 0.28 mm in drilled screw holes, indicating the art of matching structures and holes. The PSSPs-enhanced CAMR was further demonstrated in three representative cases of mandibular reconstruction. Finally, four primary techniques of CAMR were summarized based on a review of 8,672 articles. The premium role of PSSPs was distinguished by the benefits of matching structures and holes.ConclusionsThe PSSPs-enhanced surgical precision was verified through the model surgery and demonstrated in human surgery. Compared to other surgical techniques of CAMR, PSSPs contributed to the precise surgery by the art of matching structures and holes.
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Affiliation(s)
- Renshun Liu
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
| | - Yuxiong Su
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | - Jingya Pu
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | - Chunyu Zhang
- Guangzhou Janus Biotechnology Co., Ltd, Guangzhou, China
| | - Weifa Yang
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
- Correspondence: Weifa Yang
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Yuan Z, He S, Jiang T, Xie Q, Zhou N, Huang X. Augmented reality hologram combined with pre-bent distractor enhanced the accuracy of distraction vector transfer in maxillary distraction osteogenesis, a study based on 3D printed phantoms. Front Surg 2022; 9:1018030. [PMID: 36468075 PMCID: PMC9709275 DOI: 10.3389/fsurg.2022.1018030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Vector control is a significant concern in maxillary distraction osteogenesis (DO). Distraction vector planning on the patient's 3D-printed skull phantom is more intuitive for surgeons and cost-efficient than virtual surgical planning. However, the accuracy of transferring the planned vector to intraoperative (vector transfer) according to the shape of the pre-bent footplate alone is relatively limited. The application of augmented reality (AR) in surgical navigation has been studied for years. However, few studies have focused on its role in maxillary DO vector transfer. This study aimed to evaluate the accuracy of AR surgical navigation combined with the pre-bent distractor in vector transfer by comparing it with the pre-bent distractor alone. METHODS Ten patients with maxillary hypoplasia were enrolled with consent, and three identical 3D-printed skull phantoms were manufactured based on per patient's corresponding pre-operative CT data. Among these, one phantom was for pre-operative planning (n = 10), while and the other two were for the AR+Pre-bending group (n = 10) and the Pre-bending group (n = 10) for the experimental surgery, respectively. In the Pre-bending group, the distraction vector was solely determined by matching the shape of footplates and maxillary surface. In the AR+Pre-bending group, the distractors were first confirmed to have no deformation. Then AR surgical navigation was applied to check and adjust the vector in addition to the steps as in the Pre-bending Group. RESULTS For the angular deviation of the distraction vector, the AR+Pre-bending group was significantly smaller than the Pre-bending group in spatial (p < 0.001), x-y plane (p = 0.002), and y-z plane (p < 0.001), and there were no significant differences in the x-z plane (p = 0.221). The AR+Pre-bending group was more accurate in deviations of the Euclidean distance (p = 0.004) and the y-axis (p = 0.011). In addition, the AR+Pre-bending group was more accurate for the distraction result. CONCLUSIONS In this study based on 3D printed skull phantoms, the AR surgical navigation combined with the pre-bent distractor enhanced the accuracy of vector transfer in maxillary DO, compared with the pre-bending technique alone.
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Affiliation(s)
- Zongyi Yuan
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Shixi He
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Tianhua Jiang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Qingtiao Xie
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Nuo Zhou
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
| | - Xuanping Huang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning, China
- Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, China
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Dual Application of Patient-Specific Occlusion-Based Positioning Guide and Fibular Cutting Guide for Accurate Reconstruction of Segmental Mandibular Defect. J Craniofac Surg 2022:00001665-990000000-00446. [PMID: 36264681 DOI: 10.1097/scs.0000000000009073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/21/2022] [Indexed: 02/04/2023] Open
Abstract
In this study, the authors introduced a dual application of patient-specific occlusion-based positioning guide and fibular cutting guide to obtain ideal occlusal relationship and mandibular contour in patients undergoing mandibular reconstruction. A retrospective review was performed in 21 patients who underwent mandibular reconstruction with a fibular osteocutaneous free flap. Using computed tomography and intraoral scanning data, fibular cutting guide and occlusion-based positioning guide were simulated in a modeling software and 3-dimensionally printed. Both guides were applied in 9 patients, defined as dual guide group, while the fibular cutting guide was solely used in the remaining patients, defined as single guide group. Functional outcomes including occlusion status, trismus, presence of osseointegrated implant were assessed at 1-year postoperative period. To evaluate the accuracy of the reconstruction, the discrepancy between the planned simulation and actual surgical result was quantified by measuring mandibular deviation angle and volume conformity. Regarding the functional outcomes, all patients in dual guide group showed satisfactory occlusion and intact oral capacity at postoperative 1-year assessment, while 3 patients in single guide group had prolonged malocclusion. The dual guide group showed significantly decreased deviation angle in coronal (right side, 2.93°±1.98° vs. 7.02°±2.81°, P =0.003) and axial plane (right side, 3.20°±2.04° vs. 7.63°±3.40°, P =0.006). The mean volume conformity between the simulation and actual fibular object was significantly higher in the dual guide group (75.27%±6.12% vs. 59.06%±8.57%, P =0.001). In conclusion, the use of occlusion-based positioning guide combined with the fibular cutting guide can enhance the accuracy of mandible reconstruction and functional outcomes.
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Roy T, Steinbacher DM. Virtual Planning and 3D Printing in Contemporary Orthognathic Surgery. Semin Plast Surg 2022; 36:169-182. [PMID: 36532897 PMCID: PMC9750797 DOI: 10.1055/s-0042-1760209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Orthognathic surgery is a powerful tool to improve facial balance, form, and function. Virtual planning and three-dimensional printing has improved our ability to visualize complex anatomy, consider various iterations and execute complex movements, and create accurate splints, plates, and cutting guides. This article will outline the distinct advantages of the use of virtual surgical planning over traditional planning, and it will explore the utility of computer-aided design and technology within contemporary orthognathic surgery, including its expanded applications and limitations.
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Affiliation(s)
- Tulsi Roy
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Derek M. Steinbacher
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
- Address for correspondence Derek M. Steinbacher, DMD, MD Section of Plastic and Reconstructive Surgery, Yale University School of Medicine330 Cedar St, New Haven, CT 06519
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Response to: "One step forward: How do you measure accuracy?". Plast Reconstr Surg 2022; 150:485e-487e. [PMID: 35724415 DOI: 10.1097/prs.0000000000009308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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One step forward: How do you measure accuracy? Plast Reconstr Surg 2022; 150:484e-485e. [PMID: 35724396 DOI: 10.1097/prs.0000000000009309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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