1
|
Morita D, Kawarazaki A, Koimizu J, Tsujiko S, Soufi M, Otake Y, Sato Y, Numajiri T. Automatic orbital segmentation using deep learning-based 2D U-net and accuracy evaluation: A retrospective study. J Craniomaxillofac Surg 2023; 51:609-613. [PMID: 37813770 DOI: 10.1016/j.jcms.2023.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/25/2023] [Accepted: 09/05/2023] [Indexed: 10/11/2023] Open
Abstract
The purpose of this study was to verify whether the accuracy of automatic segmentation (AS) of computed tomography (CT) images of fractured orbits using deep learning (DL) is sufficient for clinical application. In the surgery of orbital fractures, many methods have been reported to create a 3D anatomical model for use as a reference. However, because the orbit bone is thin and complex, creating a segmentation model for 3D printing is complicated and time-consuming. Here, the training of DL was performed using U-Net as the DL model, and the AS output was validated with Dice coefficients and average symmetry surface distance (ASSD). In addition, the AS output was 3D printed and evaluated for accuracy by four surgeons, each with over 15 years of clinical experience. One hundred twenty-five CT images were prepared, and manual orbital segmentation was performed in all cases. Ten orbital fracture cases were randomly selected as validation data, and the remaining 115 were set as training data. AS was successful in all cases, with good accuracy: Dice, 0.860 ± 0.033 (mean ± SD); ASSD, 0.713 ± 0.212 mm. In evaluating AS accuracy, the expert surgeons generally considered that it could be used for surgical support without further modification. The orbital AS algorithm developed using DL in this study is extremely accurate and can create 3D models rapidly at low cost, potentially enabling safer and more accurate surgeries.
Collapse
Affiliation(s)
- Daiki Morita
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Ayako Kawarazaki
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jungen Koimizu
- Department of Plastic and Reconstructive Surgery, Omihachiman Community Medical Center, Shiga, Japan
| | - Shoko Tsujiko
- Department of Plastic and Reconstructive Surgery, Saiseikai Shigaken Hospital, Shiga, Japan
| | - Mazen Soufi
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Yoshito Otake
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Yoshinobu Sato
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Toshiaki Numajiri
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
2
|
Morita D, Mazen S, Tsujiko S, Otake Y, Sato Y, Numajiri T. Deep-learning-based automatic facial bone segmentation using a two-dimensional U-Net. Int J Oral Maxillofac Surg 2023; 52:787-792. [PMID: 36328865 DOI: 10.1016/j.ijom.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/16/2022] [Accepted: 10/24/2022] [Indexed: 06/04/2023]
Abstract
The use of deep learning (DL) in medical imaging is becoming increasingly widespread. Although DL has been used previously for the segmentation of facial bones in computed tomography (CT) images, there are few reports of segmentation involving multiple areas. In this study, a U-Net was used to investigate the automatic segmentation of facial bones into eight areas, with the aim of facilitating virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD/CAM) in maxillofacial surgery. CT data from 50 patients were prepared and used for training, and five-fold cross-validation was performed. The output results generated by the DL model were validated by Dice coefficient and average symmetric surface distance (ASSD). The automatic segmentation was successful in all cases, with a mean± standard deviation Dice coefficient of 0.897 ± 0.077 and ASSD of 1.168 ± 1.962 mm. The accuracy was very high for the mandible (Dice coefficient 0.984, ASSD 0.324 mm) and zygomatic bones (Dice coefficient 0.931, ASSD 0.487 mm), and these could be introduced for VSP and CAD/CAM without any modification. The results for other areas, particularly the teeth, were slightly inferior, with possible reasons being the effects of defects, bonded maxillary and mandibular teeth, and metal artefacts. A limitation of this study is that the data were from a single institution. Hence further research is required to improve the accuracy for some facial areas and to validate the results in larger and more diverse populations.
Collapse
Affiliation(s)
- D Morita
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - S Mazen
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - S Tsujiko
- Department of Plastic and Reconstructive Surgery, Saiseikai Shigaken Hospital, Shiga, Japan
| | - Y Otake
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Y Sato
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - T Numajiri
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
3
|
Verdoy SB, Sadeghi P, Ojeda AL, Palacín Porté JA, Vinyals Vinyals JM, Barceló LH, Lluis EC, Compta XG, Diaz AT, Segú JOB. Evaluation of virtual surgical planning and
three‐dimensional
configurations for reconstruction of maxillary defects using the fibula free flap. Microsurgery 2022; 42:749-756. [DOI: 10.1002/micr.30957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 07/26/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Sergi Barrantes Verdoy
- Plastic and Reconstructive Surgery Department Hospital Universitari de Bellvitge Barcelona Spain
| | - Payam Sadeghi
- Plastic Surgery Department Cleveland Clinic Cleveland Ohio USA
| | - Anna López Ojeda
- Plastic and Reconstructive Surgery Department Hospital Universitari de Bellvitge Barcelona Spain
| | - José A. Palacín Porté
- Plastic and Reconstructive Surgery Department Hospital Universitari de Bellvitge Barcelona Spain
| | - Joan M. Vinyals Vinyals
- Plastic and Reconstructive Surgery Department Hospital Universitari de Bellvitge Barcelona Spain
| | - Lia Huesa Barceló
- Plastic and Reconstructive Surgery Department Hospital Universitari de Bellvitge Barcelona Spain
| | - Enric Cisa Lluis
- Otorhinolaryngology Department Hospital Universitari de Bellvitge Barcelona Spain
| | | | | | - Josep Oriol Bermejo Segú
- Plastic and Reconstructive Surgery Department Hospital Universitari de Bellvitge Barcelona Spain
| |
Collapse
|
4
|
Deganello A, Rampinelli V, Gualtieri T, Piazza C. Versatility of the subscapular system of flaps in head and neck oncologic reconstruction. Curr Opin Otolaryngol Head Neck Surg 2022; 30:161-167. [PMID: 34670257 PMCID: PMC9928565 DOI: 10.1097/moo.0000000000000771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review analyzes the different ways of applying the subscapular system of flaps (SSSF) as a convenient and versatile solution for a large variety of head and neck oncologic defects. RECENT FINDINGS The ventral approach permits safe and efficient harvest of various chimeric SSSF in a supine position, thus allowing simultaneous flap preparation and tumor ablation. Conformational studies have revealed how similar the tip of the scapula is to the hard palate in terms of dimensions, shape, and conformation. This has led to favor horizontal placement of the scapular tip for palate reconstruction in most instances, addressing the vertical extension of the postmaxillectomy defect using denuded bony grafts surrounded by well vascularized chimeric muscular components. SUMMARY The SSSF possesses an unparalleled versatility to efficiently address small-medium sized soft tissue defects up to vast and complex composite resections. The chimeric components of these flaps benefit from a considerable independency provided by the length of the named arteries arising from the thoracodorsal pedicle, offering a high degree of freedom to accomplish the required in-setting. This reconstructive option should be implemented in every head and neck surgical team and offered to suitable patients.
Collapse
Affiliation(s)
- Alberto Deganello
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| |
Collapse
|
5
|
Breik O, Idle M, Martin T, Praveen P, Parmar S. Three-Dimensional Computer-Assisted Surgical Planning and Manufacturing in Complex Maxillary Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:151-164. [PMID: 32741512 DOI: 10.1016/j.cxom.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Omar Breik
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK.
| | - Matthew Idle
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Timothy Martin
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Prav Praveen
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Satyesh Parmar
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| |
Collapse
|
6
|
The Free Serratus-Rib Flap for Orbital Floor Reconstruction After Oncologic Resection. Ann Plast Surg 2020; 84:409-412. [DOI: 10.1097/sap.0000000000002052] [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]
|
7
|
Davies JC, Chan HH, Bernstein JM, Goldstein DP, Irish JC, Gilbert RW. Orbital Floor Reconstruction: 3-Dimensional Analysis Shows Comparable Morphology of Scapular and Iliac Crest Bone Grafts. J Oral Maxillofac Surg 2018; 76:2011-2018. [DOI: 10.1016/j.joms.2018.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/18/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
|
8
|
Tel A, Costa F, Sembronio S, Lazzarotto A, Robiony M. All-in-one surgical guide: A new method for cranial vault resection and reconstruction. J Craniomaxillofac Surg 2018; 46:967-973. [PMID: 29716817 DOI: 10.1016/j.jcms.2018.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/05/2018] [Accepted: 03/28/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Great precision is required for craniofacial surgery, and computer-aided design (CAD) methods may be used to plan surgery before it is performed. In this study, three-dimensional (3D)-printed cutting guides are used to match computer models with surgical procedures. We describe a novel method of computer-aided surgery for autologous cranioplasty that includes a new strategy for generating and using cutting guides. These guides may be used not only for osteotomies, but also for many other steps in the surgical procedure. MATERIALS AND METHODS Preoperatively, anatomical data were imported into a CAD package and used for virtual surgical planning (VSP). Cutting guides were designed after considering how to integrate all the surgical steps. Models of the microplates and micro-screws were also made. Surgical guides were exported and printed, and preoperative simulations using a replica of the patient's skull established the sequence of steps. The accuracy of the procedure was evaluated postoperatively using computed tomography (CT) scans. RESULTS In every patient examined, the all-in-one surgical-guide system was able to automate the many steps in the procedure and dramatically decreased the duration of surgery. The experimental guide enhanced every phase of surgery, including excising the lesion, and harvesting, positioning, and fixing the graft. In each step, precision was enhanced and the outcome corresponded with the VSP. CONCLUSIONS The few previous reports on cutting guides used in cranioplasty generally describe the use of separate guides for dismantling and reconstruction. The ability to perform more surgical sequences using a single tool can improve surgical accuracy. Clearly there is no single perfect surgical guide; however, effective surgical-design strategies should be used to build the best approach to each procedure.
Collapse
Affiliation(s)
- Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Fabio Costa
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Andrea Lazzarotto
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.
| |
Collapse
|