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Adell-Gómez N, Valls-Ontañón A, Malet-Contreras A, García-Piñeiro A, Gómez-Chiari M, Valls-Esteve A, Krauel L, Rubio-Palau J. Analysis of the implementation of a circuit for intra-operative superposition and comparison of the surgical outcomes using ICBCT in maxillofacial surgery. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03196-x. [PMID: 38829569 DOI: 10.1007/s11548-024-03196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE This paper describes a novel circuit for intraoperative analysis with ICBCT in maxillofacial surgery. The aim is to establish guidelines, define indications, and conduct an analysis of the implementation of the circuit for intraoperative comparison of surgical outcomes in relation to 3D virtual planning in maxillofacial surgery. METHODS The study included 150 maxillofacial surgical procedures. Intraoperative actions involved fluoroscopy localization, intraoperative CBCT acquisition, segmentation, and superimposition, among other steps. Surgical times due to intraoperative superposition were measured, including time required for ICBCT positioning and acquisition, image segmentation, and comparison of 3D surfaces from the surgical planning. RESULTS Successful intraoperative comparison was achieved in all 150 cases, enabling surgeons to detect and address modifications before concluding the surgery. Out of the total, 26 patients (17.33%) required intraoperative revisions, with 11 cases (7.33%) needing major surgical revisions. On average, the additional surgical time with this circuit implementation was 10.66 ± 3.03 min (n = 22). CONCLUSION The results of our research demonstrate the potential for performing intraoperative surgical revision, allowing for immediate evaluation, enhancing surgical outcomes, and reducing the need for re-interventions.
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Affiliation(s)
- Núria Adell-Gómez
- Innovation Department, SJD Barcelona Children's Hospital, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007, Barcelona, Spain.
- 3D Unit (3D4H), SJD Barcelona Children's Hospital, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.
| | - Adaia Valls-Ontañón
- Maxillofacial Unit, Department of Pediatric Surgery, SJD Barcelona Children's Hospital, Esplugues de Llobregat, Spain
| | - Albert Malet-Contreras
- Maxillofacial Unit, Department of Pediatric Surgery, SJD Barcelona Children's Hospital, Esplugues de Llobregat, Spain
| | - Andrés García-Piñeiro
- Maxillofacial Unit, Department of Pediatric Surgery, SJD Barcelona Children's Hospital, Esplugues de Llobregat, Spain
| | - Marta Gómez-Chiari
- Diagnostic Imaging Department, SJD Barcelona Children's Hospital, Esplugues de Llobregat, Spain
- Department of Diagnostic Imaging, Hospital de la Santa Creu i Sant Pau Institut de Recerca, Barcelona, Catalunya, Spain
| | - Arnau Valls-Esteve
- Innovation Department, SJD Barcelona Children's Hospital, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain
- 3D Unit (3D4H), SJD Barcelona Children's Hospital, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain
| | - Lucas Krauel
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007, Barcelona, Spain
- 3D Unit (3D4H), SJD Barcelona Children's Hospital, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology, Pediatric Surgery Department, SJD Barcelona Children's Hospital, Esplugues de Llobregat, Spain
| | - Josep Rubio-Palau
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007, Barcelona, Spain
- 3D Unit (3D4H), SJD Barcelona Children's Hospital, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain
- Maxillofacial Unit, Department of Pediatric Surgery, SJD Barcelona Children's Hospital, Esplugues de Llobregat, Spain
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Olivetto M, Testelin S. Surgical navigation in maxillofacial surgery: A French national survey. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101468. [PMID: 37080359 DOI: 10.1016/j.jormas.2023.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE to gain a national understanding of the utilization of surgical navigation among maxillofacial surgeons in France through a web-based questionnaire. METHODS A 14-point multiple-choice questionnaire was created and distributed to the participants, divided into two sections. The first section gathered general information about the respondents, and the second section provided an overview of the use of surgical navigation. RESULT A total of 75 participants completed the survey. The results showed that a majority of university hospital departments (65%) utilize an intra-operative 3D imaging system, while very few private clinics and general hospitals use this technology. CONCLUSION The survey suggests that surgical navigation is primarily used in university centers in French maxillofacial surgery, with limited utilization and non-standardized indications for use.
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Affiliation(s)
- Matthieu Olivetto
- Department of Maxillofacial Surgery, Hospital Center of Annecy-Genevois, Annecy, France.
| | - Sylvie Testelin
- Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, Amiens, France
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Leung YY, Leung JKC, Li ATC, Teo NEZ, Leung KPY, Au SW, Li DTS, Su YX. Accuracy and safety of in-house surgeon-designed three-dimensional-printed patient-specific implants for wafer-less Le Fort I osteotomy. Clin Oral Investig 2023; 27:705-713. [PMID: 36401069 DOI: 10.1007/s00784-022-04798-y] [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: 03/06/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The design and fabrication of three-dimensional (3D)-printed patient-specific implants (PSIs) for orthognathic surgery are customarily outsourced to commercial companies. We propose a protocol of designing PSIs and surgical guides by orthognathic surgeons-in-charge instead for wafer-less Le Fort I osteotomy. The aim of this prospective study was to evaluate the accuracy and post-operative complications of PSIs that are designed in-house for Le Fort I osteotomy. MATERIALS AND METHODS The post-operative cone beam computer tomography (CBCT) model of the maxilla was superimposed to the virtual surgical planning to compare the discrepancies of pre-determined landmarks, lines, and principal axes between the two models. Twenty-five patients (12 males, 13 females) were included. RESULTS The median linear deviations of the post-operative maxilla of the x, y, and z axes were 0.74 mm, 0.75 mm, and 0.72 mm, respectively. The deviations in the principal axes for pitch, yaw, and roll were 1.40°, 0.90°, and 0.60°, respectively. There were no post-operative complications related to the PSIs in the follow-up period. CONCLUSIONS The 3D-printed PSIs designed in-house for wafer-less Le Fort I osteotomy are accurate and safe. CLINICAL RELEVANCE Its clinical outcomes and accuracy are comparable to commercial PSIs for orthognathic surgery. TRIAL REGISTRATION Clinical trial registration number: HKUCTR-2113. Date of registration: 29 July 2016.
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Affiliation(s)
- Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Jasper Ka Chai Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Alvin Tsz Choi Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Nathan En Zuo Teo
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Karen Pui Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shun Wai Au
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dion Tik Shun Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yu-Xiong Su
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
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A Quantitative and Qualitative Clinical Validation of Soft Tissue Simulation for Orthognathic Surgery Planning. J Pers Med 2022; 12:jpm12091460. [PMID: 36143245 PMCID: PMC9503761 DOI: 10.3390/jpm12091460] [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: 08/15/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to perform a quantitative and qualitative validation of a soft tissue simulation pipeline for orthognathic surgery planning, necessary for clinical use. Simulation results were retrospectively obtained in 10 patients who underwent orthognathic surgery. Quantitatively, error was measured at 9 anatomical landmarks for each patient and different types of comparative analysis were performed considering two mesh resolutions, clinically accepted error, simulation time and error measured by means of percentage of the whole surface. Qualitatively, evaluation and binary questions were asked to two surgeons, both before and after seeing the actual surgical outcome, and their answers were compared. Finally, the quantitative and qualitative results were compared to check if these two types of validation are correlated. The quantitative results were accurate, with greater errors corresponding to gonions and lower lip. Qualitatively, surgeons answered similarly mostly and their evaluations improved when seeing the actual outcome of the surgery. The quantitative validation was not correlated to the qualitative validation. In this study, quantitative and qualitative validations were performed and compared, and the need to carry out both types of analysis in validation studies of soft tissue simulation software for orthognathic surgery planning was proved.
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Soft-Tissue Simulation for Computational Planning of Orthognathic Surgery. J Pers Med 2021; 11:jpm11100982. [PMID: 34683123 PMCID: PMC8540582 DOI: 10.3390/jpm11100982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/21/2021] [Accepted: 09/25/2021] [Indexed: 11/23/2022] Open
Abstract
Simulation technologies offer interesting opportunities for computer planning of orthognathic surgery. However, the methods used to date require tedious set up of simulation meshes based on patient imaging data, and they rely on complex simulation models that require long computations. In this work, we propose a modeling and simulation methodology that addresses model set up and runtime simulation in a holistic manner. We pay special attention to modeling the coupling of rigid-bone and soft-tissue components of the facial model, such that the resulting model is computationally simple yet accurate. The proposed simulation methodology has been evaluated on a cohort of 10 patients of orthognathic surgery, comparing quantitatively simulation results to post-operative scans. The results suggest that the proposed simulation methods admit the use of coarse simulation meshes, with planning computation times of less than 10 seconds in most cases, and with clinically viable accuracy.
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Abstract
Virtual simulation surgical system is a good way to develop surgical instruments, make surgical plan, and train surgeons. At present, due to the deformation of intraoperative soft tissue after retraction and the lack of effective data collection, the surgical simulation of facial contour surgery can only be conducted according to the preoperative computed tomography data. Due to the difficulty of obtaining real operative spatial data, it is difficult for the virtual surgery trajectory planning process to yield a good effect on surgeon training. In this study, an optical tracking device was used to record the actual posture of surgical instruments, patient position, and incision space in the surgical environment, so as to construct a more accurate actual surgical space. The clinical data obtained in this study can be used for virtual simulation of surgical instrument movement and osteotomy, as well as selection, planning, and teaching purposes of surgical programs.
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Lutz JC, Assouline Vitale LS, Graillon N, Foletti JM, Schouman T. Standard and Customized Alloplastic Facial Implants Refining Orthognathic Surgery: Outcome Evaluation. J Oral Maxillofac Surg 2020; 78:1832.e1-1832.e12. [PMID: 32574606 DOI: 10.1016/j.joms.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/08/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Conventional orthognathic osteotomies provide appropriate functional outcomes but might be unable to correct midface deficiency, achieve a satisfactory outcome in asymmetrical cases, or allow sufficient chin advancement. We evaluated the outcome of both standard and customized facial high-density porous polyethylene implants used to refine the cosmetic outcome of orthognathic surgery. PATIENTS AND METHODS We implemented a retrospective study. The sample was composed of all patients who underwent facial alloplastic augmentation between June 2011 and October 2018 in our department. The complication rate was recorded after a mean follow-up period of 41 months postoperatively, and patient satisfaction was assessed through a qualitative evaluation based on an 11-item questionnaire. RESULTS The sample was composed of 24 implants placed in 14 patients: 13 mandibular angle implants, among which 4 were customized; 8 malar implants; and 3 chin implants. No physical complications such as hematoma, infection, migration, or hypoesthesia were observed. Two implants had to be removed because of early unsatisfactory esthetic outcomes. Of 14 patients, 11 answered our questionnaire. Eighty-two percent strongly agreed that the overall outcome was satisfactory. CONCLUSIONS The results of this study confirm the low physical complication rate described in the literature, and the esthetic complication rate remains lower than the rates observed in previous reports. A high satisfaction rate was found among patients. The lowest mean satisfaction score was noted for appropriate implant symmetry (3.5), whereas the highest mean satisfaction score (3.8) was achieved when using customized implants. If standard high-density porous polyethylene implants appear to be relevant adjuncts to orthognathic surgery, customized implants seem to achieve higher satisfaction, although their prohibitive cost should be considered.
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Affiliation(s)
- Jean-Christophe Lutz
- Associate Professor, Maxillo-Facial and Plastic Surgery Department, Strasbourg University Hospital, Strasbourg, France; Faculty of Medicine, University of Strasbourg, Strasbourg, France; and Laboratory of Engineering Science, Computer Science and Imaging, National Center for Scientific Research (CNRS), ICUBE University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Strasbourg, France.
| | | | - Nicolas Graillon
- Chief Resident, Oral and Maxillofacial Surgery Department, Aix Marseille University, Public Assistance Hospitals of Marseille (APHM), French Institute for Science and Technologies in Transportation, Spatial Planning and Networks (IFSTTAR), Applied Biomechanics Laboratory (LBA), CHU Conception, Marseille, France
| | - Jean-Marc Foletti
- Associate Professor, Oral and Maxillofacial Surgery Department, Aix Marseille University, Public Assistance Hospitals of Marseille (APHM), French Institute for Science and Technologies in Transportation, Spatial Planning and Networks (IFSTTAR), Applied Biomechanics Laboratory (LBA), CHU Conception, Marseille, France
| | - Thomas Schouman
- Associate Professor, Oral and Maxillofacial Surgery Department, Public Assistance Hospitals of Paris (APHP)-Pitié-Salpetrière University Hospital, Paris, France; and Sorbonne University, UPMC Paris 06 University, Paris, France
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Kraeima J, Schepers R, Spijkervet F, Maal T, Baan F, Witjes M, Jansma J. Splintless surgery using patient-specific osteosynthesis in Le Fort I osteotomies: a randomized controlled multi-centre trial. Int J Oral Maxillofac Surg 2020; 49:454-460. [DOI: 10.1016/j.ijom.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/30/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
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