1
|
Parakarn H, Pisek P, Wangsrimongkol B. Individualized Digital Nasoalveolar Molding: A Proof of Concept. J Craniofac Surg 2024:00001665-990000000-01724. [PMID: 38920370 DOI: 10.1097/scs.0000000000010430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Nasoalveolar molding (NAM) is a recognized adjunctive therapy to primary cheiloplasty in patients with complete cleft lip and palate (CLP). The conventional technique can be time-consuming, costly, and requires experienced clinicians. Over the past decade, CAD/CAM technology has been employed to facilitate NAM therapy, showing promising results. This study introduces an individualized Digital NAM (iDNAM), a digital approach revolutionizing NAM treatment using CAD/CAM technology, and evaluates treatment outcomes. A 57-day-old infant with complete UCLP underwent intraoral and nasolabial scans, along with 3D photogrammetry. Open-source software was utilized for virtual alveolar segmentation and NAM plate design. iDNAM incorporates a nasal molding extension, introducing an innovative nasal stent activation protocol. Changes in alveolar and nasal morphology were compared between the initial and presurgery stages. After treatment with iDNAM, the alveolar cleft gap was reduced to 4.22 mm. Nostril height on the cleft side, columellar length, and nose projection increased by 0.98, 2.40, and 1.90 mm, respectively. The nasal base-columellar angle improved by 29.50 degrees. The results demonstrate a significant reduction in the alveolar cleft gap and improved nasal morphology, making iDNAM as an alternative to NAM therapy.
Collapse
Affiliation(s)
- Hathaichanok Parakarn
- Department of Orthodontics, Faculty of Dentistry, Khon Kaen University, 123 Mittrapap Highway, Nai Muang subdistrict, Muang Khon Kaen, 40002, Thailand
| | | | | |
Collapse
|
2
|
Benitez BK, Brudnicki A, Tache A, Wieprzowski Ł, Surowiec Z, Nalabothu P, Lill Y, Mueller AA. Comparative study on cleft palate morphology after passive presurgical plate therapy in unilateral cleft lip and palate. J Plast Reconstr Aesthet Surg 2024; 92:198-206. [PMID: 38547553 DOI: 10.1016/j.bjps.2024.03.001] [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: 12/12/2023] [Accepted: 03/02/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Presurgical plate therapy has been widely accepted as a treatment prior to palatal cleft closure. The effects of passive presurgical plate therapy on cleft morphology prior to single-stage unilateral cleft lip and palate (UCLP) repair were quantified. PATIENTS AND METHODS We compared the dimensions of cleft width and cleft area (true cleft and palatal cleft) measured preoperatively at 2 European cleft centers. Center A performed single-stage UCLP repair in 8-month-old infants without any presurgical orthopedic treatment. Center B initiated passive presurgical plate therapy immediately after the birth of the neonates, followed by single-stage UCLP repair at 8 months of age. RESULTS We included 28 patients with complete UCLP from Center A and 12 patients from Center B. The average anterior width of the true cleft before surgery was significantly smaller in infants at Center B than that in Center A (p = 0.001) with 95% confidence interval of (1.8, 5.7) mm, but the average posterior width was similar in the 2 groups. The mean presurgical true cleft area amounted to 106.8 mm2 (SD = 42.4 mm2) at Center A and 71.9 mm2 (SD = 32.2 mm2) at Center B, with a confidence interval for the difference being (9.8, 60.1) mm2. This corresponded to a 32.7% reduction of the true cleft area when passive presurgical plate therapy was used for the first 8 months of the infants' life. CONCLUSION Passive presurgical plate therapy in UCLP significantly reduced the cleft area. Implications for the subsequent surgical outcome might depend on the surgical technique used.
Collapse
Affiliation(s)
- Benito K Benitez
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| | - Andrzej Brudnicki
- Maxillofacial Department, Clinic of Pediatric Surgery, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Ana Tache
- Cleft & Craniofacial Team, GZA-ZNA, Ziekenhuizen, Antwerpen, Belgium.
| | - Łukasz Wieprzowski
- Maxillofacial Department, Clinic of Pediatric Surgery, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Zbigniew Surowiec
- Maxillofacial Department, Clinic of Pediatric Surgery, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, Poland.
| | - Prasad Nalabothu
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| | - Yoriko Lill
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| | - Andreas A Mueller
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland.
| |
Collapse
|
3
|
Schnabel TN, Gözcü B, Gotardo P, Lingens L, Dorda D, Vetterli F, Emhemmed A, Nalabothu P, Lill Y, Benitez BK, Mueller AA, Gross M, Solenthaler B. Automated and data-driven plate computation for presurgical cleft lip and palate treatment. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02858-6. [PMID: 37009952 DOI: 10.1007/s11548-023-02858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/22/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Presurgical orthopedic plates are widely used for the treatment of cleft lip and palate, which is the most common craniofacial birth defect. For the traditional plate fabrication, an impression is taken under airway-endangering conditions, which recent digital alternatives overcome via intraoral scanners. However, these alternatives demand proficiency in 3D modeling software in addition to the generally required clinical knowledge of plate design. METHODS We address these limitations with a data-driven and fully automated digital pipeline, endowed with a graphical user interface. The pipeline adopts a deep learning model to landmark raw intraoral scans of arbitrary mesh topology and orientation, which guides the nonrigid surface registration subsequently employed to segment the scans. The plates that are individually fit to these segmented scans are 3D-printable and offer optional customization. RESULTS With the distance to the alveolar ridges closely centered around the targeted 0.1 mm, our pipeline computes tightly fitting plates in less than 3 min. The plates were approved in 12 out of 12 cases by two cleft care professionals in a printed-model-based evaluation. Moreover, since the pipeline was implemented in clinical routine in two hospitals, 19 patients have been undergoing treatment utilizing our automated designs. CONCLUSION The results demonstrate that our automated pipeline meets the high precision requirements of the medical setting employed in cleft lip and palate care while substantially reducing the design time and required clinical expertise, which could facilitate access to this presurgical treatment, especially in low-income countries.
Collapse
Affiliation(s)
- Till N Schnabel
- Department of Computer Science, ETH Zurich, 8092, Zurich, Switzerland.
| | - Baran Gözcü
- Department of Computer Science, ETH Zurich, 8092, Zurich, Switzerland
| | | | - Lasse Lingens
- Department of Computer Science, ETH Zurich, 8092, Zurich, Switzerland
| | - Daniel Dorda
- Department of Computer Science, ETH Zurich, 8092, Zurich, Switzerland
| | - Frawa Vetterli
- Department of Computer Science, ETH Zurich, 8092, Zurich, Switzerland
| | - Ashraf Emhemmed
- Department of Computer Science, ETH Zurich, 8092, Zurich, Switzerland
| | - Prasad Nalabothu
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123, Allschwil, Switzerland
| | - Yoriko Lill
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123, Allschwil, Switzerland
| | - Benito K Benitez
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123, Allschwil, Switzerland
| | - Andreas A Mueller
- Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123, Allschwil, Switzerland
| | - Markus Gross
- Department of Computer Science, ETH Zurich, 8092, Zurich, Switzerland
- DisneyResearch|Studios, 8006, Zurich, Switzerland
| | | |
Collapse
|
4
|
Implementation of an In-House 3D Manufacturing Unit in a Public Hospital’s Radiology Department. Healthcare (Basel) 2022; 10:healthcare10091791. [PMID: 36141403 PMCID: PMC9498605 DOI: 10.3390/healthcare10091791] [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: 07/18/2022] [Revised: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: Three-dimensional printing has become a leading manufacturing technique in healthcare in recent years. Doubts in published studies regarding the methodological rigor and cost-effectiveness and stricter regulations have stopped the transfer of this technology in many healthcare organizations. The aim of this study was the evaluation and implementation of a 3D printing technology service in a radiology department. Methods: This work describes a methodology to implement a 3D printing service in a radiology department of a Spanish public hospital, considering leadership, training, workflow, clinical integration, quality processes and usability. Results: The results correspond to a 6-year period, during which we performed up to 352 cases, requested by 85 different clinicians. The training, quality control and processes required for the scaled implementation of an in-house 3D printing service are also reported. Conclusions: Despite the maturity of the technology and its impact on the clinic, it is necessary to establish new workflows to correctly implement them into the strategy of the health organization, adjusting it to the needs of clinicians and to their specific resources. Significance: This work allows hospitals to bridge the gap between research and 3D printing, setting up its transfer to clinical practice and using implementation methodology for decision support.
Collapse
|
5
|
Benitez BK, Brudnicki A, Surowiec Z, Wieprzowski Ł, Rasadurai A, Nalabothu P, Lill Y, Mueller AA. Digital Impressions from Newborns to Preschoolers with Cleft Lip and Palate: A Two-Centers Experience. J Plast Reconstr Aesthet Surg 2022; 75:4233-4242. [DOI: 10.1016/j.bjps.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/16/2022] [Indexed: 12/12/2022]
|