EPPOCRATIS: A Point-of-Care Utilization of Virtual Surgical Planning and Three-Dimensional Printing for the Management of Acute Craniomaxillofacial Trauma

Can a Point-of-Care 3D Printing Workflow Produce Accurate and Successful Results for Craniomaxillofacial Trauma?

BACKGROUND

Computer-aided design and manufacturing (CAD/CAM) is having a profound impact on craniomaxillofacial surgery, and point-of-care (POC) solutions for repairing facial trauma are starting to emerge.

PURPOSE

The purpose of this study was to demonstrate the success and accuracy of a POC 3D printing workflow for craniomaxillofacial trauma.

STUDY DESIGN, SETTING, SAMPLE

A retrospective cohort study was undertaken to analyze subjects presenting to a level 1 trauma center after sustaining facial trauma and were then treated using the POC 3D printing workflow. Subjects were excluded if they were not treated with the POC 3D printing workflow, were lost to follow-up, or if clinical data were incomplete.

PREDICTOR VARIABLE

Predictor variables included the cause of trauma (mechanism), location of the mandibular fracture, type of fracture, mandibular severity score, and repair error (ie, root mean square error (RMSE) value for planned vs actual outcome).

MAIN OUTCOME VARIABLE(S)

The primary outcome variables were case success and case error. Success was defined as clinical and radiographic evidence of bony stability at 3 months. Case accuracy was calculated overlaying preoperative plan data to postoperative data generating a numerical value (RMSE value, mm).

COVARIATES

Covariates included age (years), gender (male/female), surgery time (mins), and CAD/CAM time (preoperative).

ANALYSES

Descriptive statistics were calculated for each variable. Dependence between rates or counts was established using the Wilcoxon rank sum or Fisher's exact test. Linear regression model was computed to discern how predictor variables influence RMSE. A P value < .05 was considered statistically significant.

RESULTS

The sample included 27 subjects (19 male/8 female). The average age of all subjects was 46.4 ± 18.0 years. Common mechanisms of injury were assault (33%) and self-inflicted gunshots (SIGSW; 30%), and the average severity score for mandible injury was (13.5 ± 3.3). Ninety-three percent of cases were deemed successful. The average repair accuracy (RMSE value) was 3.4 ± 1.8 mm. A linear regression model indicated those injured by a fall (β-coefficient 1.99; P = .010), motor vehicle collision (β-coefficient 1.49; P = .043), or SIGSW (β-coefficient 2.82; P < .001) correlated with RMSE.

CONCLUSION AND RELEVANCE

In-house CAD/CAM technologies can be utilized at the POC to repair complex facial trauma accurately and successfully.

Craniomaxillofacial Trauma: The Past, Present and the Future

Reconstruction of facial trauma has seen a significant evolutionary leap in the last 100 years. The current surgical management of facial fractures was made possible by the efforts and creativity of pioneer surgeons, advances in anatomic understanding, and the continued development of biomaterials and imaging technologies. Virtual surgical planning (VSP) and 3-dimensional printing (3DP) are being incorporated into the management of acute facial trauma. The integration of this technology at the point of care is rapidly expanding globally. This article reviews the history of the management of craniomaxillofacial trauma, current practices, and future directions. The use of VSP and 3DP in facial trauma care is highlighted with a description of EPPOCRATIS, a rapid point-of-care process incorporating VSP and 3DP at the trauma center.

Improving the Treatment Outcome of Naso-Orbito-Ethmoido-Maxillary Fractures Using Virtual Three-Dimensional Anthropometric Data

BACKGROUND

Naso-orbito-ethmoido-maxillary (NOEM) fractures are usually the result of a high or moderate intensity impact to the upper midface. These types of fractures are difficult to treat and are frequently misdiagnosed. Craniometric analysis can be of real aid in the treatment of NOEM complex fractures by establishing midfacial proportions.

AIM

This study aims to establish the distances between selected anthropometric points and midfacial proportions found in the adult Caucasian population and to determine if any differences exist between genders.

METHODOLOGY

Measurements between anthropometric points, nasion (N), dacryon (D), infraorbital foramen (IOF), frontomalare orbitale (FMO), rhinion (Rhi) and porion (Po), were made on 3D models obtained using patients' CT exams.

RESULTS

Significant differences were found between genders for the orbital dimensions represented by N-FMO (p = 0.000), N-IOF (p = 0.000), Rhi-FMO (p = 0.000), Rhi-IOF (p = 0.000), nose bridge width N-D (p = 0.001), Rhi-D (p = 0.016), D-D (p = 0.038) and the projection of the nose evaluated by Rhi-Po (p = 0.000), N-Po (p = 0.000), while a t-test showed that there are no significant differences between males and females for the N-Rhi (p = 0.254).

CONCLUSIONS

The values of these measurements can be utilized during skeletal reconstruction after NOEM fractures, especially for bilateral comminuted fractures where no points of comparison are available.