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Wang K, He Z, Yang X, Shang W, Wang L. Poor condyle position after mandibular reconstruction and a classification system for patients with "VSCU" based on computed tomography: a cross-sectional study with retrospective data collection. Quant Imaging Med Surg 2024; 14:2747-2761. [PMID: 38617172 PMCID: PMC11007527 DOI: 10.21037/qims-23-1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/19/2023] [Indexed: 04/16/2024]
Abstract
Background Although the application of vascularized free bone muscle flap to reconstruct the mandible has become a standardized approach for mandible reconstruction, the results of its reconstruction are not always satisfactory. The purpose of this study was to identify the types of mandibular and condylar defects by analyzing the unsatisfactory cases of mandibular reconstruction in clinical practice, and to provide some clinical experience of reconstruction. Methods Our study retrospectively analyzed 364 patients who underwent mandibular resection and vascularized free bone flap reconstruction of the mandible and temporomandibular joint (TMJ). We innovatively proposed a "VSCU" classification system (V: vertical position, S: sagittal position, C: coronal position, U: condylar resection is not required) by analyzing computed tomography (CT) scans of mandibular branches and TMJs. Results In all, 221 cases of free iliac muscle flap and 143 cases of fibula muscle flap were included in this study, of which 23 cases had unsatisfactory results after TMJ reconstruction. We classified 23 patients with unsatisfactory mandibular reconstruction according to the "VSCU" classification system. The most common type was U + V + SfC (n=8), followed by V - SfC + U + (n=4), V - s + C + U + (n=3), V - sbcou - (n=3), V - SBC + U + (n=2), V - s + C + U - (n=1). The most common classification was insufficient mandibular rami length, followed by condylar sagittal anteriorization. There was no significant change in the position of condyle on the healthy side during mandibular reconstruction involving condyle. P1 on the affected side was 52.28±4.17 mm before operation and 58.94±5.65 mm after operation, P<0.01; P2 was 12.83±3.49 mm before operation and 24.90±7.15 mm after operation. S2 was 4.54±2.84 mm before operation and 19.10±8.54 mm after operation. A2 was 11.46±3.35 mm before operation and 24.15±8.29 mm after operation. The P values were all less than 0.01, and the differences were statistically significant. Conclusions We propose to use the "VSCU" classification system for accurate 3-dimensional (3D) analysis and positioning, and then obtain accurate models through computer-aided design and manufacturing (CAD/CAM), which can reduce the occurrence of poor reconstruction effect and unreasonable joint position, and is worthy of clinical promotion.
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Affiliation(s)
- Kexin Wang
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Zongxuan He
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Xiaochen Yang
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Shang
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Lin Wang
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
- Key Laboratory of Oral Clinical Medicine, Qingdao, China
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Lim HK, Choi YJ, Song IS, Lee JH. Retrospective evaluation of the clinical utility of reconstructed computed tomography images using artificial intelligence in the oral and maxillofacial region. J Craniomaxillofac Surg 2023; 51:543-550. [PMID: 37574384 DOI: 10.1016/j.jcms.2023.08.001] [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: 03/09/2023] [Revised: 06/30/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023] Open
Abstract
The aim of this study was to convert medical images stored in 3 mm slices in the picture archiving and communication system (PACS) to 1 mm slices, using artificial intelligence (AI), and to analyze the accuracy of the AI. The original 1.0 mm CT slices of the facial bone were obtained from 30 patients and reformatted to a rough CT slice of 3.0 mm. CT slices of 1.0 mm were subsequently reconstructed from those of 3.0 mm using AI. The AI and rough CT images were superimposed on the original CT images. Fourteen hard-tissue and five soft-tissue landmarks were selected for measuring the discrepancy. The overall average differences in values for the hard-tissue landmarks were 1.31 ± 0.38 mm and 0.81 ± 0.17 mm for the rough and AI CT images, respectively. The values for the soft-tissue landmarks were 1.18 ± 0.35 mm and 0.54 ± 0.17 mm for the rough and AI CT images, respectively. The differences for all the landmarks, excluding point A and pogonion, were statistically significant. Within the limitations of the study it seems that CT images reconstructed using AI might provide more accurate clinical information with a discrepancy of less than 1.0 mm.
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Affiliation(s)
- Ho-Kyung Lim
- Department of Oral and Maxillofacial Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Young-Jin Choi
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - In-Seok Song
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul, South Korea.
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
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Su Q, Qiao Y, Xiao Y, Yang S, Wu H, Li J, He X, Hu X, Yang H, Yong X. Research progress of 3D printed poly (ether ether ketone) in the reconstruction of craniomaxillofacial bone defects. Front Bioeng Biotechnol 2023; 11:1259696. [PMID: 37662437 PMCID: PMC10469012 DOI: 10.3389/fbioe.2023.1259696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
The clinical challenge of bone defects in the craniomaxillofacial region, which can lead to significant physiological dysfunction and psychological distress, persists due to the complex and unique anatomy of craniomaxillofacial bones. These critical-sized defects require the use of bone grafts or substitutes for effective reconstruction. However, current biomaterials and methods have specific limitations in meeting the clinical demands for structural reinforcement, mechanical support, exceptional biological performance, and aesthetically pleasing reconstruction of the facial structure. These drawbacks have led to a growing need for novel materials and technologies. The growing development of 3D printing can offer significant advantages to address these issues, as demonstrated by the fabrication of patient-specific bioactive constructs with controlled structural design for complex bone defects in medical applications using this technology. Poly (ether ether ketone) (PEEK), among a number of materials used, is gaining recognition as a feasible substitute for a customized structure that closely resembles natural bone. It has proven to be an excellent, conformable, and 3D-printable material with the potential to replace traditional autografts and titanium implants. However, its biological inertness poses certain limitations. Therefore, this review summarizes the distinctive features of craniomaxillofacial bones and current methods for bone reconstruction, and then focuses on the increasingly applied 3D printed PEEK constructs in this field and an update on the advanced modifications for improved mechanical properties, biological performance, and antibacterial capacity. Exploring the potential of 3D printed PEEK is expected to lead to more cost-effective, biocompatible, and personalized treatment of craniomaxillofacial bone defects in clinical applications.
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Affiliation(s)
- Qiao Su
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Department of Paediatrics, West China Second University Hospital, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yixin Qiao
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yile Xiao
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shuhao Yang
- Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Haoming Wu
- Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jianan Li
- State Key Laboratory of Biotherapy, State Key Laboratory and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinlong He
- State Key Laboratory of Biotherapy, State Key Laboratory and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xulin Hu
- Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- State Key Laboratory of Biotherapy, State Key Laboratory and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xin Yong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Department of Paediatrics, West China Second University Hospital, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, Sichuan, China
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Liu S, Liao Y, He B, Dai B, Zhu Z, Shi J, Huang Y, Zou G, Du C, Shi B. Mandibular resection and defect reconstruction guided by a contour registration-based augmented reality system: A preclinical trial. J Craniomaxillofac Surg 2023:S1010-5182(23)00077-X. [PMID: 37355367 DOI: 10.1016/j.jcms.2023.05.007] [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: 11/17/2022] [Revised: 02/22/2023] [Accepted: 05/21/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to verify the feasibility and accuracy of a contour registration-based augmented reality (AR) system in jaw surgery. An AR system was developed to display the interaction between virtual planning and images of the surgical site in real time. Several trials were performed with the guidance of the AR system and the surgical guide. The postoperative cone beam CT (CBCT) data were matched with the preoperatively planned data to evaluate the accuracy of the system by comparing the deviations in distance and angle. All procedures were performed successfully. In nine model trials, distance and angular deviations for the mandible, reconstructed fibula, and fixation screws were 1.62 ± 0.38 mm, 1.86 ± 0.43 mm, 1.67 ± 0.70 mm, and 3.68 ± 0.71°, 5.48 ± 2.06°, 7.50 ± 1.39°, respectively. In twelve animal trials, results of the AR system were compared with the surgical guide. Distance deviations for the bilateral condylar outer poles were 0.93 ± 0.63 mm and 0.81 ± 0.30 mm, respectively (p = 0.68). Distance deviations for the bilateral mandibular posterior angles were 2.01 ± 2.49 mm and 2.89 ± 1.83 mm, respectively (p = 0.50). Distance and angular deviations for the mandible were 1.41 ± 0.61 mm, 1.21 ± 0.18 mm (p = 0.45), and 6.81 ± 2.21°, 6.11 ± 2.93° (p = 0.65), respectively. Distance and angular deviations for the reconstructed tibiofibular bones were 0.88 ± 0.22 mm, 0.84 ± 0.18 mm (p = 0.70), and 6.47 ± 3.03°, 6.90 ± 4.01° (p = 0.84), respectively. This study proposed a contour registration-based AR system to assist surgeons in intuitively observing the surgical plan intraoperatively. The trial results indicated that this system had similar accuracy to the surgical guide.
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Affiliation(s)
- Shaofeng Liu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350004, China
| | - Yunyang Liao
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; Laboratory of Facial Plastic and Reconstruction, Fujian Medical University, Fuzhou, 350004, China
| | - Bingwei He
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, 350108, China; Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, 350108, China
| | - Bowen Dai
- Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Zhaoju Zhu
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, 350108, China; Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, 350108, China
| | - Jiafeng Shi
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, 350108, China; Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, 350108, China
| | - Yue Huang
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; Laboratory of Facial Plastic and Reconstruction, Fujian Medical University, Fuzhou, 350004, China
| | - Gengsen Zou
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; Laboratory of Facial Plastic and Reconstruction, Fujian Medical University, Fuzhou, 350004, China
| | - Chen Du
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350004, China
| | - Bin Shi
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; Laboratory of Facial Plastic and Reconstruction, Fujian Medical University, Fuzhou, 350004, China.
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Krishnadas A, Subash P, Iyer S, Manju V, Thankappan K, Pullan S, Nerurkar SA, Vinay V. Controlling and Stabilising Mandible During Reconstruction: Significance and Techniques. J Maxillofac Oral Surg 2023; 22:56-63. [PMID: 37041959 PMCID: PMC10082878 DOI: 10.1007/s12663-023-01897-5] [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: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 04/13/2023] Open
Abstract
Objective Stable and accurate positioning of condyle in the glenoid fossa is necessary for maintaining occlusion, facial symmetry and normal function of the temporomandibular joint following segmental resection of mandible. In non-reconstructed mandibular segments or those with fractured reconstruction plates the bony defect gets altered due to contraction or inadvertent muscular pull. This paper describes various techniques used to control dentate and edentate segments of the mandible during reconstruction following an ablative procedure. Discussion Secondary mandibular reconstruction has always been a tedious task for the surgeons. Several techniques have been described in literature ranging the use of external fixators, gunning splints and dentures for stabilising mandibular segments. Use of a pre-bent and adapted reconstruction plate is a common practice but may not be feasible in malignancies, benign tumours causing expansion and secondary reconstruction. The current advances in virtual surgical planning allows mandibular reconstruction to be performed in a simpler yet predictable manner. Conclusion The paper describes techniques ranging from twin K-wire placement to occlusal wafers, 3D printed splints and patient specific implants to enable accurate positioning of the segments and achieve pre-operative form. Advances in virtual surgical planning will continue to allow this field to evolve and to improve the quality of life of the patients.
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Affiliation(s)
- Arjun Krishnadas
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Pramod Subash
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Subramania Iyer
- Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - V. Manju
- Department of Prosthodontics and Implantology, Amrita School of Dentistry, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Sony Pullan
- Department of Oral and Maxillofacial Surgery, Royal Free NHS Foundation Trust, Barnet and Chase Farm Hospitals Wellhouse Lane, Barnet, UK
| | - Shibani A. Nerurkar
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Vinanthi Vinay
- Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
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Kim MK, Ham MJ, Kim WR, Kim HG, Kwon KJ, Kim SG, Park YW. Investigating the accuracy of mandibulectomy and reconstructive surgery using 3D customized implants and surgical guides in a rabbit model. Maxillofac Plast Reconstr Surg 2023; 45:8. [PMID: 36701071 PMCID: PMC9880108 DOI: 10.1186/s40902-023-00375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aimed to analyze the accuracy of the output of three-dimensional (3D) customized surgical guides and titanium implants in a rabbit model, and of mandibulectomy, reconstructive surgery, and surgical outcome; additionally, the correlation between surgical accuracy and surgical outcomes, including the differences in surgical outcome according to surgical accuracy, was analyzed. RESULTS The output of implants was accurately implemented within the error range (- 0.03-0.03 mm), and the surgical accuracy varied depending on the measured area (range - 0.4-1.1 mm). Regarding surgical outcomes, angle between the mandibular lower borders showed the most sensitive results and distance between the lingual cusps of the first molars represented the most accurate outcomes. A significant correlation was noted between surgical accuracy in the anteroposterior length of the upper borders pre- and postoperatively and the angle between the mandibular lower borders (regression coefficient = 0.491, p = 0.028). In the group wherein surgery was performed more accurately, the angle between the mandibular lower borders was reproduced more accurately (p = 0.021). A selective laser melting machine accurately printed the implants as designed. Considering the positive correlation among surgical accuracy in the mandibular upper borders, angle between the mandibular lower borders, and more accurately reproduced angle between the mandibular lower borders, the angle between the mandibular lower borders is considered a good indicator for evaluating the outcomes of reconstructive surgery. CONCLUSION To reduce errors in surgical outcomes, it is necessary to devise a positioner for the surgical guide and design a 3D surgical guide to constantly maintain the direction of bone resection. A fixed area considering the concept of three-point fixation should be selected for stable positioning of the implant; in some cases, bilateral cortical bone fixation should be considered. The angle between the mandibular lower borders is a sensitive indicator for evaluating the outcomes of reconstructive surgery.
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Affiliation(s)
- Min Keun Kim
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Min Ji Ham
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Won Rae Kim
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Hyung Giun Kim
- grid.454135.20000 0000 9353 1134Functional Materials and Components R&D Group, Korea Institute of Industrial Technology, Gangneung, 25440 Republic of Korea
| | - Kwang Jun Kwon
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Seong Gon Kim
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
| | - Young Wook Park
- grid.411733.30000 0004 0532 811XDepartment of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457 Republic of Korea
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Park HI, Lee JH, Lee SJ. The comprehensive on-demand 3D bio-printing for composite reconstruction of mandibular defects. Maxillofac Plast Reconstr Surg 2022; 44:31. [PMID: 36195777 PMCID: PMC9532487 DOI: 10.1186/s40902-022-00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The mandible is a functional bio-organ that supports facial structures and helps mastication and speaking. Large mandible defects, generally greater than 6-cm segment loss, may require composite tissue reconstruction such as osteocutaneous-vascularized free flap which has a limitation of additional surgery and a functional morbidity at the donor site. A 3D bio-printing technology is recently developed to overcome the limitation in the composite reconstruction of the mandible using osteocutaneous-vascularized free flap. Review Scaffold, cells, and bioactive molecules are essential for a 3D bio-printing. For mandibular reconstruction, materials in a 3D bio-printing require mechanical strength, resilience, and biocompatibility. Recently, an integrated tissue and organ printing system with multiple cartridges are designed and it is capable of printing polymers to reinforce the printed structure, such as hydrogel. Conclusion For successful composite tissue reconstruction of the mandible, biologic considerations and components should be presented with a comprehensive on-demand online platform model of customized approaches.
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Affiliation(s)
- Han Ick Park
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
| | - Sang Jin Lee
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, 27157, USA.
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Czyżewski W, Jachimczyk J, Hoffman Z, Szymoniuk M, Litak J, Maciejewski M, Kura K, Rola R, Torres K. Low-Cost Cranioplasty—A Systematic Review of 3D Printing in Medicine. MATERIALS 2022; 15:ma15144731. [PMID: 35888198 PMCID: PMC9315853 DOI: 10.3390/ma15144731] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/20/2022] [Accepted: 07/02/2022] [Indexed: 11/22/2022]
Abstract
The high cost of biofabricated titanium mesh plates can make them out of reach for hospitals in low-income countries. To increase the availability of cranioplasty, the authors of this work investigated the production of polymer-based endoprostheses. Recently, cheap, popular desktop 3D printers have generated sufficient opportunities to provide patients with on-demand and on-site help. This study also examines the technologies of 3D printing, including SLM, SLS, FFF, DLP, and SLA. The authors focused their interest on the materials in fabrication, which include PLA, ABS, PET-G, PEEK, and PMMA. Three-dimensional printed prostheses are modeled using widely available CAD software with the help of patient-specific DICOM files. Even though the topic is insufficiently researched, it can be perceived as a relatively safe procedure with a minimal complication rate. There have also been some initial studies on the costs and legal regulations. Early case studies provide information on dozens of patients living with self-made prostheses and who are experiencing significant improvements in their quality of life. Budget 3D-printed endoprostheses are reliable and are reported to be significantly cheaper than the popular counterparts manufactured from polypropylene polyester.
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Affiliation(s)
- Wojciech Czyżewski
- Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland; (W.C.); (K.T.)
- Department of Neurosurgery and Pediatric Neurosurgery in Lublin, 20-090 Lublin, Poland; (J.L.); (K.K.); (R.R.)
| | - Jakub Jachimczyk
- Student Scientific Society, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Zofia Hoffman
- Student Scientific Society, Medical University of Lublin, 20-059 Lublin, Poland;
- Correspondence:
| | - Michał Szymoniuk
- Student Scientific Association of Neurosurgery, Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Jakub Litak
- Department of Neurosurgery and Pediatric Neurosurgery in Lublin, 20-090 Lublin, Poland; (J.L.); (K.K.); (R.R.)
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Marcin Maciejewski
- Department of Electronics and Information Technology, Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, 20-618 Lublin, Poland;
| | - Krzysztof Kura
- Department of Neurosurgery and Pediatric Neurosurgery in Lublin, 20-090 Lublin, Poland; (J.L.); (K.K.); (R.R.)
| | - Radosław Rola
- Department of Neurosurgery and Pediatric Neurosurgery in Lublin, 20-090 Lublin, Poland; (J.L.); (K.K.); (R.R.)
| | - Kamil Torres
- Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland; (W.C.); (K.T.)
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Pampín Martínez MM, Aragón Niño I, Losa Muñoz P, González Martín Moro J, Cebrián Carretero JL. An in house 3D printed space maintainer for plate positioning in mandibular reconstruction. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Medical 3D Printing with a focus on Point-of-Care in Cranio- and Maxillofacial Surgery. A systematic review of literature. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Kim WD, Cho I, Kim YD, Cha MJ, Kim SW, Choi Y, Shin SY. Improving Left Atrial Appendage Occlusion Device Size Determination by Three-Dimensional Printing-Based Preprocedural Simulation. Front Cardiovasc Med 2022; 9:830062. [PMID: 35252401 PMCID: PMC8889006 DOI: 10.3389/fcvm.2022.830062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/18/2022] [Indexed: 01/01/2023] Open
Abstract
Background The two-dimensional (2D)-based left atrial appendage (LAA) occluder (LAAO) size determination by using transesophageal echocardiography (TEE) is limited by the structural complexity and wide anatomical variation of the LAA. Objective This study aimed to assess the accuracy of the LAAO size determination by implantation simulation by using a three-dimensional (3D)-printed model compared with the conventional method based on TEE. Methods We retrospectively reviewed patients with anatomically and physiologically properly implanted the Amplatzer Cardiac Plug and Amulet LAAO devices between January 2014 and December 2018 by using the final size of the implanted devices as a standard for size prediction accuracy. The use of 3D-printed model simulations in device sizing was compared with the conventional TEE-based method. Results A total of 28 cases with the percutaneous LAA occlusion were reviewed. There was a minimal difference [−0.11 mm; 95% CI (−0.93, 0.72 mm); P = 0.359] between CT-based reconstructed 3D images and 3D-printed left atrium (LA) models. Device size prediction based on TEE measurements showed poor agreement (32.1%), with a mean difference of 2.3 ± 3.2 mm [95% CI (−4.4, 9.0)]. The LAAO sizing by implantation simulation with 3D-printed models showed excellent correlation with the actually implanted LAAO size (r = 0.927; bias = 0.7 ± 2.5). The agreement between the 3D-printed and the implanted size was 67.9%, with a mean difference of 0.6 mm [95% CI (−1.9, 3.2)]. Conclusion The use of 3D-printed LA models in the LAAO size determination showed improvement in comparison with conventional 2D TEE method.
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Affiliation(s)
- William D. Kim
- College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Iksung Cho
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Doo Kim
- Department of Mechanical Engineering, Graduate School, Chung-Ang University, Seoul, South Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, South Korea
| | - Sang-Wook Kim
- Division of Cardiology, Chung-Ang University Hospital, Seoul, South Korea
- Heart Research Institute, Chung-Ang University Hospital, Seoul, South Korea
| | - Young Choi
- Department of Mechanical Engineering, Graduate School, Chung-Ang University, Seoul, South Korea
| | - Seung Yong Shin
- Division of Cardiology, Chung-Ang University Hospital, Seoul, South Korea
- *Correspondence: Seung Yong Shin
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Wu P, Hu L, Li H, Feng L, Liu Y, Zhang S, Li XC, Zhang ML, Yang SY, Lu RJ. Clinical application and accuracy analysis of 3D printing guide plate based on polylactic acid in mandible reconstruction with fibula flap. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:460. [PMID: 33850857 PMCID: PMC8039666 DOI: 10.21037/atm-20-6781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Due to the special anatomy morphology and physiological function of the mandible, it has always become a challenge to accurately reconstruct the mandibular defect in maxillofacial surgery. Digital three dimensions (3D) printing surgical guide, as the effective method for individual and accurate surgery, is a hotspot of clinical research at present. In this study, 3D printing PLA surgical guide plate was applied to reconstruct the mandibular defect with fibula flap, its clinical effect and accuracy were evaluated, which aimed to improve the accurate reconstruction of mandibular defects. Methods After sterilization, the dimension deformation of the PLA standard specimen were measured. Eighteen patients diagnose with mandibular tumor were collected as observation objects. Then partial mandible resection and simultaneous mandible reconstruction with fibula graft were implemented according to the computer-aided design plan. The clinical effects of 3D printing PLA guide plates application were evaluated by facial contours, occlusal stability and chewing function. Through registering the postoperative computed images reconstruction with preoperative designed shape, the reconstruction accuracy was evaluated by detecting the maximum difference including the distance between lateral convex point of the condyles, the distance between medial convex point of the condyles and the horizontal contained angle between long axis of the condyles. Results After high temperature steam sterilization, the curvature of the PLA specimen with 100% filling rate and 4.8 mm thickness were the smallest and their dimension deformation had no statistical significance (P>0.05). The minimally deformed 3D printing PLA guide plate were smoothly placed in the right place during the operation. After surgery, the face was symmetrical, the occlusal relationship was restored well and no deviation of the mandibular movement were found. The spiral computed tomography (SCT) scanning showed that the distance between lateral/medial convex points of the condyle and the horizontal contained angle were 128.34±8.68 mm, 88.69±6.75 mm and 145.87°±12.01°. Compared with preoperative design, the maximum deviation of the actual postoperative registration was 1.67±0.63, and the difference was not statistically significant (P>0.05). Conclusions The application of 3D printing PLA guide plate in the segmental section and reconstruction of the mandible can effectively simplify the operation, and better reconstruct the continuity of the mandible. The surgical accuracy can fully meet clinical needs with relatively low prices.
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Affiliation(s)
- Po Wu
- Department of Stomatology, The General Hospital of Western Theater Command PLA, Chengdu, China
| | - Lin Hu
- Department of Stomatology, Beijing Chaoyang Hospital, Beijing, China
| | - Hao Li
- Department of Stomatology, The General Hospital of Western Theater Command PLA, Chengdu, China
| | - Lin Feng
- Institute of Stomatology & Oral Maxilla Facial Key Laboratory, Chinese PLA General Hospital, Beijing, China
| | - Yu Liu
- Department of Stomatology, The General Hospital of Western Theater Command PLA, Chengdu, China
| | - Shuo Zhang
- Institute of Stomatology & Oral Maxilla Facial Key Laboratory, Chinese PLA General Hospital, Beijing, China
| | - Xue-Chao Li
- Department of Stomatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mei-Ling Zhang
- Department of Stomatology, Beijing Huairou Hospital of Traditional Chinese Medicine, Beijing, China
| | - Shu-Yong Yang
- Department of Stomatology, The General Hospital of Western Theater Command PLA, Chengdu, China
| | - Rong-Jian Lu
- Department of Stomatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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