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Schipper JAM, Merema BJ, Hollander MHJ, Spijkervet FKL, Dijkstra PU, Jansma J, Schepers RH, Kraeima J. Reliability and validity of handheld structured light scanners and a static stereophotogrammetry system in facial three-dimensional surface imaging. Sci Rep 2024; 14:8172. [PMID: 38589391 PMCID: PMC11001849 DOI: 10.1038/s41598-024-57370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
Several new systems for three-dimensional (3D) surface imaging of the face have become available to assess changes following orthognathic or facial surgery. Before they can be implemented in practice, their reliability and validity must be established. Our aim, therefore, was to study the intra- and inter-system reliability and validity of 3dMD (stereophotogrammetry), Artec Eva and Artec Space Spider (both structured light scanners). Intra- and inter-system reliability, expressed in root mean square distance, was determined by scanning a mannequin's head and the faces of healthy volunteers multiple times. Validity was determined by comparing the linear measurements of the scans with the known distances of a 3D printed model. Post-processing errors were also calculated. Intra-system reliability after scanning the mannequin's head was best with the Artec Space Spider (0.04 mm Spider; 0.07 mm 3dMD; 0.08 mm Eva). The least difference in inter-system reliability after scanning the mannequin's head was between the Artec Space Spider and Artec Eva. The best intra-system reliability after scanning human subjects was with the Artec Space Spider (0.15 mm Spider; 0.20 mm Eva; 0.23 mm 3dMD). The least difference in inter-system reliability after scanning human subjects was between the Artec Eva and Artec Space Spider. The most accurate linear measurement validity occurred with the Artec Space Spider. The post-processing error was 0.01 mm for all the systems. The Artec Space Spider is the most reliable and valid scanning system.
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Affiliation(s)
- J A M Schipper
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - B J Merema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M H J Hollander
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, 14 Arun Amarin Rd, Bangkok, 10700, Thailand
| | - J Jansma
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R H Schepers
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Vosselman N, Kraeima J, Ng Wei Siang K, Raghoebar GM, Witjes MJH, de Visscher SAHJ. Guided placement of zygomatic implants in head and neck cancer patients: implant survival and patient outcomes at 1-3 years of follow-up. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00057-2. [PMID: 38494409 DOI: 10.1016/j.ijom.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
Zygomatic implants (ZI) are a valuable option for supporting an obturator prosthesis after maxillary resection. This study was performed to assess the clinical outcomes of a digitally validated guided technique for ZI placement, followed by immediate prosthetic obturation. The primary objective was to evaluate implant survival, while the secondary objective was to assess patient-reported quality of life post-rehabilitation. Twelve patients treated for head and neck cancer received a total of 36 ZI after ablative surgery. The mean duration of ZI follow-up was 30.1 months. The survival rate of ZI placed in non-irradiated patients was 100%, while it was 85% in irradiated patients. Patient-reported outcomes were evaluated using the Liverpool Oral Rehabilitation Questionnaire (LORQv3) and the University of Washington Quality of Life Questionnaire (UW-QOL v4). Most patients reported satisfactory outcomes in the oral function domain of the LORQv3 (mean score 17.7 ± 4.5; possible range 12-48, with lower scores indicating better outcomes). Regarding the UW-QOL v4, the swallowing and chewing domains had the highest scores (mean 97.5 ± 8.7 and 95.8 ± 14.4, respectively; maximum possible score of 100). In conclusion, this treatment approach improves function and quality of life after maxillary ablative surgery. However, irradiated patients showed a noticeable trend of higher implant failure, and this was influenced by tumour position and size impacting the radiation dose to the zygomatic bone.
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Affiliation(s)
- N Vosselman
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - J Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - K Ng Wei Siang
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Radiation Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - S A H J de Visscher
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Oldhoff MGE, Assink N, Kraeima J, de Vries JPPM, Ten Duis K, Meesters AML, IJpma FFA. 3D-assisted corrective osteotomies of the distal radius: a comparison of pre-contoured conventional implants versus patient-specific implants. Eur J Trauma Emerg Surg 2024; 50:37-47. [PMID: 38261077 PMCID: PMC10924012 DOI: 10.1007/s00068-023-02415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/25/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE There is a debate whether corrective osteotomies of the distal radius should be performed using a 3D work-up with pre-contoured conventional implants (i.e., of-the-shelf) or patient-specific implants (i.e., custom-made). This study aims to assess the postoperative accuracy of 3D-assisted correction osteotomy of the distal radius using either implant. METHODS Twenty corrective osteotomies of the distal radius were planned using 3D technologies and performed on Thiel embalmed human cadavers. Our workflow consisted of virtual surgical planning and 3D printed guides for osteotomy and repositioning. Subsequently, left radii were fixated with patient-specific implants, and right radii were fixated with pre-contoured conventional implants. The accuracy of the corrections was assessed through measurement of rotation, dorsal and radial angulation and translations with postoperative CT scans in comparison to their preoperative virtual plan. RESULTS Twenty corrective osteotomies were executed according to their plan. The median differences between the preoperative plan and postoperative results were 2.6° (IQR: 1.6-3.9°) for rotation, 1.4° (IQR: 0.6-2.9°) for dorsal angulation, 4.7° (IQR: 2.9-5.7°) for radial angulation, and 2.4 mm (IQR: 1.3-2.9 mm) for translation of the distal radius, thus sufficient for application in clinical practice. There was no significant difference in accuracy of correction when comparing pre-contoured conventional implants with patient-specific implants. CONCLUSION 3D-assisted corrective osteotomy of the distal radius with either pre-contoured conventional implants or patient-specific implants results in accurate corrections. The choice of implant type should not solely depend on accuracy of the correction, but also be based on other considerations like the availability of resources and the preoperative assessment of implant fitting.
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Affiliation(s)
- Miriam G E Oldhoff
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne M L Meesters
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Assink N, Oldhoff MGE, Ten Duis K, Kraeima J, Doornberg JN, Witjes MJH, de Vries JPPM, Meesters AML, IJpma FFA. Development of patient-specific osteosynthesis including 3D-printed drilling guides for medial tibial plateau fracture surgery. Eur J Trauma Emerg Surg 2024; 50:11-19. [PMID: 37391531 PMCID: PMC10924019 DOI: 10.1007/s00068-023-02313-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE A substantial proportion of conventional tibial plateau plates have a poor fit, which may result in suboptimal fracture reduction due to applied -uncontrolled- compression on the bone. This study aimed to assess whether patient-specific osteosyntheses could facilitate proper fracture reduction in medial tibial plateau fractures. METHODS In three Thiel embalmed human cadavers, a total of six tibial plateau fractures (three Schatzker 4, and three Schatzker 6) were created and CT scans were made. A 3D surgical plan was created and a patient-specific implant was designed and fabricated for each fracture. Drilling guides that fitted on top of the customized plates were designed and 3D printed in order to assist the surgeon in positioning the plate and steering the screws in the preplanned direction. After surgery, a postoperative CT scan was obtained and outcome was compared with the preoperative planning in terms of articular reduction, plate positioning, and screw direction. RESULTS A total of six patient-specific implants including 41 screws were used to operate six tibial plateau fractures. Three fractures were treated with single plating, and three fractures with dual plating. The median intra-articular gap was reduced from 6.0 (IQR 4.5-9.5) to 0.9 mm (IQR 0.2-1.4), whereas the median step-off was reduced from 4.8 (IQR 4.1-5.3) to 1.3 mm (IQR 0.9-1.5). The median Euclidean distance between the centre of gravity of the planned and actual implant was 3.0 mm (IQR: 2.8-3.7). The lengths of the screws were according to the predetermined plan. None of the screws led to screw penetration. The median difference between the planned and actual screw direction was 3.3° (IQR: 2.5-5.1). CONCLUSION This feasibility study described the development and implementation of a patient-specific workflow for medial tibial plateau fracture surgery that facilitates proper fracture reduction, tibial alignment and accurately placed screws by using custom-made osteosynthesis plates with drilling guides.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Miriam G E Oldhoff
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Joep Kraeima
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Job N Doornberg
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Max J H Witjes
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Anne M L Meesters
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Assink N, ten Duis K, de Vries JPPM, Witjes MJH, Kraeima J, Doornberg JN, IJpma FFA. 3D surgical planning including patient-specific drilling guides for tibial plateau fractures. Bone Jt Open 2024; 5:46-52. [PMID: 38240277 PMCID: PMC10797644 DOI: 10.1302/2633-1462.51.bjo-2023-0130.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Aims Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026). Conclusion The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kaj ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Max J. H. Witjes
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joep Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Job N. Doornberg
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Flinders University, Adelaide, Australia
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Zee MJM, Pijpker PAJ, Kraeima J, Viddeleer AR, Diercks RL. Patient specific instrumentation in ACL reconstruction: a proof-of-concept cadaver experiment assessing drilling accuracy when using 3D printed guides. Arch Orthop Trauma Surg 2024; 144:289-296. [PMID: 37773534 PMCID: PMC10774211 DOI: 10.1007/s00402-023-05072-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Accurate positioning of the femoral tunnel in ACL reconstruction is of the utmost importance to reduce the risk of graft failure. Limited visibility during arthroscopy and a wide anatomical variance attribute to femoral tunnel malposition using conventional surgical techniques. The purpose of this study was to determine whether a patient specific 3D printed surgical guide allows for in vitro femoral tunnel positioning within 2 mm of the planned tunnel position. MATERIALS AND METHODS A patient specific guide for femoral tunnel positioning in ACL reconstruction was created for four human cadaveric knee specimens based on routine clinical MRI data. Fitting properties were judged by two orthopedic surgeons. MRI scanning was performed both pre- and post-procedure. The planned tunnel endpoint was compared to the actual drilled femoral tunnel. RESULTS This patient specific 3D printed guide showed a mean deviation of 5.0 mm from the center of the planned femoral ACL origin. CONCLUSION In search to improve accuracy and consistency of femoral tunnel positioning in ACL reconstruction, the use of a patient specific 3D printed surgical guide is a viable option to explore further. The results are comparable to those of conventional techniques; however, further design improvements are necessary to improve accuracy and enhance reproducibility.
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Affiliation(s)
- Mark J M Zee
- Department of Orthopedic Surgery, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands.
| | - Peter A J Pijpker
- 3D Lab, Department of Orthopedic Surgery, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab, Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands
| | - Alain R Viddeleer
- Medical Imaging Center, Department of Radiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands
| | - Ronald L Diercks
- Department of Orthopedic Surgery, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands
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Huizinga MP, Stenekes MW, Kraeima J, de Visscher SAHJ, Raghoebar GM, Werker PMN, Witjes MJH. Prefabricated fibula free flaps in reconstruction of maxillofacial defects: Two cases of transplanting a fractured fibula. Head Neck 2023; 45:E67-E72. [PMID: 37818676 DOI: 10.1002/hed.27542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/20/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The two-staged prefabricated vascularized fibula free flap is used in maxillofacial reconstruction. We describe the possible cause and management of two cases of fibula fracture after implant placement. METHODS The patients were treated with two-stage reconstruction with a prefabricated vascularized fibula free flap. Six dental implants were placed in both fibulas. Fibula fractures occurred during the osseointegration period before the second procedure. The reconstruction was continued as planned. RESULTS Both fibulas fractured in the distal segment, possibly due to a thinner cortex more distally. Harvesting of a fractured fibula flap is more difficult than normally due to callus formation and fibrosis. Both transplants became fully functional with extended healing and additional surgery. CONCLUSION The fracture apparently did not compromise the vascularisation of the fibula and proved still sufficient for successful harvest and transfer of the flap. The patient should be made aware that additional corrective surgery may be indicated.
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Affiliation(s)
- Martin P Huizinga
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin W Stenekes
- Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M N Werker
- Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Assink N, Bosma E, Meesters AML, van Helden SH, Nijveldt RJ, ten Duis K, Witjes MJH, de Vries JPPM, Kraeima J, IJpma FFA. Initial and Residual 3D Fracture Displacement Is Predictive for Patient-Reported Functional Outcome at Mid-Term Follow-Up in Surgically Treated Tibial Plateau Fractures. J Clin Med 2023; 12:6055. [PMID: 37762994 PMCID: PMC10531969 DOI: 10.3390/jcm12186055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Conventional measures of fracture displacement have low interobserver reliability. This study introduced a novel 3D method to measure tibial plateau fracture displacement and its impact on functional outcome. METHODS A multicentre study was conducted on patients who had tibial plateau fracture surgery between 2003 and 2018. Eligible patients had a preoperative CT scan (slice thickness ≤ 1 mm) and received a Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A total of 362 patients responded (57%), and assessment of initial and residual fracture displacement was performed via measurement using the 3D gap area (mm2). Patients were divided into four groups based on the 3D gap area size. Differences in functional outcome between these groups were assessed using analysis of variance (ANOVA). Multiple linear regression was used to determine the association between fracture displacement and patient-reported outcome. RESULTS Functional outcome appeared significantly worse when initial or residual fracture displacement increased. Multivariate linear regression showed that initial 3D gap area (per 100 mm2) was significantly negatively associated with all KOOS subscales: symptoms (-0.9, p < 0.001), pain (-0.0, p < 0.001), ADL (-0.8, p = 0.002), sport (-1.4, p < 0.001), and QoL (-1.1, p < 0.001). In addition, residual gap area was significantly negatively associated with the subscales symptoms (-2.2, p = 0.011), ADL (-2.2, p = 0.014), sport (-2.6, p = 0.033), and QoL (-2.4, p = 0.023). CONCLUSION A novel 3D measurement method was applied to quantify initial and residual displacement. This is the first study which can reliably classify the degree of displacement and indicates that increasing displacement results in poorer patient-reported functional outcomes.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | - Eelke Bosma
- Department of Trauma Surgery, Martini Hospital, 9712 CP Groningen, The Netherlands;
| | - Anne M. L. Meesters
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | - Sven H. van Helden
- Department of Trauma Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands; (S.H.v.H.); (R.J.N.)
| | - Robert J. Nijveldt
- Department of Trauma Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands; (S.H.v.H.); (R.J.N.)
| | - Kaj ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
| | - Max J. H. Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | | | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
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Assink N, El Moumni M, Kraeima J, Bosma E, Nijveldt RJ, van Helden SH, Vaartjes TP, Ten Brinke JG, Witjes MJH, de Vries JPPM, IJpma FFA. Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery: Results in a Large Multicenter Cohort. J Bone Joint Surg Am 2023; 105:1237-1245. [PMID: 37196070 DOI: 10.2106/jbjs.22.00500] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Radiographic measurements of initial displacement of tibial plateau fractures and of postoperative reduction are used to determine treatment strategy and prognosis. We assessed the association between radiographic measurements and the risk of conversion to total knee arthroplasty (TKA) at the time of follow-up. METHODS A total of 862 patients surgically treated for tibial plateau fractures between 2003 and 2018 were eligible for this multicenter cross-sectional study. Patients were approached for follow-up, and 477 (55%) responded. The initial gap and step-off were measured on the preoperative computed tomography (CT) scans of the responders. Condylar widening, residual incongruity, and coronal and sagittal alignment were measured on postoperative radiographs. Critical cutoff values for gap and step-off were determined using receiver operating characteristic curves. Postoperative reduction measurements were categorized as adequate or inadequate on the basis of cutoff values in international guidelines. Multivariable analysis was performed to assess the association between each radiographic measurement and conversion to TKA. RESULTS Sixty-seven (14%) of the patients had conversion to TKA after a mean follow-up of 6.5 ± 4.1 years. Assessment of the preoperative CT scans revealed that a gap of >8.5 mm (hazard ratio [HR] = 2.6, p < 0.001) and step-off of >6.0 mm (HR = 3.0, p < 0.001) were independently associated with conversion to TKA. Assessment of the postoperative radiographs demonstrated that residual incongruity of 2 to 4 mm was not associated with increased risk of TKA compared with adequate fracture reduction of <2 mm (HR = 0.6, p = 0.176). Articular incongruity of >4 mm resulted in increased risk of TKA. Coronal (HR = 1.6, p = 0.05) and sagittal malalignment (HR = 3.7 p < 0.001) of the tibia were strongly associated with conversion to TKA. CONCLUSIONS Substantial preoperative fracture displacement was a strong predictor of conversion to TKA. Postoperative gaps or step-offs of >4 mm as well as inadequate alignment of the tibia were strongly associated with an increased risk of TKA. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
- 3D Lab, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelke Bosma
- Department of Trauma Surgery, Martini Hospital, Groningen, The Netherlands
| | - Robert J Nijveldt
- Department of Trauma Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Sven H van Helden
- Department of Trauma Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Thijs P Vaartjes
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
- Department of Trauma Surgery, Gelre Hospital, Apeldoorn, The Netherlands
| | - Joost G Ten Brinke
- Department of Trauma Surgery, Gelre Hospital, Apeldoorn, The Netherlands
| | - Max J H Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Frank F A IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
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van Veldhuizen WA, van der Wel H, Kuipers HY, Kraeima J, Ten Duis K, Wolterink JM, de Vries JPPM, Schuurmann RCL, IJpma FFA. Development of a Statistical Shape Model and Assessment of Anatomical Shape Variations in the Hemipelvis. J Clin Med 2023; 12:jcm12113767. [PMID: 37297962 DOI: 10.3390/jcm12113767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Knowledge about anatomical shape variations in the pelvis is mandatory for selection, fitting, positioning, and fixation in pelvic surgery. The current knowledge on pelvic shape variation mostly relies on point-to-point measurements on 2D X-ray images and computed tomography (CT) slices. Three-dimensional region-specific assessments of pelvic morphology are scarce. Our aim was to develop a statistical shape model of the hemipelvis to assess anatomical shape variations in the hemipelvis. CT scans of 200 patients (100 male and 100 female) were used to obtain segmentations. An iterative closest point algorithm was performed to register these 3D segmentations, so a principal component analysis (PCA) could be performed, and a statistical shape model (SSM) of the hemipelvis was developed. The first 15 principal components (PCs) described 90% of the total shape variation, and the reconstruction ability of this SSM resulted in a root mean square error of 1.58 (95% CI: 1.53-1.63) mm. In summary, an SSM of the hemipelvis was developed, which describes the shape variations in a Caucasian population and is able to reconstruct an aberrant hemipelvis. Principal component analyses demonstrated that, in a general population, anatomical shape variations were mostly related to differences in the size of the pelvis (e.g., PC1 describes 68% of the total shape variation, which is attributed to size). Differences between the male and female pelvis were most pronounced in the iliac wing and pubic rami regions. These regions are often subject to injuries. Future clinical applications of our newly developed SSM may be relevant for SSM-based semi-automatic virtual reconstruction of a fractured hemipelvis as part of preoperative planning. Lastly, for companies, using our SSM might be interesting in order to assess which sizes of pelvic implants should be produced to provide proper-fitting implants for most of the population.
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Affiliation(s)
| | - Hylke van der Wel
- Department of Oral and Maxillofacial Surgery/3D Lab, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Hennie Y Kuipers
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery/3D Lab, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Jelmer M Wolterink
- Department of Applied Mathematics, Technical Medical Centre, 7500 AE Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
- Multimodality Medical Imaging Group, Technical Medical Centre, University of Twente, 7500 AE Enschede, The Netherlands
| | - Frank F A IJpma
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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11
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van der Wel H, Qiu B, Spijkervet FKL, Jansma J, Schepers RH, Kraeima J. Morphological Variation of the Mandible in the Orthognathic Population-A Morphological Study Using Statistical Shape Modelling. J Pers Med 2023; 13:jpm13050854. [PMID: 37241024 DOI: 10.3390/jpm13050854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to investigate the value of 3D Statistical Shape Modelling for orthognathic surgery planning. The goal was to objectify shape variations in the orthognathic population and differences between male and female patients by means of a statistical shape modelling method. Pre-operative CBCT scans of patients for whom 3D Virtual Surgical Plans (3D VSP) were developed at the University Medical Center Groningen between 2019 and 2020 were included. Automatic segmentation algorithms were used to create 3D models of the mandibles, and the statistical shape model was built through principal component analysis. Unpaired t-tests were performed to compare the principal components of the male and female models. A total of 194 patients (130 females and 64 males) were included. The mandibular shape could be visually described by the first five principal components: (1) The height of the mandibular ramus and condyles, (2) the variation in the gonial angle of the mandible, (3) the width of the ramus and the anterior/posterior projection of the chin, (4) the lateral projection of the mandible's angle, and (5) the lateral slope of the ramus and the inter-condylar distance. The statistical test showed significant differences between male and female mandibular shapes in 10 principal components. This study demonstrates the feasibility of using statistical shape modelling to inform physicians about mandible shape variations and relevant differences between male and female mandibles. The information obtained from this study could be used to quantify masculine and feminine mandibular shape aspects and to improve surgical planning for mandibular shape manipulations.
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Affiliation(s)
- Hylke van der Wel
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Bingjiang Qiu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Johan Jansma
- Department of Oral and Maxillofacial Surgery, Expertcenter for Orthofacial Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Rutger H Schepers
- Department of Oral and Maxillofacial Surgery, Expertcenter for Orthofacial Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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12
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Pinkster HJ, Meesters AM, IJpma FF, Taal E, Kraeima J, Ten Klooster PM. Developing a patient satisfaction measure for imaging-based patient information during clinical consultations. Patient Experience Journal 2022. [DOI: 10.35680/2372-0247.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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13
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Assink N, Kraeima J, Meesters AML, El Moumni M, Bosma E, Nijveldt RJ, van Helden SH, de Vries JPPM, Witjes MJH, IJpma FFA. 3D assessment of initial fracture displacement of tibial plateau fractures is predictive for risk on conversion to total knee arthroplasty at long-term follow-up. Eur J Trauma Emerg Surg 2022; 49:867-874. [PMID: 36264307 PMCID: PMC10175438 DOI: 10.1007/s00068-022-02139-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Currently used classification systems and measurement methods are insufficient to assess fracture displacement. In this study, a novel 3D measure for fracture displacement is introduced and associated with risk on conversion to total knee arthroplasty (TKA). METHODS A multicenter cross-sectional study was performed including 997 patients treated for a tibial plateau fracture between 2003 and 2018. All patients were contacted for follow-up and 534 (54%) responded. For all patients, the 3D gap area was determined in order to quantify the degree of initial fracture displacement. A cut-off value was determined using ROC curves. Multivariate analysis was performed to assess the association of 3D gap area with conversion to TKA. Subgroups with increasing levels of 3D gap area were identified, and Kaplan-Meier survival curves were plotted to assess survivorship of the knee free from conversion to TKA. RESULTS A total of 58 (11%) patients underwent conversation to TKA. An initial 3D gap area ≥ 550 mm2 was independently associated with conversion to TKA (HR 8.4; p = 0.001). Four prognostic groups with different ranges of the 3D gap area were identified: excellent (0-150 mm2), good (151-550 mm2), moderate (551-1000 mm2), and poor (> 1000 mm2). Native knee survival at 10-years follow-up was 96%, 95%, 76%, and 59%, respectively, in the excellent, good, moderate, and poor group. CONCLUSION A novel 3D measurement method was developed to quantify initial fracture displacement of tibial plateau fractures. 3D fracture assessment adds to current classification methods, identifies patients at risk for conversion to TKA at follow-up, and could be used for patient counselling about prognosis. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Joep Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne M L Meesters
- Department of Trauma Surgery, University of Groningen, University Medical Center HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University of Groningen, University Medical Center HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Eelke Bosma
- Department of Trauma Surgery, Martini Hospital, Groningen, The Netherlands
| | - Robert J Nijveldt
- Department of Trauma Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Sven H van Helden
- Department of Trauma Surgery, Isala Hospital, Zwolle, The Netherlands
| | | | - Max J H Witjes
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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14
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van der Wel H, Kraeima J, Spijkervet FKL, Schepers RH, Jansma J. Postoperative skeletal stability at the one-year follow-up after splintless Le Fort I osteotomy using patient-specific osteosynthesis versus conventional osteosynthesis: a randomized controlled trial. Int J Oral Maxillofac Surg 2022; 52:679-685. [PMID: 36202719 DOI: 10.1016/j.ijom.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/23/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to assess the 1-year skeletal stability of the osteotomized maxilla after Le Fort I surgery, comparing conventional osteosynthesis with patient-specific osteosynthesis. Patients were assigned to a conventional or patient-specific osteosynthesis group using prospective randomization. The primary outcome was the three-dimensional change in postoperative skeletal position of the maxilla between the 2-week and 1-year follow-up cone beam computed tomography scans. Fifty-eight patients completed the protocol for the 2-week postoperative analysis, and 27 patients completed the 1-year follow-up study protocol. Of the 27 patients completing the entire protocol, 13 were in the conventional group and 14 in the patient-specific osteosynthesis group. The three-dimensional translation analysis showed that the use of the patient-specific osteosynthesis resulted in a skeletally stable result, comparable to that of conventional miniplate fixation. For both the patient-specific osteosynthesis and conventional miniplate fixation groups, median translations of less than 1 mm and median rotations of less than 1° were observed, indicating that both methods of fixation resulted in a stable result for the 27 patients examined. For the Le Fort I osteotomy, the choice between patient-specific osteosynthesis and conventional osteosynthesis did not affect the postoperative skeletal stability after 1 year of follow-up.
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Affiliation(s)
- H van der Wel
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
| | - J Kraeima
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - F K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - R H Schepers
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Department of Oral and Maxillofacial Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - J Jansma
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Department of Oral and Maxillofacial Surgery, Martini Hospital Groningen, Groningen, the Netherlands
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15
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Roelofs LJM, Meesters AML, Assink N, Kraeima J, Van der Meulen TD, Doornberg JN, De Vries JPPM, Hoekstra J, ten Duis K, IJpma FFA. A new quantitative 3D gap area measurement of fracture displacement of intra-articular distal radius fractures: Reliability and clinical applicability. PLoS One 2022; 17:e0275206. [PMID: 36166437 PMCID: PMC9514643 DOI: 10.1371/journal.pone.0275206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Gap and step-off measurements are generally used in the surgical decision-making process of distal radius fractures. Unfortunately, there is no consensus on treatment choice as these measurements are prone to inter- and intraobserver variability. In this study, we aim to introduce a new 3D fracture quantification method and compare it to conventional fracture analysis. Methods Forty patients with a minimally displaced intra-articular distal radius fracture that was treated nonoperatively between 2008–2015 were included. 2D-CT images were reassessed by three orthopedic trauma surgeons who performed gap and step-off measurements. Subsequently, 3D models were created and a 3D measurement method for fracture displacement was developed. For each fracture, the ‘3D gap area’ (3D surface between all fracture fragments) was determined by three observers. Interobserver agreements were calculated for all measurements, and the intraobserver agreement was calculated for the new 3D measurement. All patients completed two questionnaires in order to link our measurements to functional outcome. Results The interobserver agreement of the 2D measurements was fair (ICC = 0.54) for the gap and poor (ICC = 0.21) for the step-off. The median gap was 2.8 (IQR: 1.9–3.5) mm and step-off was 0.9 (IQR: 0.0–1.6) mm. Interobserver agreement on 3D gap area measurements was excellent (ICC = 0.81), with a median difference between measurements of 6.0 (IQR: 2.0–19.0) mm2, which indicates reliable assessment of 3D fracture displacement. Intraobserver agreement was also excellent (ICC = 0.98), with a median difference of 4.0 (IQR: 1.5–5.5) mm2. No significant differences in clinical outcome were found between the above and below 2mm displacement groups. The score of the DASH was 3.4 (IQR: 0.4–8.8) versus 4.2 (IQR: 0.0–11.6) respectively. Results from the PRWE questionnaire shows a similar result of 3.5 (IQR: 0.0–12.6) versus 5.0 (IQR: 0.0–25.5). Conclusion 3D gap area is a more objective measurement method compared to the conventional gap and step-off measurements to quantify the level of fracture displacement of distal radius fractures. 3D fracture assessment can be used in addition to the currently used classification systems of distal radius fractures.
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Affiliation(s)
- Lisanne J. M. Roelofs
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne M. L. Meesters
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nick Assink
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab/Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim D. Van der Meulen
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Job N. Doornberg
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Surgery, Subdivision of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jean-Paul P. M. De Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost Hoekstra
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kaj ten Duis
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank F. A. IJpma
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
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16
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Merema BBJ, Witjes MJH, Van Bakelen NB, Kraeima J, Spijkervet FKL. Four-Dimensional Determination of the Patient-Specific Centre of Rotation for Total Temporomandibular Joint Replacements: Following the Groningen Principle. J Pers Med 2022; 12:jpm12091439. [PMID: 36143224 PMCID: PMC9502215 DOI: 10.3390/jpm12091439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 12/05/2022] Open
Abstract
For patients who suffer from severe dysfunction of the temporomandibular joint (TMJ), a total joint replacement (TJR) in the form of a prosthesis may be indicated. The position of the centre of rotation in TJRs is crucial for good postoperative oral function; however, it is not determined patient-specifically (PS) in any current TMJ-TJR. The aim of this current study was to develop a 4D-workflow to ascertain the PS mean axis of rotation, or fixed hinge, that mimics the patient’s specific physiological mouth opening. Twenty healthy adult patients were asked to volunteer for a 4D-scanning procedure. From these 4D-scanning recordings of mouth opening exercises, patient-specific centres of rotation and axes of rotation were determined using our JawAnalyser tool. The mean CR location was positioned 28 [mm] inferiorly and 5.5 [mm] posteriorly to the centre of condyle (CoC). The 95% confidence interval ranged from 22.9 to 33.7 [mm] inferior and 3.1 to 7.8 [mm] posterior to the CoC. This study succeeded in developing an accurate 4D-workflow to determine a PS mean axis of rotation that mimics the patient’s specific physiological mouth opening. Furthermore, a change in concept is necessary for all commercially available TMJ-TJR prostheses in order to comply with the PS CRs calculated by our study. In the meantime, it seems wise to stick to placing the CR 15 [mm] inferiorly to the CoC, or even beyond, towards 28 [mm] if the patient’s anatomy allows this.
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Abstract
BACKGROUND Success of valgus-type supramalleolar osteotomy (SMOT) depends on adequate correction of malalignment, which can be hard to achieve with current 2-dimensional (2D) planning and operative techniques. A personalized digital 3-dimensional (3D) workflow to virtually plan and perform a 2-step 3D-guided medial opening (MO) SMOT has the potential to improve precision of correction. METHODS Computed tomography (CT)-based Proplan medical 3D models were made to virtually plan the desired MO SMOT, and exported to 3-Matic medical to develop patient-specific 2-step cutting and wedge guides. Workflow accuracy was tested in this limited clinical pilot study (3 patients) by comparing the virtual planned position of the osteotomized distal tibial fragment with the 1-year post-MO SMOT configuration. Two millimeters or less translation deviation in every plane was defined as accurate. RESULTS Primary outcome analysis of the osteotomized distal tibial fragment deviation showed a median translation in all planes of 0.7 (range 0-8.2) mm (interquartile range 1.55) with an excellent interrater reliability of the measurements (intraclass correlation coefficient 0.998). There was a strong reduction in ankle pain as reflected by an increase of the AOFAS-AH score and decrease of NRS pain score with an unrestricted hindfoot motion 1 year after surgery. CONCLUSION 3D virtually planned bone cutting and wedge guides is a promising approach associated with minimal postoperative deviation from the desired correction in medial opening supramalleolar osteotomy.
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Affiliation(s)
- Tom van Raaij
- Department of Orthopedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Hylke van der Wel
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Mark Beldman
- Department of Orthopedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Astrid de Vries
- Department of Orthopedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, the Netherlands
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18
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Pijpker PAJ, Kuijlen JMA, Tamási K, Oterdoom DLM, Vergeer RA, Rijtema G, Coppes MH, Kraeima J, Groen RJM. The Accuracy of Patient-Specific Spinal Drill Guides Is Non-Inferior to Computer-Assisted Surgery: The Results of a Split-Spine Randomized Controlled Trial. J Pers Med 2022; 12:jpm12071084. [PMID: 35887581 PMCID: PMC9317516 DOI: 10.3390/jpm12071084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
In recent years, patient-specific spinal drill guides (3DPGs) have gained widespread popularity. Several studies have shown that the accuracy of screw insertion with these guides is superior to that obtained using the freehand insertion technique, but there are no studies that make a comparison with computer-assisted surgery (CAS). The aim of this study was to determine whether the accuracy of insertion of spinal screws using 3DPGs is non-inferior to insertion via CAS. A randomized controlled split-spine study was performed in which 3DPG and CAS were randomly assigned to the left or right sides of the spines of patients undergoing fixation surgery. The 3D measured accuracy of screw insertion was the primary study outcome parameter. Sixty screws inserted in 10 patients who completed the study protocol were used for the non-inferiority analysis. The non-inferiority of 3DPG was demonstrated for entry-point accuracy, as the upper margin of the 95% CI (−1.01 mm−0.49 mm) for the difference between the means did not cross the predetermined non-inferiority margin of 1 mm (p < 0.05). We also demonstrated non-inferiority of 3D angular accuracy (p < 0.05), with a 95% CI for the true difference of −2.30°−1.35°, not crossing the predetermined non-inferiority margin of 3° (p < 0.05). The results of this randomized controlled trial (RCT) showed that 3DPGs provide a non-inferior alternative to CAS in terms of screw insertion accuracy and have considerable potential as a navigational technique in spinal fixation.
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Affiliation(s)
- Peter A. J. Pijpker
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
- 3D-Lab, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
- Correspondence:
| | - Jos M. A. Kuijlen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Katalin Tamási
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - D. L. Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Rob A. Vergeer
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Gijs Rijtema
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Maarten H. Coppes
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
| | - Joep Kraeima
- 3D-Lab, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Rob J. M. Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.M.A.K.); (K.T.); (D.L.M.O.); (R.A.V.); (G.R.); (M.H.C.); (R.J.M.G.)
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19
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Assink N, Reininga IHF, Ten Duis K, Doornberg JN, Hoekstra H, Kraeima J, Witjes MJH, de Vries JPPM, IJpma FFA. Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients. Eur J Trauma Emerg Surg 2022; 48:1737-1749. [PMID: 34463771 PMCID: PMC9192447 DOI: 10.1007/s00068-021-01773-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/15/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this systematic review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess whether 3D-assisted surgery results in improved clinical outcome as compared to surgery based on conventional imaging modalities. METHODS A literature search was performed in Pubmed and Embase for articles reporting on the use of 3D techniques in operative management of tibial plateau fractures. This systematic review was performed in concordance with the PRISMA-guidelines. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Differences in terms of operation time, blood loss, fluoroscopy frequency, intra-operative revision rates and patient-reported outcomes between 3D-assisted and conventional surgery were assessed. Data were pooled using the inverse variance weighting method in RevMan. RESULTS Twenty articles evaluating 948 patients treated with 3D-assisted surgery and 126 patients with conventional surgery were included. Five different concepts of 3D-assisted surgery were identified: '3D virtual visualization', '3D printed hand-held fracture models', 'Pre-contouring of osteosynthesis plates', '3D printed surgical guides', and 'Intra-operative 3D imaging'. 3D-assisted surgery resulted in reduced operation time (104.7 vs. 126.4 min; P < 0.01), less blood loss (241 ml vs. 306 ml; P < 0.01), decreased frequency of fluoroscopy (5.8 vs. 9.1 times; P < 0.01). No differences in functional outcome was found (Hospital for Special Surgery Knee-Rating Scale: 88.6 vs. 82.8; P = 0.23). CONCLUSIONS Five concepts of 3D-assisted surgical management of tibial plateau fractures emerged over the last decade. These include 3D virtual fracture visualization, 3D-printed hand-held fracture models for surgical planning, 3D-printed models for pre-contouring of osteosynthesis plates, 3D-printed surgical guides, and intra-operative 3D imaging. 3D-assisted surgery may have a positive effect on operation time, blood loss, and fluoroscopy frequency.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Inge H F Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Job N Doornberg
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Harm Hoekstra
- Department of Traumatology, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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20
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Glas HH, Kraeima J, Tribius S, Leusink FKJ, Rendenbach C, Heiland M, Stromberger C, Rashad A, Fuller CD, Mohamed ASR, Lai SY, Witjes MJH. Three-Dimensional Evaluation of Isodose Radiation Volumes in Cases of Severe Mandibular Osteoradionecrosis for the Prediction of Recurrence after Segmental Resection. J Pers Med 2022; 12:jpm12050834. [PMID: 35629256 PMCID: PMC9143211 DOI: 10.3390/jpm12050834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Pre-operative margin planning for the segmental resection of affected bone in mandibular osteoradionecrosis (ORN) is difficult. The aim of this study was to identify a possible relation between the received RT dose, exposed bone volume and the progression of ORN after segmental mandibular resection. Method: Patients diagnosed with grade 3-4 ORN for which a segmental resection was performed were included in the study. Three-dimensional reconstructions of RT isodose volumes were fused with postoperative imaging. The primary outcome was the recurrence of ORN after segmental resection. Subsequently, RT exposed mandibular bone volumes were calculated and the location of the bone cuts relative to the isodose volumes were assessed. Results: Five out of thirty-three patients developed recurrent ORN after segmental mandibular resection. All cases with recurrent ORN were resected inside an isodose volume of ≥56 Gy. The absolute mandibular volume radiated with 56 Gy was significantly smaller in the recurrent group (10.9 mL vs. 30.7 mL, p = 0.006), as was the proportion of the mandible radiated with 56 Gy (23% vs. 45%, p = 0.013). Conclusion: The volume of radiated bone was not predictive for risk of progression. The finding that recurrent ORN occurred with bone resection margins within the 56 Gy isodose volume suggests that this could serve as a starting point for the pre-operative planning of reducing the risk of ORN recurrence.
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Affiliation(s)
- Haye H. Glas
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
- Correspondence: ; Tel.: +31-(0)50-361-25-61
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Silke Tribius
- Hermann-Holthusen-Institute for Radiation Oncology, Asklepios Hospital St. Georg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Frank K. J. Leusink
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, 1100DD Amsterdam, The Netherlands;
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12203 Berlin, Germany; (C.R.); (M.H.)
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12203 Berlin, Germany; (C.R.); (M.H.)
| | - Carmen Stromberger
- Department of Radiation Oncology and Radiation Therapy, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12203 Berlin, Germany;
| | - Ashkan Rashad
- Department of Oral, Maxillofacial and Facial Plastic Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany;
| | - Clifton D. Fuller
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.D.F.); (A.S.R.M.); (S.Y.L.)
| | - Abdallah S. R. Mohamed
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.D.F.); (A.S.R.M.); (S.Y.L.)
| | - Stephen Y. Lai
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.D.F.); (A.S.R.M.); (S.Y.L.)
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Max J. H. Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
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21
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Vosselman N, Glas HH, Merema BJ, Kraeima J, Reintsema H, Raghoebar GM, Witjes MJH, de Visscher SAHJ. Three-Dimensional Guided Zygomatic Implant Placement after Maxillectomy. J Pers Med 2022; 12:jpm12040588. [PMID: 35455704 PMCID: PMC9027393 DOI: 10.3390/jpm12040588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 12/27/2022] Open
Abstract
Zygomatic implants are used in patients with maxillary defects to improve the retention and stability of obturator prostheses, thereby securing good oral function. Prosthetic-driven placement of zygomatic implants is even difficult for experienced surgeons, and with a free-hand approach, deviation from the preplanned implant positions is inevitable, thereby impeding immediate implant-retained obturation. A novel, digitalized workflow of surgical planning was used in 10 patients. Maxillectomy was performed with 3D-printed cutting, and drill guides were used for subsequent placement of zygomatic implants with immediate placement of implant-retained obturator prosthesis. The outcome parameters were the accuracy of implant positioning and the prosthetic fit of the obturator prosthesis in this one-stage procedure. Zygomatic implants (n = 28) were placed with good accuracy (mean deviation 1.73 ± 0.57 mm and 2.97 ± 1.38° 3D angle deviation), and in all cases, the obturator prosthesis fitted as pre-operatively planned. The 3D accuracy of the abutment positions was 1.58 ± 1.66 mm. The accuracy of the abutment position in the occlusal plane was 2.21 ± 1.33 mm, with a height accuracy of 1.32 ± 1.57 mm. This feasibility study shows that the application of these novel designed 3D-printed surgical guides results in predictable zygomatic implant placement and provides the possibility of immediate prosthetic rehabilitation in head and neck oncology patients after maxillectomy.
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22
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Rozema R, Kruitbosch HT, van Minnen B, Dorgelo B, Kraeima J, van Ooijen PMA. Structural similarity analysis of midfacial fractures-a feasibility study. Quant Imaging Med Surg 2022; 12:1571-1578. [PMID: 35111649 DOI: 10.21037/qims-21-564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022]
Abstract
The structural similarity index metric is used to measure the similarity between two images. The aim here was to study the feasibility of this metric to measure the structural similarity and fracture characteristics of midfacial fractures in computed tomography (CT) datasets following radiation dose reduction, iterative reconstruction (IR) and deep learning reconstruction. Zygomaticomaxillary fractures were inflicted on four human cadaver specimen and scanned with standard and low dose CT protocols. Datasets were reconstructed using varying strengths of IR and the subsequently applying the PixelShine™ deep learning algorithm as post processing. Individual small and non-dislocated fractures were selected for the data analysis. After attenuating the osseous anatomy of interest, registration was performed to superimpose the datasets and subsequently to measure by structural image quality. Changes to the fracture characteristics were measured by comparing each fracture to the mirrored contralateral anatomy. Twelve fracture locations were included in the data analysis. The most structural image quality changes occurred with radiation dose reduction (0.980036±0.011904), whilst the effects of IR strength (0.995399±0.001059) and the deep learning algorithm (0.999996±0.000002) were small. Radiation dose reduction and IR strength tended to affect the fracture characteristics. Both the structural image quality and fracture characteristics were not affected by the use of the deep learning algorithm. In conclusion, evidence is provided for the feasibility of using the structural similarity index metric for the analysis of structural image quality and fracture characteristics.
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Affiliation(s)
- Romke Rozema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Herbert T Kruitbosch
- Center for Information Technology, University of Groningen, Groningen, The Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart Dorgelo
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, Martini Hospital, Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter M A van Ooijen
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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23
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Meesters AML, Trouwborst NM, de Vries JPPM, Kraeima J, Witjes MJH, Doornberg JN, Reininga IHF, IJpma FFA, ten Duis K. Does 3D-Assisted Acetabular Fracture Surgery Improve Surgical Outcome and Physical Functioning?-A Systematic Review. J Pers Med 2021; 11:966. [PMID: 34683107 PMCID: PMC8541524 DOI: 10.3390/jpm11100966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022] Open
Abstract
Three-dimensional technology is increasingly being used in acetabular fracture treatment. No systematic reviews are available about the added clinical value of 3D-assisted acetabular fracture surgery compared to conventional surgery. Therefore, this study aimed to investigate whether 3D-assisted acetabular fracture surgery compared to conventional surgery improves surgical outcomes in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy usage, complications, and postoperative fracture reduction, and whether it improves physical functioning. Pubmed and Embase databases were searched for articles on 3D technologies in acetabular fracture surgery, published between 2010 and February 2021. The McMaster critical review form was used to assess the methodological quality. Differences between 3D-assisted and conventional surgery were evaluated using the weighted mean and odds ratios. Nineteen studies were included. Three-dimensional-assisted surgery resulted in significantly shorter operation times (162.5 ± 79.0 versus 296.4 ± 56.0 min), less blood loss (697.9 ± 235.7 mL versus 1097.2 ± 415.5 mL), and less fluoroscopy usage (9.3 ± 5.9 versus 22.5 ± 20.4 times). The odds ratios of complications and fracture reduction were 0.5 and 0.4 for functional outcome in favour of 3D-assisted surgery, respectively. Three-dimensional-assisted surgery reduces operation time, intraoperative blood loss, fluoroscopy usage, and complications. Evidence for the improvement of fracture reduction and functional outcomes is limited.
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Affiliation(s)
- Anne M. L. Meesters
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
| | - Neeltje M. Trouwborst
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
| | - Jean-Paul P. M. de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Joep Kraeima
- 3D Lab, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Max J. H. Witjes
- 3D Lab, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Job N. Doornberg
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Inge H. F. Reininga
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
| | - Kaj ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.M.T.); (I.H.F.R.); (F.F.A.I.); (K.t.D.)
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24
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Meesters AML, Assink N, ten Duis K, Fennema EM, Kraeima J, Witjes MJH, de Vries JPPM, Stirler VMA, IJpma FFA. Accuracy of Patient-Specific Drilling Guides in Acetabular Fracture Surgery: A Human Cadaver Study. J Pers Med 2021; 11:jpm11080763. [PMID: 34442407 PMCID: PMC8400721 DOI: 10.3390/jpm11080763] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/26/2021] [Accepted: 07/31/2021] [Indexed: 12/14/2022] Open
Abstract
Due to the complex anatomical shape of the pelvis, screw placement can be challenging in acetabular fracture surgery. This study aims to assess the accuracy of screw placement using patient-specific surgical drilling guides applied to pre-contoured conventional implants in acetabular fracture surgery. CT scans were made of four human cadavers to create 3D models of each (unfractured) pelvis. Implants were pre-contoured on 3D printed pelvic models and optically scanned. Following virtual preoperative planning, surgical drilling guides were designed to fit on top of the implant and were 3D printed. The differences between the pre-planned and actual screw directions (degrees) and screw entry points (mm) were assessed from the pre- and postoperative CT-scans. The median difference between the planned and actual screw direction was 5.9° (IQR: 4–8°) for the in-plate screws and 7.6° (IQR: 6–10°) for the infra-acetabular and column screws. The median entry point differences were 3.6 (IQR: 2–5) mm for the in-plate screws and 2.6 (IQR: 2–3) mm for the infra-acetabular and column screws. No screws penetrated into the hip joint or caused soft tissue injuries. Three-dimensional preoperative planning in combination with surgical guides that envelope pre-contoured conventional implants result in accurate screw placement during acetabular fracture surgery.
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Affiliation(s)
- Anne M. L. Meesters
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Nick Assink
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Kaj ten Duis
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Eelco M. Fennema
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Joep Kraeima
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Max J. H. Witjes
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Jean-Paul P. M. de Vries
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Vincent M. A. Stirler
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Frank F. A. IJpma
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
- Correspondence: ; Tel.: +31-50-361-6161
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25
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Qiu B, van der Wel H, Kraeima J, Glas HH, Guo J, Borra RJH, Witjes MJH, van Ooijen PMA. Automatic Segmentation of Mandible from Conventional Methods to Deep Learning-A Review. J Pers Med 2021; 11:629. [PMID: 34357096 PMCID: PMC8307673 DOI: 10.3390/jpm11070629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/05/2023] Open
Abstract
Medical imaging techniques, such as (cone beam) computed tomography and magnetic resonance imaging, have proven to be a valuable component for oral and maxillofacial surgery (OMFS). Accurate segmentation of the mandible from head and neck (H&N) scans is an important step in order to build a personalized 3D digital mandible model for 3D printing and treatment planning of OMFS. Segmented mandible structures are used to effectively visualize the mandible volumes and to evaluate particular mandible properties quantitatively. However, mandible segmentation is always challenging for both clinicians and researchers, due to complex structures and higher attenuation materials, such as teeth (filling) or metal implants that easily lead to high noise and strong artifacts during scanning. Moreover, the size and shape of the mandible vary to a large extent between individuals. Therefore, mandible segmentation is a tedious and time-consuming task and requires adequate training to be performed properly. With the advancement of computer vision approaches, researchers have developed several algorithms to automatically segment the mandible during the last two decades. The objective of this review was to present the available fully (semi)automatic segmentation methods of the mandible published in different scientific articles. This review provides a vivid description of the scientific advancements to clinicians and researchers in this field to help develop novel automatic methods for clinical applications.
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Affiliation(s)
- Bingjiang Qiu
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Hylke van der Wel
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Haye Hendrik Glas
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jiapan Guo
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Ronald J. H. Borra
- Medical Imaging Center (MIC), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Max Johannes Hendrikus Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Peter M. A. van Ooijen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Qiu B, van der Wel H, Kraeima J, Glas HH, Guo J, Borra RJH, Witjes MJH, van Ooijen PMA. Mandible Segmentation of Dental CBCT Scans Affected by Metal Artifacts Using Coarse-to-Fine Learning Model. J Pers Med 2021; 11:560. [PMID: 34208429 PMCID: PMC8232763 DOI: 10.3390/jpm11060560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
Accurate segmentation of the mandible from cone-beam computed tomography (CBCT) scans is an important step for building a personalized 3D digital mandible model for maxillofacial surgery and orthodontic treatment planning because of the low radiation dose and short scanning duration. CBCT images, however, exhibit lower contrast and higher levels of noise and artifacts due to extremely low radiation in comparison with the conventional computed tomography (CT), which makes automatic mandible segmentation from CBCT data challenging. In this work, we propose a novel coarse-to-fine segmentation framework based on 3D convolutional neural network and recurrent SegUnet for mandible segmentation in CBCT scans. Specifically, the mandible segmentation is decomposed into two stages: localization of the mandible-like region by rough segmentation and further accurate segmentation of the mandible details. The method was evaluated using a dental CBCT dataset. In addition, we evaluated the proposed method and compared it with state-of-the-art methods in two CT datasets. The experiments indicate that the proposed algorithm can provide more accurate and robust segmentation results for different imaging techniques in comparison with the state-of-the-art models with respect to these three datasets.
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Affiliation(s)
- Bingjiang Qiu
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Hylke van der Wel
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Haye Hendrik Glas
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jiapan Guo
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Ronald J. H. Borra
- Medical Imaging Center (MIC), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Max Johannes Hendrikus Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Peter M. A. van Ooijen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Vosselman N, Glas HH, de Visscher SAHJ, Kraeima J, Merema BJ, Reintsema H, Raghoebar GM, Witjes MJH. Immediate implant-retained prosthetic obturation after maxillectomy based on zygomatic implant placement by 3D-guided surgery: a cadaver study. Int J Implant Dent 2021; 7:54. [PMID: 34121148 PMCID: PMC8200332 DOI: 10.1186/s40729-021-00335-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/30/2021] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study was to introduce a complete 3D workflow for immediate implant retained prosthetic rehabilitation following maxillectomy in cancer surgery. The workflow consists of a 3D virtual surgical planning for tumor resection, zygomatic implant placement, and for an implant-retained prosthetic-obturator to fit the planned outcome situation for immediate loading. Materials and methods In this study, 3D virtual surgical planning and resection of the maxilla, followed by guided placement of 10 zygomatic implants, using custom cutting and drill/placement-guides, was performed on 5 fresh frozen human cadavers. A preoperatively digitally designed and printed obturator prosthesis was placed and connected to the zygomatic implants. The accuracy of the implant positioning was obtained using 3D deviation analysis by merging the pre- and post-operative CT scan datasets. Results The preoperatively designed and manufactured obturator prostheses matched accurately the per-operative implant positions. All five obturators could be placed and fixated for immediate loading. The mean prosthetic point deviation on the cadavers was 1.03 ± 0.85 mm; the mean entry point deviation was 1.20 ± 0.62 mm; and the 3D angle deviation was 2.97 ± 1.44°. Conclusions It is possible to 3D plan and accurately execute the ablative surgery, placement of zygomatic implants, and immediate placement of an implant-retained obturator prosthesis with 3D virtual surgical planning.The next step is to apply the workflow in the operating room in patients planned for maxillectomy.
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Affiliation(s)
- N Vosselman
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, Groningen, RB, The Netherlands.
| | - H H Glas
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, Groningen, RB, The Netherlands
| | - S A H J de Visscher
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, Groningen, RB, The Netherlands
| | - J Kraeima
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, Groningen, RB, The Netherlands
| | - B J Merema
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, Groningen, RB, The Netherlands
| | - H Reintsema
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, Groningen, RB, The Netherlands
| | - G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, Groningen, RB, The Netherlands
| | - M J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, Groningen, RB, The Netherlands
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Qiu B, Guo J, Kraeima J, Glas HH, Zhang W, Borra RJH, Witjes MJH, van Ooijen PMA. Recurrent Convolutional Neural Networks for 3D Mandible Segmentation in Computed Tomography. J Pers Med 2021; 11:jpm11060492. [PMID: 34072714 PMCID: PMC8229770 DOI: 10.3390/jpm11060492] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: Classic encoder–decoder-based convolutional neural network (EDCNN) approaches cannot accurately segment detailed anatomical structures of the mandible in computed tomography (CT), for instance, condyles and coronoids of the mandible, which are often affected by noise and metal artifacts. The main reason is that EDCNN approaches ignore the anatomical connectivity of the organs. In this paper, we propose a novel CNN-based 3D mandible segmentation approach that has the ability to accurately segment detailed anatomical structures. Methods: Different from the classic EDCNNs that need to slice or crop the whole CT scan into 2D slices or 3D patches during the segmentation process, our proposed approach can perform mandible segmentation on complete 3D CT scans. The proposed method, namely, RCNNSeg, adopts the structure of the recurrent neural networks to form a directed acyclic graph in order to enable recurrent connections between adjacent nodes to retain their connectivity. Each node then functions as a classic EDCNN to segment a single slice in the CT scan. Our proposed approach can perform 3D mandible segmentation on sequential data of any varied lengths and does not require a large computation cost. The proposed RCNNSeg was evaluated on 109 head and neck CT scans from a local dataset and 40 scans from the PDDCA public dataset. The final accuracy of the proposed RCNNSeg was evaluated by calculating the Dice similarity coefficient (DSC), average symmetric surface distance (ASD), and 95% Hausdorff distance (95HD) between the reference standard and the automated segmentation. Results: The proposed RCNNSeg outperforms the EDCNN-based approaches on both datasets and yields superior quantitative and qualitative performances when compared to the state-of-the-art approaches on the PDDCA dataset. The proposed RCNNSeg generated the most accurate segmentations with an average DSC of 97.48%, ASD of 0.2170 mm, and 95HD of 2.6562 mm on 109 CT scans, and an average DSC of 95.10%, ASD of 0.1367 mm, and 95HD of 1.3560 mm on the PDDCA dataset. Conclusions: The proposed RCNNSeg method generated more accurate automated segmentations than those of the other classic EDCNN segmentation techniques in terms of quantitative and qualitative evaluation. The proposed RCNNSeg has potential for automatic mandible segmentation by learning spatially structured information.
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Affiliation(s)
- Bingjiang Qiu
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (B.Q.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Jiapan Guo
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
- Correspondence:
| | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (B.Q.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Haye Hendrik Glas
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (B.Q.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Weichuan Zhang
- Institute for Integrated and Intelligent System, Griffith University, Nathan, QLD 4111, Australia;
- CSIRO Data61, Epping, NSW 1710, Australia
| | - Ronald J. H. Borra
- Medical Imaging Center (MIC), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
| | - Max Johannes Hendrikus Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; (B.Q.); (J.K.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Peter M. A. van Ooijen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands;
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
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Pijpker PAJ, Oosterhuis TS, Witjes MJH, Faber C, van Ooijen PMA, Kosinka J, Kuijlen JMA, Groen RJM, Kraeima J. A semi-automatic seed point-based method for separation of individual vertebrae in 3D surface meshes: a proof of principle study. Int J Comput Assist Radiol Surg 2021; 16:1447-1457. [PMID: 34043144 PMCID: PMC8354998 DOI: 10.1007/s11548-021-02407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this paper is to present and validate a new semi-automated 3D surface mesh segmentation approach that optimizes the laborious individual human vertebrae separation in the spinal virtual surgical planning workflow and make a direct accuracy and segmentation time comparison with current standard segmentation method. METHODS The proposed semi-automatic method uses the 3D bone surface derived from CT image data for seed point-based 3D mesh partitioning. The accuracy of the proposed method was evaluated on a representative patient dataset. In addition, the influence of the number of used seed points was studied. The investigators analyzed whether there was a reduction in segmentation time when compared to manual segmentation. Surface-to-surface accuracy measurements were applied to assess the concordance with the manual segmentation. RESULTS The results demonstrated a statically significant reduction in segmentation time, while maintaining a high accuracy compared to the manual segmentation. A considerably smaller error was found when increasing the number of seed points. Anatomical regions that include articulating areas tend to show the highest errors, while the posterior laminar surface yielded an almost negligible error. CONCLUSION A novel seed point initiated surface based segmentation method for the laborious individual human vertebrae separation was presented. This proof-of-principle study demonstrated the accuracy of the proposed method on a clinical CT image dataset and its feasibility for spinal virtual surgical planning applications.
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Affiliation(s)
- Peter A J Pijpker
- 3D-Lab and Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - Tim S Oosterhuis
- 3D-Lab and Bernoulli Institute, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Max J H Witjes
- 3D-Lab and Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Chris Faber
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter M A van Ooijen
- Department of Radiation Oncology and Data Science Center in Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jiří Kosinka
- Bernoulli Institute, University of Groningen, Groningen, The Netherlands
| | - Jos M A Kuijlen
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- 3D-Lab and Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Qiu B, van der Wel H, Kraeima J, Hendrik Glas H, Guo J, Borra RJH, Witjes MJH, van Ooijen PMA. Robust and Accurate Mandible Segmentation on Dental CBCT Scans Affected by Metal Artifacts Using a Prior Shape Model. J Pers Med 2021; 11:364. [PMID: 34062762 PMCID: PMC8147374 DOI: 10.3390/jpm11050364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022] Open
Abstract
Accurate mandible segmentation is significant in the field of maxillofacial surgery to guide clinical diagnosis and treatment and develop appropriate surgical plans. In particular, cone-beam computed tomography (CBCT) images with metal parts, such as those used in oral and maxillofacial surgery (OMFS), often have susceptibilities when metal artifacts are present such as weak and blurred boundaries caused by a high-attenuation material and a low radiation dose in image acquisition. To overcome this problem, this paper proposes a novel deep learning-based approach (SASeg) for automated mandible segmentation that perceives overall mandible anatomical knowledge. SASeg utilizes a prior shape feature extractor (PSFE) module based on a mean mandible shape, and recurrent connections maintain the continuity structure of the mandible. The effectiveness of the proposed network is substantiated on a dental CBCT dataset from orthodontic treatment containing 59 patients. The experiments show that the proposed SASeg can be easily used to improve the prediction accuracy in a dental CBCT dataset corrupted by metal artifacts. In addition, the experimental results on the PDDCA dataset demonstrate that, compared with the state-of-the-art mandible segmentation models, our proposed SASeg can achieve better segmentation performance.
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Affiliation(s)
- Bingjiang Qiu
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (H.H.G.); (M.J.H.W.)
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.G.); (P.M.A.v.O.)
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Hylke van der Wel
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Haye Hendrik Glas
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jiapan Guo
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.G.); (P.M.A.v.O.)
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Ronald J. H. Borra
- Medical Imaging Center (MIC), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Max Johannes Hendrikus Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.Q.); (H.v.d.W.); (H.H.G.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Peter M. A. van Ooijen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.G.); (P.M.A.v.O.)
- Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Glas HH, Kraeima J, van Ooijen PMA, Spijkervet FKL, Yu L, Witjes MJH. Augmented Reality Visualization for Image-Guided Surgery: A Validation Study Using a Three-Dimensional Printed Phantom. J Oral Maxillofac Surg 2021; 79:1943.e1-1943.e10. [PMID: 34033801 DOI: 10.1016/j.joms.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Oral and maxillofacial surgery currently relies on virtual surgery planning based on image data (CT, MRI). Three-dimensional (3D) visualizations are typically used to plan and predict the outcome of complex surgical procedures. To translate the virtual surgical plan to the operating room, it is either converted into physical 3D-printed guides or directly translated using real-time navigation systems. PURPOSE This study aims to improve the translation of the virtual surgery plan to a surgical procedure, such as oncologic or trauma surgery, in terms of accuracy and speed. Here we report an augmented reality visualization technique for image-guided surgery. It describes how surgeons can visualize and interact with the virtual surgery plan and navigation data while in the operating room. The user friendliness and usability is objectified by a formal user study that compared our augmented reality assisted technique to the gold standard setup of a perioperative navigation system (Brainlab). Moreover, accuracy of typical navigation tasks as reaching landmarks and following trajectories is compared. RESULTS Overall completion time of navigation tasks was 1.71 times faster using augmented reality (P = .034). Accuracy improved significantly using augmented reality (P < .001), for reaching physical landmarks a less strong correlation was found (P = .087). Although the participants were relatively unfamiliar with VR/AR (rated 2.25/5) and gesture-based interaction (rated 2/5), they reported that navigation tasks become easier to perform using augmented reality (difficulty Brainlab rated 3.25/5, HoloLens 2.4/5). CONCLUSION The proposed workflow can be used in a wide range of image-guided surgery procedures as an addition to existing verified image guidance systems. Results of this user study imply that our technique enables typical navigation tasks to be performed faster and more accurately compared to the current gold standard. In addition, qualitative feedback on our augmented reality assisted technique was more positive compared to the standard setup.?>.
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Affiliation(s)
- H H Glas
- Technical Physician, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - J Kraeima
- Technical Physician, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P M A van Ooijen
- Associate Professor Faculty of Medical Sciences, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F K L Spijkervet
- Professor, Oral and Maxillofacial Surgeon, Head of the Department, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Yu
- Lecturer in the Department of Computer Science and Software Engineering (CSSE), Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J H Witjes
- Oral and Maxillofacial Surgeon, Principal Investigator, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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IJpma FFA, Meesters AML, Merema BBJ, ten Duis K, de Vries JPPM, Banierink H, Wendt KW, Kraeima J, Witjes MJH. Feasibility of Imaging-Based 3-Dimensional Models to Design Patient-Specific Osteosynthesis Plates and Drilling Guides. JAMA Netw Open 2021; 4:e2037519. [PMID: 33599774 PMCID: PMC7893502 DOI: 10.1001/jamanetworkopen.2020.37519] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE In acetabular fracture surgery, achieving an optimal reconstruction of the articular surface decreases the risk of osteoarthritis and the subsequent need for total hip arthroplasty. However, no one-size-fits-all osteosynthesis plate is available owing to differences in fracture patterns and variations in pelvic anatomy. Currently, osteosynthesis plates need to be manually contoured intraoperatively, often resulting in inadequate reduction and fixation of the fractured segments. OBJECTIVE To determine the feasibility and accuracy of a novel concept of fast-track 3-dimensional (3-D) virtual surgical planning and patient-specific osteosynthesis for complex acetabular fracture surgery. DESIGN, SETTING, AND PARTICIPANTS This case series study examines the use of patient-specific osteosynthesis plates for patients needing operative treatment for displaced associated-type acetabular fractures at a tertiary university-affiliated referral center and level 1 trauma center between January 1, 2017, and December 31, 2018. Models were created in 3-D based on computed tomography (CT) data, fractures were virtually reduced, and implant positions were discussed in a multidisciplinary team of clinicians and engineers. Patient-specific osteosynthesis plates with drilling guides were designed, produced, sterilized and clinically applied within 4 days. Data were analyzed at the 1-year follow-up. EXPOSURES Development and clinical implementation of personalized fracture surgery. MAIN OUTCOMES AND MEASURES The primary outcome was the quality of the reduction as determined by the postoperative CT scan. The secondary outcomes were accuracy of the screw placement and clinical outcome using patient-reported outcome measures. RESULTS Ten patients with a median (range) age of 63 (46-79) years with an acetabular fracture were included. The median (interquartile range [IQR]) preoperative gap was 20 (15-22) mm, and the median (IQR) step-off was 5 (3-11) mm. Postoperatively, the median (IQR) gap was reduced to 3 (2-5) mm (P = .005), and the median (IQR) step-off was reduced to 0 (0-2) mm (P = .01), indicating good fracture reduction, indicating good fracture reduction. The mean difference between the preoperative and postoperative gap was 14.6 (95% CI, 10-19) mm, and the mean difference in step-off was 5.7 (95% CI, 2-9) mm. The median (IQR) difference in screw direction between the planning and actual surgery was only 7.1° (7°-8°). All patients retained their native hip and reported good physical functioning at follow-up. CONCLUSIONS AND RELEVANCE These findings suggest that 3-D virtual surgical planning, manufacturing, and clinical application of patient-specific osteosynthesis plates and drilling guides was feasible and yielded good clinical outcomes. Fast-track personalized surgical treatment could open a new era for the treatment of complex injuries.
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Affiliation(s)
- Frank F. A. IJpma
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne M. L. Meesters
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bram B. J. Merema
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kaj ten Duis
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jean-Paul P. M. de Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hester Banierink
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Klaus W. Wendt
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joep Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Max J. H. Witjes
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Pijpker PA, Kraeima J, Witjes MJ, Oterdoom DM, Vergeer RA, Coppes MH, Groen RJ, Kuijlen JM. Accuracy of Patient-Specific 3D-Printed Drill Guides for Pedicle and Lateral Mass Screw Insertion: An Analysis of 76 Cervical and Thoracic Screw Trajectories. Spine (Phila Pa 1976) 2021; 46:160-168. [PMID: 33093310 PMCID: PMC7787187 DOI: 10.1097/brs.0000000000003747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/08/2020] [Accepted: 08/13/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Single-center retrospective case series. OBJECTIVE The purpose of this study was to assess the safety and accuracy of three-dimensional (3D)-printed individualized drill guides for pedicle and lateral mass screw insertion in the cervical and upper-thoracic region, by comparing the preoperative 3D surgical plan with the postoperative results. SUMMARY OF BACKGROUND DATA Posterior spinal fusion surgery can provide rigid intervertebral fixation but screw misplacement involves a high risk of neurovascular injury. However, modern spine surgeons now have tools such as virtual surgical planning and 3D-printed drill guides to facilitate spinal screw insertion. METHODS A total of 15 patients who underwent posterior spinal fusion surgery involving patient-specific 3D-printed drill guides were included in this study. After segmentation of bone and screws, the postoperative models were superimposed onto the preoperative surgical plan. The accuracy of the realized screw trajectories was quantified by measuring the entry point and angular deviation. RESULTS The 3D deviation analysis showed that the entry point and angular deviation over all 76 screw trajectories were 1.40 ± 0.81 mm and 6.70 ± 3.77°, respectively. Angular deviation was significantly higher in the sagittal plane than in the axial plane (P = 0.02). All screw positions were classified as "safe" (100%), showing no neurovascular injury, facet joint violation, or violation of the pedicle wall. CONCLUSIONS 3D virtual planning and 3D-printed patient-specific drill guides appear to be safe and accurate for pedicle and lateral mass screw insertion in the cervical and upper-thoracic spine. The quantitative 3D deviation analyses confirmed that screw positions were accurate with respect to the 3D-surgical plan.Level of Evidence: 4.
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Affiliation(s)
- Peter A.J. Pijpker
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Joep Kraeima
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
| | - Max J.H. Witjes
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands
| | - D.L. Marinus Oterdoom
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Rob A. Vergeer
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Maarten H. Coppes
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Rob J.M. Groen
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
| | - Jos M.A. Kuijlen
- University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, The Netherlands
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Rozema R, Kruitbosch HT, van Minnen B, Dorgelo B, Kraeima J, van Ooijen PMA. Iterative reconstruction and deep learning algorithms for enabling low-dose computed tomography in midfacial trauma. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 132:247-254. [PMID: 34034999 DOI: 10.1016/j.oooo.2020.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 08/31/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of this study was to quantitatively assess the image quality of Advanced Modeled Iterative Reconstruction (ADMIRE) and the PixelShine (PS) deep learning algorithm for the optimization of low-dose computed tomography protocols in midfacial trauma. STUDY DESIGN Six fresh frozen human cadaver head specimens were scanned by computed tomography using both standard and low-dose scan protocols. Three iterative reconstruction strengths were applied to reconstruct bone and soft tissue data sets and these were subsequently applied to the PS algorithm. Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were calculated for each data set by using the image noise measurements of 10 consecutive image slices from a standardized region of interest template. RESULTS The low-dose scan protocol resulted in a 61.7% decrease in the radiation dose. Radiation dose reduction significantly reduced, and iterative reconstruction and the deep learning algorithm significantly improved, the CNR for bone and soft tissue data sets. The algorithms improved image quality after substantial dose reduction. The greatest improvement in SNRs and CNRs was found using the iterative reconstruction algorithm. CONCLUSION Both the ADMIRE and PS algorithms significantly improved image quality after substantial radiation dose reduction.
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Affiliation(s)
- Romke Rozema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Herbert T Kruitbosch
- Center for Information Technology, University of Groningen, Groningen, The Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart Dorgelo
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Radiology, Martini Hospital, Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter M A van Ooijen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Tuin AJ, Meulstee JW, Loonen TG, Kraeima J, Spijkervet FK, Vissink A, Jansma J, Schepers RH. Three-dimensional facial volume analysis using algorithm-based personalized aesthetic templates. Int J Oral Maxillofac Surg 2020; 49:1379-1384. [DOI: 10.1016/j.ijom.2020.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/24/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
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Kraeima J, Glas HH, Merema BBJ, Vissink A, Spijkervet FKL, Witjes MJH. Three-dimensional virtual surgical planning in the oncologic treatment of the mandible. Oral Dis 2020; 27:14-20. [PMID: 32881177 DOI: 10.1111/odi.13631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/30/2020] [Accepted: 08/22/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In case of surgical removal of oral squamous cell carcinomas, a resection of mandibular bone is frequently part of the treatment. Nowadays, such resections frequently include the application of 3D virtual surgical planning (VSP) and guided surgery techniques. In this paper, current methods for 3D VSP leads for optimisation of the workflow, and patient-specific application of guides and implants are reviewed. RECENT FINDINGS Current methods for 3D VSP enable multi-modality fusion of images. This fusion of images is not restricted to a specific software package or workflow. New strategies for 3D VSP in Oral and Maxillofacial Surgery include finite element analysis, deep learning and advanced augmented reality techniques. These strategies aim to improve the treatment in terms of accuracy, predictability and safety. CONCLUSIONS Application of the discussed novel technologies and strategies will improve the accuracy and safety of mandibular resection and reconstruction planning. Accurate, easy-to-use, safe and efficient three-dimensional VSP can be applied for every patient with malignancies needing resection of the mandible.
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Affiliation(s)
- Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Haye H Glas
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bram Barteld Jan Merema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Merema BJ, Kraeima J, Witjes MJH, van Bakelen NB, Spijkervet FKL. Accuracy of fit analysis of the patient-specific Groningen temporomandibular joint prosthesis. Int J Oral Maxillofac Surg 2020; 50:538-545. [PMID: 32943309 DOI: 10.1016/j.ijom.2020.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Total joint replacement (TJR) with a prosthesis can be indicated for patients with severe temporomandibular joint (TMJ) dysfunction. Surgical accuracy is necessary for correct translation of the preoperatively predicted functional outcome, wear, and biomechanical behaviour of the patient-specific TMJ-TJR prosthesis. This study describes the first clinical applications of the patient-specific TMJ-TJR prosthesis according to the Groningen principles (G-TMJ-TJR), which was developed and validated in a prior human cadaver test study. The aim of this study was to validate the accuracy of placement of the patient-specific G-TMJ-TJR in the clinical setting. It was hypothesized that a virtual surgical plan (VSP) combined with guided placement of the patient-specific G-TMJ-TJR would be performed as predictably and accurately as in the prior cadaver series. All patients who received a VSP-based patient-specific G-TMJ-TJR between December 2017 and March 2020 were included in this study. The accuracy analysis was based on postoperative cone beam computed tomography (CBCT) data. All 11 prostheses could be inserted using routine pre-auricular and retromandibular surgical approaches. Analysis of the VSPs and postoperative CBCTs showed an average three-dimensional deviation of 1.07mm (standard deviation 0.46mm, range 0.33-1.91mm) for all of the fossa and mandibular components. The patient-specific G-TMJ-TJR can be applied predictably and accurately in a clinical setting.
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Affiliation(s)
- B J Merema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - N B van Bakelen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Merema BBJ, Kraeima J, de Visscher SAHJ, van Minnen B, Spijkervet FKL, Schepman K, Witjes MJH. Novel finite element-based plate design for bridging mandibular defects: Reducing mechanical failure. Oral Dis 2020; 26:1265-1274. [PMID: 32176821 PMCID: PMC7507837 DOI: 10.1111/odi.13331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION When the application of a free vascularised flap is not possible, a segmental mandibular defect is often reconstructed using a conventional reconstruction plate. Mechanical failure of such reconstructions is mostly caused by plate fracture and screw pull-out. This study aims to develop a reliable, mechanically superior, yet slender patient-specific reconstruction plate that reduces failure due to these causes. PATIENTS AND METHODS Eight patients were included in the study. Indications were as follows: fractured reconstruction plate (2), loosened screws (1) and primary reconstruction of a mandibular continuity defect (5). Failed conventional reconstructions were studied using finite element analysis (FEA). A 3D virtual surgical plan (3D-VSP) with a novel patient-specific (PS) titanium plate was developed for each patient. Postoperative CBCT scanning was performed to validate reconstruction accuracy. RESULTS All PS plates were placed accurately according to the 3D-VSP. Mean 3D screw entry point deviation was 1.54 mm (SD: 0.85, R: 0.10-3.19), and mean screw angular deviation was 5.76° (SD: 3.27, R: 1.26-16.62). FEA indicated decreased stress and screw pull-out inducing forces. No mechanical failures appeared (mean follow-up: 16 months, R: 7-29). CONCLUSION Reconstructing mandibular continuity defects with bookshelf-reconstruction plates with FEA underpinning the design seems to reduce the risk of screw pull-out and plate fractures.
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Affiliation(s)
- Bram B. J. Merema
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Baucke van Minnen
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Fred K. L. Spijkervet
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Kees‐Pieter Schepman
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Max J. H. Witjes
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
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Merema BBJ, Kraeima J, Glas HH, Spijkervet FKL, Witjes MJH. Patient-specific finite element models of the human mandible: Lack of consensus on current set-ups. Oral Dis 2020; 27:42-51. [PMID: 32372548 PMCID: PMC7818111 DOI: 10.1111/odi.13381] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/28/2022]
Abstract
The use of finite element analysis (FEA) has increased rapidly over the last decennia and has become a popular tool to design implants, osteosynthesis plates and prostheses. With increasing computer capacity and the availability of software applications, it has become easier to employ the FEA. However, there seems to be no consensus on the input variables that should be applied to representative FEA models of the human mandible. This review aims to find a consensus on how to define the representative input factors for a FEA model of the human mandible. A literature search carried out in the PubMed and Embase database resulted in 137 matches. Seven papers were included in this current study. Within the search results, only a few FEA models had been validated. The material properties and FEA approaches varied considerably, and the available validations are not strong enough for a general consensus. Further validations are required, preferably using the same measuring workflow to obtain insight into the broad array of mandibular variations. A lot of work is still required to establish validated FEA settings and to prevent assumptions when it comes to FEA applications.
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Affiliation(s)
- Bram Barteld Jan Merema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Haye H Glas
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Onclin P, Kraeima J, Merema BBJ, Meijer HJA, Vissink A, Raghoebar GM. Utilising the nasal aperture for template stabilisation for guided surgery in the atrophic maxilla. Int J Implant Dent 2020; 6:23. [PMID: 32588142 PMCID: PMC7316938 DOI: 10.1186/s40729-020-00221-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/24/2020] [Indexed: 11/20/2022] Open
Abstract
Background Templates aim to facilitate implant placement in the prosthetically preferred position. Mucosa-supported and bone-supported templates are commonly used in the edentulous maxilla. In the atrophic maxilla (Cawood V and VI), however, these templates can be easily displaced due to a lack of supportive tissues, even in cases where anterior sites offer sufficient bone for implant placement. To assist in positioning and stabilisation, we designed a template that utilises the nasal aperture as a fulcrum to create a forced and exclusive fit. The aim of this study was to assess the clinical usability of the developed template and the corresponding implant placement accuracy in patients with edentulous atrophic maxillae. Deviations between planned and placed implant positions were measured by aligning pre- and post-operative cone beam computed tomography scans. Results Twenty-four implants were placed in 11 patients. One template did not fit properly due to a slight undercut. All implants could be placed with good primary stability. The implants had high accuracy at the implant shoulder (global deviation 1.1 ± 0.5 mm, lateral deviation 0.8 ± 0.5 mm) and a mean angular deviation of 7.2 ± 3.4°. Conclusions The developed surgical template offers stabilised and secure template placement in the edentulous atrophic maxilla, resulting in satisfying implant placement accuracy when using a semi-guided approach. Trial registration Netherlands Trial Register, NL6561, registered 26 September 2017.
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Affiliation(s)
- Pieter Onclin
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands.
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands
| | - Bram B J Merema
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands.,Department of Implant Dentistry, University of Groningen, University Medical Centre Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands
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Rivas R, Overbosch J, Kwee T, Kraeima J, Dierckx RAJO, Jutte PC, van Ooijen PM. Radiofrequency ablation of atypical cartilaginous tumors in long bones: a retrospective study. Int J Hyperthermia 2020; 36:1189-1195. [PMID: 31884842 DOI: 10.1080/02656736.2019.1687943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Purpose: To determine the size of the ablation zone after radiofrequency ablation (RFA) of atypical cartilaginous bone tumors (ACT) using temperature-controlled 20 and 30 mm RFA straight non-cooled electrodes.Materials and methods: Sixteen patients with ACT in their long bones, who had undergone a single-session single-application CT-guided temperature-controlled RFA, were included retrospectively in the study. Tumors with a diameter of 10-25 mm were treated with 20 mm electrodes (n = 10), and tumors of 25-35 mm, with 30 mm electrodes (n = 6). The ablated zone was measured after three months on MRI images.Results: All the tumors were within the ablated zone on the 3-month follow-up MRI scan. The mean ablation time with the electrode, at a target temperature of 90 °C, was 7.6 minutes (range 6-10). The median of the largest ablation diameters, on applying the 20 and 30 mm electrodes, were 42 mm (IQR 8.5, range 30-51 mm) and 44.5 mm (IQR 4.5, range 42-63 mm), respectively.Conclusions: All the retrospectively viewed tumors in the long bones of ACT patients treated with RFA were completely ablated. The ablation zone diameters in the bones were larger than expected, when compared to other tissues, such as the liver.
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Affiliation(s)
- Ricardo Rivas
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jelle Overbosch
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas Kwee
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paul C Jutte
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter M van Ooijen
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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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] [What about the content of this article? (0)] [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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van der Helm HC, Kraeima J, Xi T, Jansma J, Schepers RH. The use of xenografts to prevent inferior border defects following bilateral sagittal split osteotomies: three-dimensional skeletal analysis using cone beam computed tomography. Int J Oral Maxillofac Surg 2020; 49:1029-1035. [PMID: 31987591 DOI: 10.1016/j.ijom.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 11/12/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Abstract
The aim of this retrospective study was to investigate grafting in the osteotomy gap during bilateral sagittal split osteotomy (BSSO), using a xenograft and fibrin glue. Hard tissue defects in the inferior mandibular border were assessed using cone beam computed tomography scans taken 1 week and 1year postoperatively. The study group of 20 patients underwent bone grafting during BSSO (mean age 26.1years; mean horizontal displacement 8.5mm) and the control group of 20 patients did not (mean age 30.2 years; mean horizontal displacement 7.6mm). The mean height of the mandibular defects was significantly lower in the study group, but there was no significant difference in volume measurements between the groups. Grafting had a negligible effect on large displacements (9.0-15.0mm), which might have been due to an inadequate amount and/or positioning of the graft, or to poor dimensional stability. This may be resolved by improved graft positioning or by using a different kind of (xeno)graft.
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Affiliation(s)
- H C van der Helm
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
| | - J Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - T Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Jansma
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - R H Schepers
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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Assink N, Kraeima J, Slump CH, Ten Duis K, de Vries JPPM, Meesters AML, van Ooijen P, Witjes MJH, IJpma FFA. Quantitative 3D measurements of tibial plateau fractures. Sci Rep 2019; 9:14395. [PMID: 31591466 PMCID: PMC6779915 DOI: 10.1038/s41598-019-50887-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/16/2019] [Indexed: 12/14/2022] Open
Abstract
Fracture gap and step-off measurements on 2DCT-slices probably underestimate the complex multi-directional features of tibial plateau fractures. Our aim was to develop a quantitative 3D-CT (Q3DCT) fracture analysis of these injuries. CT-based 3D models were created for 10 patients with a tibial plateau fracture. Several 3D measures (gap area, articular surface involvement, 3D displacement) were developed and tested. Gaps and step-offs were measured in 2D and 3D. All measurements were repeated by six observers and the reproducibility was determined by intra-class correlation coefficients. Q3DCT measurements demonstrated a median gap of 5.3 mm, step-off of 5.2 mm, gap area of 235 mm2, articular surface involvement of 33% and 3D displacement of 6.1 mm. The inter-rater reliability was higher in the Q3DCT than in the 2DCT measurements for both the gap (0.96 vs. 0.81) and step-off (0.63 vs. 0.32). Q3DCT measurements showed excellent reliability (ICC of 0.94 for gap area, 1 for articular surface involvement and 0.99 for 3D displacement). Q3DCT fracture analysis of tibial plateau fractures is feasible and shows excellent reliability. 3D measurements could be used together with the current classification systems to quantify the true extent of these complex multi-directional fractures in a standardized way.
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Affiliation(s)
- N Assink
- Department of Technical Medicine & MIRA Institute for Biomedical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - J Kraeima
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - C H Slump
- Department of Technical Medicine & MIRA Institute for Biomedical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - K Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - J P P M de Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - A M L Meesters
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - P van Ooijen
- 3D Lab/Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - M J H Witjes
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - F F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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Qiu B, Guo J, Kraeima J, Glas HH, Borra RJH, Witjes MJH, van Ooijen PMA. Automatic segmentation of the mandible from computed tomography scans for 3D virtual surgical planning using the convolutional neural network. ACTA ACUST UNITED AC 2019; 64:175020. [DOI: 10.1088/1361-6560/ab2c95] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Pijpker PA, Wagemakers M, Kraeima J, Vergeer RA, Kuijlen JM, Groen RJ. Three-Dimensional Printed Polymethylmethacrylate Casting Molds for Posterior Fossa Reconstruction in the Surgical Treatment of Chiari I Malformation: Technical Note and Illustrative Cases. World Neurosurg 2019; 129:148-156. [DOI: 10.1016/j.wneu.2019.05.191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
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Tuin A, Meulstee J, Loonen T, Kraeima J, Spijkervet F, Vissink A, Jansma J, Schepers R. 3D Facial Volume Analysis Using Algorithm Based Personalized Templates. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kraeima J, Jansma J, Witjes M, Spijkervet F, Schepers R. Splintless surgery: does patient-specific CAD-CAM osteosyntheses improve the accuracy maxillary translation after a Le Fort I osteotomy? a multi center randomised clinical trial. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Witjes M, Glas H, Lai S, Tribius S, Heiland M, Ashkan R, ten Hove I, Roodenburg J, Spijkervet F, Kraeima J. Surgical management of osteoradionecrosis using three-dimensional isodose curve visualization: a multi center retrospective study. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mohamed A, Al Feghali K, Ng S, Elhalawani H, Hutcheson K, Chambers M, Phan J, Kraeima J, Glas H, Witjes M, Gunn G, Garden A, Rosenthal D, Frank S, Morrison W, Fuller C, Lai S. PV-0202 3-D reconstruction of radiotherapy dose associated with advanced osteoradionecrosis after IMRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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