Clinical feasibility of computer-aided surgical simulation (CASS) in the treatment of complex craniomaxillofacial deformities
Clinical feasibility of computer-aided surgical simulation (CASS) in the treatment of complex craniomaxillofacial deformities
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DOI：
10.1016/j.joms.2006.04.001
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发表时间：
2007-04-01
影响因子：
1.9
通讯作者：
Briggs, Michaelanne E.
中科院分区：
文献类型：
--
作者：
Gateno, Jaime;Xia, James J.;Briggs, Michaelanne E.
目的：本研究的目的是建立我们的三维计算机辅助手术模拟（卡斯）的临床可行性，为复杂的颅颌面surgery.Materials and Methods：五个连续的病人，复杂的颅颌面畸形，包括半侧颜面矮小，肿瘤消融后的缺陷，和畸形后颞下颌关节重建，被使用。采用作者的卡斯计划方法对患者的手术干预进行计划。最初进行了计算机断层扫描（CT）。计划过程的第一步是创建一个复合颅骨模型，该模型以高度的准确度再现了骨骼结构和牙列。第二步是量化畸形。第三步，在电脑中模拟整个手术过程。通常先完成上颌截骨，然后是下颌和下巴手术。如果需要，还模拟了骨移植物的形状和尺寸。如果模拟结果不令人满意，则可以修改手术计划并重新开始模拟。最后一步是制作手术夹板。利用作者的计算机辅助设计/制造技术，在计算机中设计和制造手术夹板和模板，并通过光固化快速成型设备制造。为了最大限度地减少对患者的潜在风险，手术也计划按照目前的计划方法，和丙烯酸手术夹板创建作为备份place.Results：所有5例患者都成功地计划使用我们的卡斯计划方法。计算机生成的手术夹板在手术时成功地用于所有患者。备用丙烯酸手术夹板和计划从未使用过。术后6周CT扫描显示手术计划在手术室精确再现，畸形按计划矫正。结论：本研究的结果表明，我们的卡斯计划方法的临床可行性。使用我们的卡斯方法，我们能够在一次手术中治疗具有显著不对称性的患者，而过去通常在2个阶段完成。我们还能够模拟不同的外科手术，以创建适当的计划。然后在手术室使用计算机生成的手术夹板将计算机化的手术计划传送给患者。(C)2007年美国口腔颌面外科医师协会。
Purpose: The purpose of this study was to establish clinical feasibility of our 3-dimensional computer-aided surgical simulation (CASS) for complex craniomaxillofacial surgery.Materials and Methods: Five consecutive patients with complex craniomaxillofacial deformities, including hemifacial microsomia, defects after tumor ablation, and deformity after TMJ reconstruction, were used. The patients' surgical interventions were planned by using the authors' CASS planning method. Computed tomography (CT) was initially obtained. The first step of the planning process was to create a composite skull model, which reproduces both the bony structures and the dentition with a high degree of accuracy. The second step was to quantify the deformity. The third step was to simulate the entire surgery in the computer. The maxillary osteotomy was usually completed first, followed by mandibular and chin surgeries. The shape and size of the bone graft, if needed, was also simulated. If the simulated outcomes were not satisfactory, the surgical plan could be modified and simulation could be started over. The final step was to create surgical splints. Using the authors' computer-aided designing/manufacturing techniques, the surgical splints and templates were designed in the computer and fabricated by a stereolithographic apparatus. To minimize the potential risks to the patients, the surgeries were also planned following the current planning methods, and acrylic surgical splints were created as a backup plan.Results: All 5 patients were successfully planned using our CASS planning method. The computer-generated surgical splints were successfully used on all patients at the time of the surgery. The backup acrylic surgical splints and plans were never used. Six-week postoperative CT scans showed the surgical plans were precisely reproduced in the operating room and the deformities were corrected as planned.Conclusion: The results of this study have shown the clinical feasibility of our CASS planning method. Using our CASS method, we were able to treat patients with significant asymmetries in a single operation that in the past was usually completed in 2 stages. We were also able to simulate different surgical procedures to create the appropriate plan. The computerized surgical plan was then transferred to the patient in the operating room using computer-generated surgical splints. (C) 2007 American Association of Oral and Maxillofacial Surgeons.