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DOI: 10.1055/s-0031-1283054
Computer-Assisted Innovations in Craniofacial Surgery
Publikationsverlauf
Publikationsdatum:
26. Juli 2011 (online)
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ABSTRACT
Reconstructive surgery for complex craniofacial defects challenges even the most experienced surgeons. Preoperative reconstructive planning requires consideration of both functional and aesthetic properties of the mandible, orbit, and midface. Technological innovations allow for computer-assisted preoperative planning, computer-aided manufacturing of patient-specific implants (PSIs), and computer-assisted intraoperative navigation. Although many case reports discuss computer-assisted preoperative planning and creation of custom implants, a general overview of computer-assisted innovations is not readily available. This article reviews innovations in computer-assisted reconstructive surgery including anatomic considerations when using PSIs, technologies available for preoperative planning, work flow and process of obtaining a PSI, and implant materials available for PSIs. A case example follows illustrating the use of this technology in the reconstruction of an orbital-frontal-temporal defect with a PSI. Computer-assisted reconstruction of complex craniofacial defects provides the reconstructive surgeon with innovative options for challenging reconstructive cases. As technology advances, applications of computer-assisted reconstruction will continue to expand.
KEYWORDS
Computer-assisted - computer-designed - computer-aided design/computer-aided manufacturing - custom implants - patient-specific implants - virtual reconstruction - preoperative planning - stereolithographic models
REFERENCES
- 1 Toth B A, Ellis D S, Stewart W B. Computer-designed prostheses for orbitocranial reconstruction. Plast Reconstr Surg. 1988; 81 315-324
- 2 Toth J M, Wang M, Estes B T, Scifert J L, Seim III H B, Turner A S. Polyetheretherketone as a biomaterial for spinal applications. Biomaterials. 2006; 27 324-334
- 3 Frodel Jr J L. Computer-designed implants for fronto-orbital defect reconstruction. Facial Plast Surg. 2008; 24 22-34
- 4 Scolozzi P, Martinez A, Jaques B. Complex orbito-fronto-temporal reconstruction using computer-designed PEEK implant. J Craniofac Surg. 2007; 18 224-228
- 5 Bell R B. Computer planning and intraoperative navigation in cranio-maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 2010; 22 135-156
- 6 Ellis D S, Toth B A, Stewart W B. Three dimensional imaging and computer-designed prostheses in the evaluation and management of orbitocranial deformities. Adv Ophthalmic Plast Reconstr Surg. 1992; 9 261-272
- 7 Burm J S, Chung C H, Oh S J. Pure orbital blowout fracture: new concepts and importance of medial orbital blowout fracture. Plast Reconstr Surg. 1999; 103 1839-1849
- 8 Hammer B, Prein J. Correction of post-traumatic orbital deformities: operative techniques and review of 26 patients. J Craniomaxillofac Surg. 1995; 23 81-90
- 9 Ramieri G, Spada M C, Bianchi S D, Berrone S. Dimensions and volumes of the orbit and orbital fat in posttraumatic enophthalmos. Dentomaxillofac Radiol. 2000; 29 302-311
- 10 Schön R, Metzger M C, Zizelmann C, Weyer N, Schmelzeisen R. Individually preformed titanium mesh implants for a true-to-original repair of orbital fractures. Int J Oral Maxillofac Surg. 2006; 35 990-995
- 11 Metzger M C, Schön R, Zizelmann C, Weyer N, Gutwald R, Schmelzeisen R. Semiautomatic procedure for individual preforming of titanium meshes for orbital fractures. Plast Reconstr Surg. 2007; 119 969-976
- 12 O'Connell D A, Futran N D. Reconstruction of the midface and maxilla. Curr Opin Otolaryngol Head Neck Surg. 2010; 18 304-310
- 13 He Y, Zhu H G, Zhang Z Y, He J, Sader R. Three-dimensional model simulation and reconstruction of composite total maxillectomy defects with fibula osteomyocutaneous flap flow-through from radial forearm flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108 e6-e12
- 14 Fuller S C, Strong E B. Computer applications in facial plastic and reconstructive surgery. Curr Opin Otolaryngol Head Neck Surg. 2007; 15 233-237
- 15 Hallermann W, Olsen S, Bardyn T, Taghizadeh F, Banic A, Iizuka T. A new method for computer-aided operation planning for extensive mandibular reconstruction. Plast Reconstr Surg. 2006; 117 2431-2437
- 16 Kernan B T, Wimsatt III J A. Use of a stereolithography model for accurate, preoperative adaptation of a reconstruction plate. J Oral Maxillofac Surg. 2000; 58 349-351
- 17 Singare S, Dichen L, Bingheng L, Yanpu L, Zhenyu G, Yaxiong L. Design and fabrication of custom mandible titanium tray based on rapid prototyping. Med Eng Phys. 2004; 26 671-676
- 18 Hemmy D C, David D J, Herman G T. Three-dimensional reconstruction of craniofacial deformity using computed tomography. Neurosurgery. 1983; 13 534-541
- 19 Komori T, Takato T, Akagawa T. Use of a laser-hardened three-dimensional replica for simulated surgery. J Oral Maxillofac Surg. 1994; 52 516-521
- 20 Bill J S, Reuther J F, Dittmann W et al.. Stereolithography in oral and maxillofacial operation planning. Int J Oral Maxillofac Surg. 1995; 24 (1 Pt 2) 98-103
- 21 Hirsch D L, Garfein E S, Christensen A M, Weimer K A, Saddeh P B, Levine J P. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg. 2009; 67 2115-2122
- 22 Schipper J, Ridder G J, Spetzger U, Teszler C B, Fradis M, Maier W. Individual prefabricated titanium implants and titanium mesh in skull base reconstructive surgery. A report of cases. Eur Arch Otorhinolaryngol. 2004; 261 282-290
- 23 Cabraja M, Klein M, Lehmann T N. Long-term results following titanium cranioplasty of large skull defects. Neurosurg Focus. 2009; 26 E10
- 24 Metzger M C, Hohlweg-Majert B, Schön R et al.. Verification of clinical precision after computer-aided reconstruction in craniomaxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104 e1-e10
- 25 Frodel J L, Lee S. The use of high-density polyethylene implants in facial deformities. Arch Otolaryngol Head Neck Surg. 1998; 124 1219-1223
- 26 Wellisz T. Clinical experience with the Medpor porous polyethylene implant. Aesthetic Plast Surg. 1993; 17 339-344
- 27 Xu J J, Teng L, Jin X L, Ji Y, Lu J J, Zhang B. Porous polyethylene implants in orbital blow-out fractures and enophthalmos reconstruction. J Craniofac Surg. 2009; 20 918-920
- 28 Menderes A, Baytekin C, Topcu A, Yilmaz M, Barutcu A. Craniofacial reconstruction with high-density porous polyethylene implants. J Craniofac Surg. 2004; 15 719-724
- 29 Cenzi R, Farina A, Zuccarino L, Carinci F. Clinical outcome of 285 Medpor grafts used for craniofacial reconstruction. J Craniofac Surg. 2005; 16 526-530
- 30 Kim M M, Boahene K D, Byrne P J. Use of customized polyetheretherketone (PEEK) implants in the reconstruction of complex maxillofacial defects. Arch Facial Plast Surg. 2009; 11 53-57
- 31 Mastronardi L, Ducati A, Ferrante L. Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up. Acta Neurochir (Wien). 2006; 148 307-312 discussion 312
- 32 Sekerci Z, Uğur A, Ergün R, Sanli M. Early changes in the cervical foraminal area after anterior interbody fusion with polyetheretherketone (PEEK) cage containing synthetic bone particulate: a prospective study of 20 cases. Neurol Res. 2006; 28 568-571
- 33 Hanasono M M, Goel N, DeMonte F. Calvarial reconstruction with polyetheretherketone implants. Ann Plast Surg. 2009; 62 653-655
- 34 Morrison C, Macnair R, MacDonald C, Wykman A, Goldie I, Grant M H. In vitro biocompatibility testing of polymers for orthopaedic implants using cultured fibroblasts and osteoblasts. Biomaterials. 1995; 16 987-992
- 35 Rubin J P, Yaremchuk M J. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg. 1997; 100 1336-1353
- 36 Gellrich N C, Schramm A, Hammer B et al.. Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformity. Plast Reconstr Surg. 2002; 110 1417-1429
Kelli RudmanM.D.
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin
9200 West Wisconsin Avenue, Milwaukee, WI 53226
eMail: krudman@mcw.edu