Computer-assisted orthognathic surgery: waferless maxillary positioning, versatility, and accuracy of an image-guided visualisation display

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system.

Download Full-text

An integrated orthognathic surgery system for virtual planning and image-guided transfer without intermediate splint

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2014.09.007 ◽

2014 ◽

Vol 42 (8) ◽

pp. 2010-2017 ◽

Cited By ~ 9

Author(s):

Dae-Seung Kim ◽

Sang-Yoon Woo ◽

Hoon Joo Yang ◽

Kyung-Hoe Huh ◽

Sam-Sun Lee ◽

...

Keyword(s):

Orthognathic Surgery ◽

Virtual Planning ◽

Image Guided

Download Full-text

Accuracy and reliability of three-dimensional computer-assisted planning for orthognathic surgery

Maxillofacial Plastic and Reconstructive Surgery ◽

10.1186/s40902-018-0154-4 ◽

2018 ◽

Vol 40 (1) ◽

Cited By ~ 2

Author(s):

Tae-Geon Kwon

Keyword(s):

Orthognathic Surgery ◽

Three Dimensional ◽

Computer Assisted

Download Full-text

Computer-Assisted Open Heart CABG: Image-Guided Navigation for All Target Vessels

Functional Imaging and Modeling of the Heart - Lecture Notes in Computer Science ◽

10.1007/978-3-642-01932-6_51 ◽

2009 ◽

pp. 476-485 ◽

Cited By ~ 1

Author(s):

Claudia Gnahm ◽

Christine Hartung ◽

Reinhard Friedl ◽

Martin Hoffmann ◽

Klaus Dietmayer

Keyword(s):

Computer Assisted ◽

Open Heart ◽

Image Guided

Download Full-text

Real-Time Image-Guided Navigation in the Management of Alveolar Cleft Repair

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211057744 ◽

2021 ◽

pp. 105566562110577

Author(s):

Yuying Zhang ◽

Jiawei Dai ◽

Xiazhou Fu ◽

Jiegang Yang ◽

Yuchuan Fu ◽

...

Keyword(s):

Real Time ◽

Navigation System ◽

Preoperative Planning ◽

Surgical Simulation ◽

Surgical Navigation ◽

Computer Assisted ◽

Alignment Procedure ◽

Alveolar Cleft ◽

Image Guided ◽

Dynamic Navigation

Objectives: To present the use of dynamic navigation system in the repair of alveolar cleft. Patients and Participants: A total of three non-syndromic patients with unilateral alveolar cleft were involved in this study. Real-time computer-aided navigation were used to achieve restoration and reconstruction with standardized surgical technique. Methods: With the individual virtual 3-dimensional (3-D) modeling based on computed tomography (CT) data, preoperative planning and surgical simulation were carried out with the navigation system. During preoperative virtual planning, the defect volume or the quantity of graft is directly assessed at the surgical region. With the use of this system, the gingival periosteum flap incision can be tracked in real-time, and the bone graft can be navigated under the guidance of the 3-D views until it matches the preoperatively planned position. Results: Three patients with alveolar cleft were successfully performed under navigation guidance. Through the model alignment procedure, accurate matches between the actual intraoperative position and the CT images were achieved within the systematic error of 0.3 mm. The grafted bone was implanted according to the preoperative plan with the aid of instrument- and probe-based navigation. All the patients were healed well without serious complications. Conclusions: These findings suggest that image-guided surgical navigation, including preoperative planning, surgical simulation, postoperative assessment, and computer-assisted navigation was feasible and yielded good clinical outcomes. Clinical relevance: This dynamic navigation could be proved to be a valuable option for this complicated surgical procedure in the management of alveolar cleft repair.

Download Full-text

Commentary on Computer-Assisted Orthognathic Surgery

Integrated Procedures in Facial Cosmetic Surgery ◽

10.1007/978-3-030-46993-1_68 ◽

2021 ◽

pp. 853-855

Author(s):

Seied Omid Keyhan ◽

Behnaz Poorian

Keyword(s):

Orthognathic Surgery ◽

Computer Assisted

Download Full-text

Computer-Aided Planning in Orthognathic Surgery: A Comparative Study with the Establishment of Burstone Analysis-Derived 3D Norms

Journal of Clinical Medicine ◽

10.3390/jcm8122106 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2106 ◽

Cited By ~ 1

Author(s):

Cheng-Ting Ho ◽

Rafael Denadai ◽

Hsin-Chih Lai ◽

Lun-Jou Lo ◽

Hsiu-Hsia Lin

Keyword(s):

Orthognathic Surgery ◽

Three Dimensional ◽

Computer Assisted ◽

Class Iii ◽

Facial Soft Tissue ◽

Skeletal Class ◽

Nasolabial Angle ◽

Normal Occlusion ◽

Computer Aided ◽

Cephalometric Measurements

Three-dimensional (3D) computer-aided simulation has revolutionized orthognathic surgery treatment, but scarce 3D cephalometric norms have been defined to date. The purposes of this study were to (1) establish a normative database of 3D Burstone cephalometric measurements for adult male and female Chinese in Taiwan, (2) compare this 3D norm dataset with the two-dimensional (2D) Burstone norms from Caucasian and Singaporean Chinese populations, and (3) apply these 3D norms to assess the outcome of a computer-aided simulation of orthognathic surgery. Three-dimensional Burstone cephalometric analysis was performed on 3D digital craniofacial image models generated from cone-beam computed tomography datasets of 60 adult Taiwanese Chinese individuals with normal occlusion and balanced facial profile. Three-dimensional Burstone analysis was performed on 3D image datasets from patients with skeletal Class III pattern (n = 30) with prior computer-aided simulation. Three-dimensional Burstone cephalometric measurements showed that Taiwanese Chinese males had significantly (p < 0.05) larger anterior and posterior facial heights, maxillary length, and mandibular ramus height than females, with no significant (p > 0.05) difference for facial soft-tissue parameters. The 3D norm dataset revealed Taiwanese Chinese-specific facial characteristics, with Taiwanese presenting (p < 0.05) a more convex profile, protrusive maxillary apical bases, protruding mandible, protruding upper and lower lips, and a shorter maxillary length and lower facial height than Caucasians. Taiwanese had significantly (p < 0.05) larger maxillary projection, vertical height ratio, lower face throat angle, nasolabial angle, and upper lip protrusion than Singaporean Chinese. No significant (p > 0.05) difference was observed between 3D norms and computer-aided simulation-derived 3D patient images for horizontal skeletal, vertical skeletal, and dental measurements, with the exception of two dental parameters (p < 0.05). This study contributes to literature by providing gender- and ethnic-specific 3D Burstone cephalometric norms, which can assist in the multidisciplinary-based delivery of orthodontic surgical care for Taiwanese Chinese individuals worldwide, including orthodontic management, computer-assisted simulation, and outcome assessment.

Download Full-text