scholarly journals “6 Anatomical Landmarks” Technique for Satisfactory Free-Hand Orbital Reconstruction With Standard Preformed Titanium Mesh

2021 ◽  
pp. 194338752110076
Author(s):  
Gabriele Canzi ◽  
Federica Corradi ◽  
Giorgio Novelli ◽  
Alberto Bozzetti ◽  
Davide Sozzi
Keyword(s):  
Maxillofacial Surgery ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Patient Specific ◽  
Clinical Activity ◽  
Computer Assisted ◽  
Anatomical Landmarks ◽  
Orbital Reconstruction ◽  
Patient Specific Implants ◽  
Duration Of Surgery

Study Design: Retrospective study. Objective: Resolution of clinical signs and symptoms following orbital fractures depends on the accurate restoration of the orbital volume. Computer-Assisted procedures and Patient Specific Implants represent modern solutions, but they require additional resources. A more reproducible option is the use of standard preformed titanium meshes, widely available and cheaper; with their use quality of results is proportional to the accuracy with which they are positioned. This work identifies 6 reproducible and constant anatomical landmarks, as an intraoperative guide for the precise positioning of titanium preformed meshes. Methods: 90 patients treated at the Maxillofacial Surgery Department, Niguarda Trauma Center, Milan, for unilateral orbital reconstruction (January 2012 to December 2018), were studied. In all cases reconstruction was performed respecting the 6 proposed anatomical landmarks. The outcomes analyzed are: post-operative CT adherence to the 6 anatomical markers and symmetry achieved respect to controlateral orbit; number/year of re-interventions and duration of surgery; resolution of clinical defects (at least 12-months follow-up); incidence of complications. Results: Satisfactory results were obtained in terms of restoration of orbital size, shape and volume. Clinical defects early recovered with a low incidence of complications and re-interventions. Operating times and radiological accuracy have shown a progressive improvement during years of application of this technique. Conclusions: The proposed “6 anatomical landmarks” is an easy free-hand technique that allows everyone to obtain high levels of reconstructive accuracy and it should be a skill of all surgeons who deal with orbital reconstruction in daily clinical activity.

scholarly journals Computer-Assisted Secondary Orbital Reconstruction

2020 ◽  
pp. 194338752093500
Author(s):  
Daman D. Singh ◽  
Lara Schorn ◽  
E. Bradley Strong ◽  
Michael Grant ◽  
Alexander Schramm ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Computer Assisted ◽  
Data Sets ◽  
Orbital Reconstruction ◽  
Secondary Reconstruction ◽  
Patient Specific Implants ◽  
Before And After ◽  
Secondary Orbital Reconstruction

Study Design: This study presents a case-control study of 33 patients who underwent secondary orbital reconstruction, evaluating techniques and outcome. Objective: Adequate functional and aesthetical appearance are main goals for secondary orbital reconstruction. Insufficient premorbid orbital reconstruction can result in hypoglobus, enophthalmos, and diplopia. Computer-assisted surgery and the use of patient-specific implants (PSIs) is widely described in the literature. The authors evaluate the use of selective laser-melted PSIs and hypothesize that PSIs are an excellent option for secondary orbital reconstruction. Methods: The sample was composed of 33 patients, previously treated with primary orbital reconstruction, presenting themselves with indications for secondary reconstruction (i.e. enophthalmos, diplopia, or limited eye motility). Computed tomography and/or cone beam data sets were assessed before and after secondary reconstruction comparing intraorbital volumes, infraorbital angles, and clinical symptoms. Clinical outcomes were assessed using a standardized protocol. Results: Results show a significant change in intraorbital volumes and a reduction of clinical symptoms after secondary reconstruction. Conclusions: Outcomes of this study suggest that secondary orbital reconstruction can be performed routinely using selective laser-melted PSIs and titanium spacers.

scholarly journals Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction

2021 ◽  
Vol 11 ◽  
Author(s):  
Henriette L. Möllmann ◽  
Laura Apeltrath ◽  
Nadia Karnatz ◽  
Max Wilkat ◽  
Erik Riedel ◽  
...  
Keyword(s):  
Computer Assisted Surgery ◽  
Reference Points ◽  
Mandibular Reconstruction ◽  
Patient Specific ◽  
Computer Assisted ◽  
Advantages And Disadvantages ◽  
Patient Specific Implants ◽  
Operative Complications ◽  
The Difference ◽  
And Training

ObjectivesThis retrospective study compared two mandibular reconstruction procedures—conventional reconstruction plates (CR) and patient-specific implants (PSI)—and evaluated their accuracy of reconstruction and clinical outcome.MethodsOverall, 94 patients had undergone mandibular reconstruction with CR (n = 48) and PSI (n = 46). Six detectable and replicable anatomical reference points, identified via computer tomography, were used for defining the mandibular dimensions. The accuracy of reconstruction was assessed using pre- and postoperative differences.ResultsIn the CR group, the largest difference was at the lateral point of the condyle mandibulae (D2) -1.56 mm (SD = 3.8). In the PSI group, the largest difference between preoperative and postoperative measurement was shown at the processus coronoid (D5) with +1.86 mm (SD = 6.0). Significant differences within the groups in pre- and postoperative measurements were identified at the gonion (D6) [t(56) = -2.217; p = .031 <.05]. In the CR group, the difference was 1.5 (SD = 3.9) and in the PSI group -1.04 (SD = 4.9). CR did not demonstrate a higher risk of plate fractures and post-operative complications compared to PSI.ConclusionFor reconstructing mandibular defects, CR and PSI are eligible. In each case, the advantages and disadvantages of these approaches must be assessed. The functional and esthetic outcome of mandibular reconstruction significantly improves with the experience of the surgeon in conducting microvascular grafts and familiarity with computer-assisted surgery. Interoperator variability can be reduced, and training of younger surgeons involved in planning can be reaching better outcomes in the future.

scholarly journals Increasing the Accuracy of Orbital Reconstruction With Selective Laser-Melted Patient-Specific Implants Combined With Intraoperative Navigation

2015 ◽  
Vol 73 (6) ◽  
pp. 1113-1118 ◽  
Author(s):  
Majeed Rana ◽  
Christopher H.K. Chui ◽  
Maximillian Wagner ◽  
Ruediger Zimmerer ◽  
Madiha Rana ◽  
...  
Keyword(s):  
Intraoperative Navigation ◽  
Patient Specific ◽  
Orbital Reconstruction ◽  
Patient Specific Implants

scholarly journals Imaging, Virtual Planning, Design, and Production of Patient-Specific Implants and Clinical Validation in Craniomaxillofacial Surgery

2012 ◽  
Vol 5 (3) ◽  
pp. 137-143 ◽  
Author(s):  
Per Dérand ◽  
Lars-Erik Rännar ◽  
Jan-M Hirsch
Keyword(s):  
Additive Manufacturing ◽  
Treatment Plan ◽  
Maxillofacial Surgery ◽  
Bone Substitutes ◽  
Patient Specific ◽  
Virtual Design ◽  
Patient Specific Implants ◽  
Cutting Guide ◽  
Ablative Surgery ◽  
Cutting Guides

The purpose of this article was to describe the workflow from imaging, via virtual design, to manufacturing of patient-specific titanium reconstruction plates, cutting guide and mesh, and its utility in connection with surgical treatment of acquired bone defects in the mandible using additive manufacturing by electron beam melting (EBM). Based on computed tomography scans, polygon skulls were created. Following that virtual treatment plans entailing free microvascular transfer of fibula flaps using patient-specific reconstruction plates, mesh, and cutting guides were designed. The design was based on the specification of a Compact UniLOCK 2.4 Large (Synthes®, Switzerland). The obtained polygon plates were bent virtually round the reconstructed mandibles. Next, the resections of the mandibles were planned virtually. A cutting guide was outlined to facilitate resection, as well as plates and titanium mesh for insertion of bone or bone substitutes. Polygon plates and meshes were converted to stereolithography format and used in the software Magics for preparation of input files for the successive step, additive manufacturing. EBM was used to manufacture the customized implants in a biocompatible titanium grade, Ti6Al4V ELI. The implants and the cutting guide were cleaned and sterilized, then transferred to the operating theater, and applied during surgery. Commercially available software programs are sufficient in order to virtually plan for production of patient-specific implants. Furthermore, EBM-produced implants are fully usable under clinical conditions in reconstruction of acquired defects in the mandible. A good compliance between the treatment plan and the fit was demonstrated during operation. Within the constraints of this article, the authors describe a workflow for production of patient-specific implants, using EBM manufacturing. Titanium cutting guides, reconstruction plates for fixation of microvascular transfer of osteomyocutaneous bone grafts, and mesh to replace resected bone that can function as a carrier for bone or bone substitutes were designed and tested during reconstructive maxillofacial surgery. A clinically fit, well within the requirements for what is needed and obtained using traditional free hand bending of commercially available devices, or even higher precision, was demonstrated in ablative surgery in four patients.

Craniofacial Reconstruction Using Patient-Specific Implants Polyether Ether Ketone With Computer-Assisted Planning

2015 ◽  
Vol 26 (3) ◽  
pp. 663-666 ◽  
Author(s):  
Oscar J. Manrique ◽  
Frank Lalezarzadeh ◽  
Erez Dayan ◽  
Joseph Shin ◽  
Daniel Buchbinder ◽  
...  
Keyword(s):  
Patient Specific ◽  
Computer Assisted ◽  
Craniofacial Reconstruction ◽  
Patient Specific Implants ◽  
Polyether Ether Ketone ◽  
Ether Ketone

Computer-Aided Design and Manufacturing of a Novel Maxillofacial Surgery Instrument: Application in the Sagittal Split Osteotomy

2016 ◽  
Vol 10 (4) ◽  
Author(s):  
Erol Cansiz ◽  
Fatih Turan ◽  
Yunus Ziya Arslan
Keyword(s):  
Computer Aided Design ◽  
Maxillofacial Surgery ◽  
Inferior Alveolar Nerve ◽  
Patient Specific ◽  
Computer Assisted ◽  
Lateral Side ◽  
Sagittal Split Osteotomy ◽  
Surgical Application

Mandibular sagittal split osteotomy (SSO) is an operation performed for the correction of mandibular deformities. In this operation, sharp rotary tools are used during osteotomies and this can induce some complications. For example, if the inferior alveolar nerve is damaged, paralysis of the teeth, the lateral side of the tongue, and the corner of the lip can occur. To decrease the occurrence of such possible complications, we designed and manufactured a novel computer-assisted, patient-specific SSO guide and soft tissue retractor in our previous study. And, we first tested this apparatus on a cadaveric bone in vitro. Now, in this study, a surgical application of the instrument, which was designed and manufactured according to the requirements of the mandibular sagittal split osteotomies, was performed. This paper gives and discusses the results obtained from in vivo application of the apparatus.

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