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(1)
(2)
©The Author(s), under exclusive license to Springer Nature Switzerland AG2023
E. Tokgöz, M. A. Carro, Cosmetic and Reconstructive Facial Plastic Surgery
https://doi.org/10.1007/978-3-031-31168-0_10
Robotics Applications in Facial Plastic
Surgeries
EmreTokgöz
1
and MarinaA.Carro
2
Whiting School of Engineering, Johns Hopkins University, Baltimore,
MD, USA
The Frank H. Netter M.D. School of Medicine, Quinnipiac University,
North Haven, CT, USA
MarinaA.Carro
Email: Marina.Carro@quinnipiac.edu
Keywords Robotics applications in facial plastic surgeries – Soft robotics
in facial plastic surgery – Robotics applications on head, neck, and transoral
surgeries – Technology integration into robotics use in facial plastic surgery
– Free flap reconstruction – Robotics & facelift plastic surgery – Hair
transplantation & robotics
Emre Tokgöz completed two Ph.D. degrees, one in Mathematics and
another one in Industrial Engineering, at the University of Oklahoma along
with a master’s degree in Computer Science and two master’s degrees in
Mathematics. Due to his interest in biomedical engineering applications of
mathematics and engineering, he pursued an online biomedical engineering
master’s degree for professionals at Johns Hopkins University. His other
research interests include nonlinear optimization, game theory,
deep/machine learning, financial engineering, facility allocation problems,
vehicle routing problems, systems’ design and improvement, network
theory and analysis, inventory systems, and Riemannian geometry.
https://t.me/medicina_free
Marina A. Carro is a second-year medical student at the Frank H. Netter
School of Medicine (Quinnipiac University). Prior to medical school, she
worked as a project manager at Clínica Esperanza Hope Clinic in
Providence, Rhode Island, where she organized and managed a satellite
COVID-19 vaccination clinic for underserved populations in the area.
Additionally, she has worked as a certified nursing assistant for 3years in
the emergency department and intensive care unit at South County Hospital
in Kingston, Rhode Island. Currently, she is on the board for the Frank H.
Netter Wellness Committee, ENT Surgical Interest Group, and American
Medical Student Association at Netter. She hopes to continue exploring her
interests in clinical procedural research, healthcare business and
administration, and provide equitable healthcare for marginalized patients
throughout the rest of her career.
1 Introduction
It was the Hindu surgeons who were trained to understand the anatomy and
skilled in skin-shifting and other phases of reconstructive work [176].
Sushruta, who was the father of Hindu surgery, wrote in detail of an
operation for the reconstruction of a lost nose by the advancement of a
cheek-flap, and this is the oldest known description of rhinoplasty, written
during 750–800BC, that was based on previously developed techniques.
Plastic operations for the repair of lips by means of cheek flaps were
explained in this work as well as methods of repairing split or mutilated
lobes of ears. This method of utilizing sliding flaps was called, many
centuries later, the French method [176]. The facial prosthetics using wax
and earthen ceramics for developing prosthetic eyes, ears, and noses are
going back to Egyptian developments during 500BC [177]. The
development of facial prosthetics is advanced by using 3D printing [27].
Advanced manufacturing allows extremely detailed life-like replicas of
facial features that can be produced within hours and is a small fraction of
the cost of traditional prosthetics with low 3D costs [178]. Effectiveness of
the 3D printing applications on small-sized custom implants or prosthetics,
such as those used for craniofacial disorders, has been observed to be
effective [179].
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Robotics is another important advancement that also takes place in 3D
printing as well as other facial plastic surgery and the associated
applications in head and neck surgeries commonly. There are other
technologies that are incorporated into facial plastic surgeries in addition to
3D printing and robotics, such as augmented reality (AR), virtual reality
(VR), simulation software, CT scan images, machine learning, deep
learning, artificial intelligence, cameras, sensors, laser technologies, and
software used for advanced data analysis. We will cover several
technologies that relate to robotics in this work, with emphasis on robotics
applications on head and neck surgeries as well as facial plastic surgeries.
Personalized facial reconstruction is needed for development of
individualized and economical treatment of patients [27]. There are
anatomical geometric challenges faced during the treatment of
chondromyxoid fibroma (CMF), which is a type of cartilage tumor that
exist between the bones [120, 121]. Autologous bone grafting has its
limitations, including bone size and complications, that may be faced, such
as pain, infection, and functional disability [122]. Anatomical precision
increases with 3D printed implants, which allows individualized treatment.
Facial injury repairment that required multiple surgeries, imprecisely fitting
plating systems, or bone grafts can be accurately fitted with a singlecomponent 3D implant. Which can substantially increase the structural
integrity and cosmesis of the reconstruction. The effectiveness of using
robotics has been tested for cell crosslinking that contains material via a
biocompatible chemical reaction or photoinitiated crosslinking with deposit
of bio-printed skin directly into wound or burn defects of mice in [123].
This additive manufacturing technique allows advancement of surgeries and
practicality of applications. Inkjet approach allowed high-speed construct of
skin defects [124], and accuracy of robotics has allowed advancement of
reconstructive surgeries [125].
Large incisions were needed prior to CAS to fully view the operational
area and other structures to allocate the lesion. Computer-assisted surgery
(CAS) is used for plastic surgical procedures that utilize technologies such
as imaging scans, computer technology, and robotics. CAS allowed:
Smaller incisions and openings than the traditional techniques
Minimal invasion during procedures
Effective allocation of the lesion, which shortens the operation length
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Identification of the critical structures associated with the operational
section and avoiding them
Planning and simulation of the best route to be followed
For instance, some of the historically inoperable brain tumors become
operable upon advancements in CAS technologies. Resection of tumors
require careful attention on surrounding tissue, nerves, and blood vessels.
Robotic surgery applications within oral and maxillofacial surgery/head
and neck surgery include, but are not limited to, the following [15]:
Robot-assisted radical tonsillectomy
Base of tongue neoplasms
Removal of salivary gland pathology (i.e., benign neoplasms, malignant
neoplasms, and salivary stones)
Removal of benign or malignant parapharyngeal space tumors
Select cases of oral and maxillofacial surgeries, such as open reduction,
facial osteotomies, internal fixation of fractures, and placement of facial
implants, require careful incision management with the goal of executing a
successful operation along with minimization of surgical footprint routinely
by utilizing well-concealed incisions during the procedure. For instance,
such approaches were limited during the management of tumors of the
oropharynx. Dental implants’ surgical placement and restoration through
increased utilization of three-dimensional (3D) imaging, such as cone beam
computed tomography (CBCT) and intraoral scanning (IOS) becoming a
common practice in the office-based and academic settings, allowed the
implant team to perform restoratively driven planning in a collaborative
fashion using CAS [15]. Examples of such applications of robotics included
the following:
RoboDent use for computer aided dental implantology [116]
Impact of smoking on disease-specific survival outcomes in patients with
human papillomavirus-associated oropharyngeal cancer treated with
transoral robotic surgery [117]
Transoral robotic surgery usage for tonsillar cancer [118]
Da Vinci’s Xi surgical system is used in [1] to perform scaffold
implantation and second-stage flap raising as a feasibility study. The goal of
the study was to regenerate bone in the greater omentum as part of facial
skeleton reconstruction.
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