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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_537_Библиотеки_им_академика_М_И_Перельмана
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67.
Levitt, S., Patel, V., Sosa, D., Carola, N., & Tokgöz, E. (2023). Preexisting conditions leading to
total knee arthroplasty. In Total knee arthroplasty: Medical and biomedical engineering and
science concepts. Springer. ISBN #: 978-3-031-31099-7.
68. Sosa, D., Carola, N., Patel, V., Levitt, S., & Tokgöz, E. (2023). Surgical approach comparison in
total knee arthroplasty. In Total knee arthroplasty: Medical and biomedical engineering and
science concepts. Springer. ISBN #: 978-3-031-31099-7.
69. Sosa, D., Carola, N., Patel, V., Levitt, S., & Tokgöz, E. (2023). Perioperative patient care for
total knee arthroplasty. In Total knee arthroplasty: Medical and biomedical engineering and
science concepts. Springer. ISBN #: 978-3-031-31099-7.
70. Levitt, S., Patel, V., Carola, N., Sosa, D., & Tokgöz, E. (2023). Complications of total knee
arthroplasty. In Total knee arthroplasty: Medical and biomedical engineering and science
concepts. Springer. ISBN #: 978-3-031-31099-7.
71. Carola, N., Patel, V., Levitt, S., Sosa, D., & Tokgöz, E. (2023). Ergonomics of total knee
arthroplasty. In Total knee arthroplasty: Medical and biomedical engineering and science
concepts. Springer. ISBN #: 978-3-031-31099-7.
72. Marina, A. C., & Tokgöz, E. (2023). Non-surgical facial aesthetic procedures. In Cosmetic and
reconstructive facial plastic surgery: A review of medical and biomedical engineering and
science concepts. Springer. ISBN #: 978-3031311673.
73. Marina, A. C., & Tokgöz, E. (2023). Aesthetic surgery of the upper face and cheeks. In Cosmetic
and reconstructive facial plastic surgery: A review of medical and biomedical engineering and
science concepts. Springer. ISBN #: 978-3031311673.
74. Marina, A. C., & Tokgöz, E. (2023). Aesthetic surgery of the nose and lower face. In Cosmetic
and reconstructive facial plastic surgery: A review of medical and biomedical engineering and
science concepts. Springer. ISBN #: 978-3031311673.
75. Marina, A. C., Donofrio, G., & Tokgöz, E. (2023). Surgical reconstruction of craniofacial
malformations. In Cosmetic and reconstructive facial plastic surgery: A review of medical and
biomedical engineering and science concepts. Springer. ISBN #: 978-3031311673.
76. Marina, A. C., & Tokgöz, E. (2023). Surgical reconstruction of craniofacial trauma and burns. In
Cosmetic and reconstructive facial plastic surgery: A review of medical and biomedical
engineering and science concepts. Springer. ISBN #: 978-3031311673.
77. Musafer, H., & Tokgöz, E. (2023). A facial wrinkle detection by using deep learning with an
efficient optimizer. In Cosmetic and reconstructive facial plastic surgery: A review of medical
and biomedical engineering and science concepts. Springer. ISBN #: 978-3031311673.
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©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_7
Cosmetic and Reconstructive Facial
Plastic Surgery Related Simulation and
Optimization Efforts
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 Plastic surgery simulation – Plastic surgery optimization –
Imaging techniques for reconstructive plastic surgery – Surface imaging
techniques in plastic surgery – CT scans for plastic surgery – Mandibular
reconstruction & imaging modalities – Maxillary surgery & imaging
modalities
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.
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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
Reconstructive surgery aims to treat body parts affected aesthetically or
functionally by developmental abnormalities, congenital defects, or trauma
while cosmetic surgery has both surgical and nonsurgical procedures that
enhance and reshape structures of the body to improve appearance and
confidence [120]. There is a variety of cosmetic and reconstructive plastic
surgery procedures and craniofacial is one of these types.
The use of 3-Dimensional (3D) imaging technology for facial
asymmetry and contour observations as a part of plastic surgery by Karlan
in 1979 long after the introduction of 3D imaging technology in 1944 sets
up the foundations of the current use of this technique in plastic surgery.
The ultimate goal for using such technology is to assist/guide the surgeon so
that the surgeon plans the best possible way of surgery with the guide of
technology while surgical procedure outcomes are maximized for patients’
favor as much as possible. Preoperative planning for postoperative outcome
optimization is the key in this process by standardizing patient topographic
measurements. Aesthetic, functional, and psychological perspectives are
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some of these outcomes that can be listed that are observed in the literature.
Measurements such as surface area, volume, distances between structures,
and curvature are a few of the data collected upon the imaging modalities
used [11]. Noting the expenses associated with such technologies, there has
been analysis of cost-effectiveness reported in several studies that you will
be reading throughout this work. Computed tomography (CT) and magnetic
resonance imaging (MRI) are two of these technologies that have been used
for facial reconstructive surgeries that will be covered.
There are other technologies and methods introduced in plastic surgery
applications that made imaging technologies such as CT serve as the
benchmark for further development by using these technologies and
methods. Implant development methods by using advanced manufacturing
and augmented reality technology are examples of such technologies and
methods to guide the surgeon to be covered throughout this work.
The advanced manufacturing application requires patient-specific CT
data collection initially. These CT data are then used as a part of computeraided design (CAD) to develop the 3D model of an individual patient’s
implant design. Design, fabrication, and implantation using the CAD and
advanced manufacturing are the key applications. A biocompatible material
such as titanium needs to be used to produce the implant; a manufacturer
can be worked with in order to order such an implant. Recent advancements
in 3D printing technology allowed certain organizations to own their own
3D printers to print such implants due to lowered prices of printers;
technologies such as high-pressure heat treatment (e.g., see [121]) as a part
of additive manufacturing can help with implants’ mechanical property
improvement.
The application of AR in reconstructive plastic facial surgery is based
on the use of AR technology to be able to design the implant and use it
virtually during the surgery.
2 Imaging and Simulation Techniques for
Optimizing Reconstructive Facial Plastic Surgery
Outcomes
There have been several imaging technologies used for attempting to
optimize noninvasive and invasive face surface reconstruction for several
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purposes including rhinoplasty [4, 24–28], face skin malignancy [29],
orthognathic surgery [30–32], cleft lip repair [19–22], and injectables [23].
It is the surgeon’s attempt to work with the patient to optimize the look to
be able to generate a fair optimal look from the patient’s perspective. It is
often the case then that the imaging modalities, scanning devices, and the
integration of technologies used play a crucial role in the work done.
2D imaging modalities (assuming x and y coordinates) have the loss of
the third dimension (z-coordinate) that gives height and depth to the image
[2]. As one can guess, this imaging modality does not include the accuracy
on the third dimension. Analysis by using 2D photography can result in lack
of standardization, changes in magnification, and variability in head
position [25, 27]. Given that there is strong advancement in scanning,
camera, and data storage ability of computing technology, 3D and 4D are
the most preferred methods for plastic and reconstructive surgery
simulation and planning that provide accurate information on the volume
and real-life image design. The 3D images are normally taken with digital
camera or scanners in an environment with appropriate light. The collected
data images stored in a computer/network are then manipulated using a
software. One or more cameras and scanners can be used and the precision
of the camera and scanners matter for good quality images. The software
merges the collected images to regenerate the collected data through the
taken images. With the advancement of technology today, the simulation of
the 3D images over time (known as 4D imaging technology) allows to
simulate a patient’s 3D body part as seconds pass by. Some of the recent
2D, 3D, and 4D surface imaging technologies used by plastic surgeons
include the following:
Canfield Scientific (NJ, USA) – Imaging systems of the company include
VECTRA©, IntelliStudio©, VISIA©, Vectra©, and Reveal©; Products
used for 3D imaging and simulation, 2D image capture improvement,
and facial skin analysis.
3D SHAPE GMBH (Enlargen, Germany):
– CAM3D – Optical 3D sensor used for object shape scanning that
utilizes 1 projector and 1 camera.
– CAM3D D – Optical 3D sensor used for object shape scanning that
utilizes 1 projector and 2 cameras for the two-view scanning.
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– CAM3D DF – Device with two switchable measurement field sizes
(3D SHAPE GMBH, Enlargen, Germany).
– SLIM3D – Software utilizing reverse engineering to process and
display the data as triangle mashes (3D SHAPE GMBH, Enlargen,
Germany).
Axis Three (Belfast, Northern Ireland) – Provides 3D surgical simulation
tools for aesthetic consultations; products include 3D images of a
patient’s face in order to simulate facial surgery outcomes.
Crisalix Virtual Aesthetics (Lausanne, Switzerland) – Provider of 3D and
4D virtual reality aesthetic simulation software for displaying the
patient’s face view after a plastic surgery.
MirrorMe3D (NY, USA) – Provides a tool that combines surgical
planning with remote patient monitoring with the MirrorMe Platform and
creates virtual surgical plans for plastic and reconstructive surgery.
One of the goals of plastic surgery is to comfort skin cancer patients
look after reconstructive surgical procedures to ultimately help them feel
comfortable during their daily life interactions and maximize quality of life
[12–17]. Some of the scanning 3D modalities for surface imaging include
[19, 20]:
Stereophotogrammetry.
Laser scanning.
Structured-light scanning (e.g., handheld sonography scanners).
The distance between multiple cameras and the object is calculated in
3D stereophotogrammetry, which can result in accurate reproduction of the
face’s surface with realistic color and texture data resulting in a lifelike
rendering [18]. Optimal 3D surface imaging through analysis of the
following has also been attained in the literature [35–42]:
Gender differences’ measurements.
Age differences’ measurements.
Facial growth progress [40].
Symmetry establishment [41, 42].
Volume analysis [33].
Soft tissue structures (through mesh diagram analysis [35]).
Wrinkles on periorbital surface.
Burn defect recovery through tissue adaption.
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Classification of diseases.
The optimization of facial reconstruction depends on scores for
personalized aesthetic outcomes on a continuous scale [1]. The
advancements in artificial intelligence (AI) technology including
convolutional neural networks in recent years are particularly useful in
image analysis that can be used by interested groups.
The imaging techniques used by the surgeons also include:
Magnetic resonance imaging (MRI).
Computed tomography (CT).
The use of MRI has several advantages and disadvantages [3]:
It is a pain-free and noninvasive method however the use of contrast
associated with it can be harmful.
MRI of hard biological tissues is challenging due to the fleeting lifetime
and low strength of their response to resonant stimuli, especially at low
magnetic fields [45].
Structural display of soft tissue has high quality.
Allows preplanning before operation that involves angiography.
Some of the metals within the body of the patients do not allow MRI
imaging.
Implantable medical devices may malfunction during use (i.e.,
pacemakers).
CT scans have several advantages and disadvantages in applications:
Even though it is painless and noninvasive, it requires taking a certain
dose of ionized radiation into the body and it may require contrast
materials that can harm the body.
Displays soft tissue damage. It shows detailed soft tissue variation from
different angles.
Displays hard tissue damage. Hard tissue variation from different angles
is possible for reconstructive analysis.
Overall, a virtual 3D model attained upon using one of these methods
allows the surgeon to visualize the anatomical structure from different
angles and provides the surgeon a roadmap that allows for surgical
navigation throughout the operation [43].
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Figure 1 demonstrates CT scan images of a preoperative case of a
patient and the associated postoperative facial reconstruction attempt of the
multiple fractures. This case is determined to have fronto-naso-orbitoethmoid fractures [44].
Fig. 1 Frontal and midface fractures of pre- and postoperative CT scan of fractures [44]
One of the most recent technological advancements for attaining
optimal reconstructive design is the use of 3D printing and advanced
manufacturing. Production of solid objects layer by layer from bottom to
top is possible in 3D printing, which is considered as a form of additive
manufacturing [73]. While 3D printing offers custom-made solutions for
specific cases, there are certain weaknesses that may be experienced,
including the time it takes to 3D print, relatively high cost, and lack of high
internal stress, which may result in internal fractures [74].
Optimization of reconstructive surgical procedures using:
Augmented reality (AR; also known as mixed reality).
Artificial intelligence (AI).
Virtual surgical planning (VSP) for soft tissue reconstruction.
Bioprinting.
have also been investigated in several articles that will be also covered
throughout this work [75]. Applications of AR/VR include, but are not
limited to, the following:
Haptic device surgical planning applications: Cleft-lip repair [126],
cranio-maxillofacial reconstruction [125], fracture reduction [127, 128],
facial contouring [123, 124], and orthopedic fracture reduction [129–131]
and drilling [133].
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Haptic device surgical training applications: Orthopedic fracture
reduction [142–144], orthognathic surgery [140, 141], and orthopedic
drilling and burring [34, 145, 146].
3D eyewear surgical planning applications: Cranio-maxillofacial
reconstruction [125] and fracture reduction [127] and orthopedic fracture
reduction [130]
3D eyewear surgical training: Orthopedic drilling and burring [146]
AR device applications in surgical navigation: Bone tumor resection
[139], facial contouring [137], maxillofacial surgery [138], and
orthognathic surgery [134–136].
AR device applications in surgical planning: Orthopedic fracture
reduction [132].
Examples of the use of technologies outlined in this section in the
research literature of craniofacial, mandibular, maxillary, orbital, and
zygomatic reconstructive surgeries will be explained next.
3 Craniofacial Reconstruction and Imaging
Modalities
Optimization of craniofacial reconstruction is quickly advancing as the
technology and the corresponding industrial advancements increase. One of
the most recent advancements in maximizing the ability to correct
craniofacial deformity is the use of Vvrtual surgical planning (VSP),
computer-aided design (CAD), and computer-aided modeling (CAM)
techniques to design virtual surgery with stereolithography and real-time
surgical navigation [47]. Patient outcome satisfaction using these
techniques may improve through the reduction of operating and graftischemia times and increase of reconstructive accuracy [48, 49].
The view of the skeleton through different angles and planes is possible
by using CT through computer manipulation in 3D with digitized
information transferring possibility into a design software. CAD/CAM
implants can provide an increased level of refinement in both reconstruction
and esthetic applications [70]. CAD/CAM can provide implants customized
for the specific needs of the patient with the possibility of design process’
completion virtually [71]. Cone beam CT scans that are available in many
dental offices have the advantages of less expense and less radiation
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exposure to the patient [72]. CBCT has a limited role in the CAD/CAM
implant process due to their field is limited and head positioning devices
distort the soft tissue envelope.
Traditional techniques such as CT and MRI imaging are used for
preoperative observations in the research literature. The following are a few
of the recent applications that are seen in reconstructive plastic surgery:
CT scans, computer-aided design, and computer-aided manufacturing are
used for construction of artificial implants for craniomaxillofacial bone
defects [62]. The authors concluded the benefit of computer-aided,
individually fabricated construction of artificial implants for the
compound used to be a good craniomaxillofacial surgical technique that
resulted in improved aesthetic construction and functional recovery after
reconstruction.
Impact of CT-guided producers on upper, middle, and lower face
reconstruction of 20 patients that took place in 26 CT-guided producers
in multiple institutions are investigated [63]. The authors reported the
benefits of optimal safety and effectiveness of the procedure in
craniomaxillofacial surgery with the furthermore need of investigation.
Impact of hard and soft tissue variations on facial asymmetry upon 2-jaw
surgery is investigated in [64] by using 3D imaging software. Pre- and
postsurgical CT images are the inputs of the 3D imaging software. The
positive impact of 3D imaging analysis on quantification of hard and soft
tissues’ linear and angular measurements is observed for optimizing
surgical planning.
Fine cuts of craniomaxillofacial surgery patients’ CT scans are used as
inputs for 3 different navigation systems that utilized either infrared or
electromagnetic technologies [65]. The CT scans are compiled by the
software of the systems to form multisurface 3-D models that are used as
guiding material for navigating the surgeon. The optimal benefit of using
navigation systems is determined to be identification of lesions that are
hard to spot and accurate bone alignment using 2D models.
Facial trauma patients with Le Fort fractures are studies in [67] using
multislice computed tomography (MSCT) examination in which case 2D
and 3D images are used for evaluation. Multiplanar reformatted images
were developed using the machine software in coronal and sagittal
planes. The thin axial slices were transmitted directly from the MSCT
scanner to a workstation for reconstruction of 3D images. MSCT is
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