Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_537_Библиотеки_им_академика_М_И_Перельмана
.pdf
(vMs) calculations being one such method. The finite element method
(FEM) is a popular method used for numerically solving differential
equations, and FEA is the analysis by using this method. Von Mises stress is
a value used for understanding the nature of materials from a yield/fracture
perspective. The associated calculations are particularly useful for ductile
materials such as metals. In the case when the von Mises stress of a material
under load is equal or greater than the yield limit of the same material under
simple tension than the material will yield [78].
The primary analysis method for biomechanical performance appears to
be FEA for personalized mandibular reconstruction [81–83]. Given specific
physiological constraints and loads, FEA is helpful in stress, strain, and
displacement distribution’s numerical simulation.
There are strain gauges attached to the external surface of additively
manufactured mandibular reconstruction assemblies, and these gauges used
for measuring the direction and magnitude of strains under loadings that are
applied to the mandibular bone surface to verify the accuracy of the
calculations. Combined use of the FEA with strain gauges is useful for
verification of calculation accuracies and helpful to produce outcomes with
higher reliability [87].
One way of testing individualized mandibular plate design is by
simulating the designed plate on a momentary left group clenching and
incisal clenching tasks [77]. Fixation screws are placed in [77] certain areas
of the applications with 3D loads applied on four principal muscles:
masseter, temporalis, lateral, and medial pterygoid. Either the left molars or
incisors area were restrained from moving vertically with retraining of the
mandibular condyles. The authors compared biomechanical performances
of the original design with the design structured by using a generic contour
customization (D1) and the design generated by using a tangent arc upper
margin in mandibular angle region (D2). The maximum vMs of structurally
optimized mandibular fixation plate values are determined to be much
lower than that of the initial plates designed on both groups. The authors
concluded that the structurally optimized mandibular plate had
biomechanical advantages over the original design in personalized design.
D1 was observed to have better biomechanical performance compared to
D2 due to its advantages of safety, preferable flexibility, and comparable
stability. When compared to D1, D2 had biomechanical benefits for
reducing the maximum tension through tangent arc upper margin in
https://t.me/medicina_free
mandibular angle region, which was indicated by lower peak maximum
principal stress [77].
A method by optimizing parameters of a mathematical model through
the response surface methodology to determine a suitable mandibular
reconstruction implant is introduced in [90]. Central composite design is
used by the authors to obtain sample data, and the least square method is
used to calculate coefficients of a fitting equation and apply the desirability
function method to optimize multiple responses. The objective of the
mathematical optimization model is to determine the maximum stress value
for designing a personalized craniofacial reconstruction implant by using
the angle of V-shaped titanium plate, the thickness of titanium plate
establishment, and the thickness of the V-shaped design. The authors
determined a set of optimized parameters suitable for mandibular implant
configuration that can be used as reference for clinical mandible implant
design. Figure 7 is an example of a V-shaped implant in the mandibular
section with von Mises stress calculations used as a part of the design to
determine a distribution of the stress loads throughout the mandibular
implant designed [90].
https://t.me/medicina_free
Fig. 7 A V-shaped mandibular implant designed using optimization with von Mises calculations
[90]
7 Biomechanics of Craniofacial Surgery
Craniofacial fractures require stabilization and fixation principal
components in order to establish the preinjury anatomic alignment and
maintaining the bone fragments in that alignment for sufficient time to
allow osseous union [95]. Biomechanics of craniofacial surgery has
included several different considerations and observations in the research
literature, including the following [90]:
Mechanical analysis of forces, loads, stresses, strains, compressions,
tensions, shears, Young’s modulus values, fatigue damages, and shear
loading within the region.
Physiological material properties determined for bone and craniofacial
skeleton under normal and pathological conditions.
Plantation material properties used for fixation such as wires, screws, and
plates and the impact of integrated mechanisms such as screws and
plates, locking plates, lag screws, and external fixators on physiological
and functional outcomes.
Tertiary factors impacting biomechanics of craniofacial surgeries such as
osteogenesis and radiation.
Computational mechanical analysis tools such as finite element method
for analysis.
Virtual surgical planning, cutting guides, and intra-operative navigation.
There are certain outcomes attained in the literature that relate to these
biomechanical considerations. Proper maxillary-mandibular fixations are
attained by using stainless steel wires, which are known for their excellent
tensile strength and are typically manufactured from nickel-chromium steel.
Wires can only pull but cannot resist compression due to their good tensile
but minimum compressive strength. Inter-fragmentary wiring is determined
to be an excellent way to gain initial control of the bony segments prior to
adapting plates [96].
The conventional plates engage the bone through screws to generate a
single rigid entity by spanning the fracture. Fixation by using a combination
of plate and screw provides both tensile and compressive strength, which is
known to be the standard for craniofacial fractures [90]. A variety of screw
https://t.me/medicina_free
and plate anatomies can be used in such applications, including, but not
limited to, the following:
Self-tapping screw
Nonself-tapping locking screw
Self-drilling locking screw
Locking plate
Conventional plate with locking ability
The engagement of the screw with the bone through the locking plate
can tighten (lock) the bone. Majority of the plates used for rigid internal
fixation have locking ability when they are combined with locking screws.
Stability comes without the need to compress the bone surface [97].
All in all, the craniofacial skeleton and enveloping soft tissues are
viscoelastic composite materials that are time-dependent and change with
loading. A variety of biomechanical factors play a critical role in the
treatment employed by craniofacial surgeons. There are advancements in
better understanding of craniofacial biomechanics; however, the soft tissue
involvement limits this understanding with the variability of physiological
elements in this region.
8 Biomechanics of Rhinoplasty
The variability of nose region’s soft tissue with the level of soft tissue’s
thickness impacts the biomechanics during rhinoplasty. This differential
nature of the soft tissue makes rhinoplasty as one of the most challenging
operations in facial plastic surgery. We must note that we can cover limited
amount of information in this book noting that there is extensive
information on rhinoplasty with numerous books written on this concept.
CT scans have been used for development of normative data for the
thickness of the nasal soft tissue envelope at various anatomical sites and
have shown that experts in nasal analysis can reliably predict soft tissue
thickness from photographs only [58]. Noting the previously outlined
general factors that impact mechanics of face, there are some additional
factors that impact rhinoplasty. The nose is covered by a nasal superficial
musculoaponeurotic system (SMAS) as a part of the facial SMAS [51]. The
forces are distributed by an aponeurosis that interconnects the superficial
muscles of the nose [58].
https://t.me/medicina_free
Nasal respiration can be impacted by the varying trans-nasal pressure of
the nasal valves that are coming off the maxilla [52]. Nasal musculature has
several descriptions; we use the cadaver macroscopic observations
explained in [57]. The muscles functionally is divided into four groups:
elevators, depressors, compressors, and minor dilator muscles in [53].
Another mechanical factor relates the transverse convexity of the
cartilages that disappear only after the alar cartilages are completely
elevated off the underlying mucosa. Mucosa can act as a restraining force
on the alar cartilages, controlling their shape [57].
It is important to understand the soft tissue nature of the nostril rim with
virtually no direct cartilaginous component existing. The importance of
such realization and analysis for defining deformities and planning
operations on the nasal base cannot be underestimated.
Analysis of all seven areas of the nostril base seen on basilar view and
careful angular analysis on lateral view is essential [57]. The correlative
nature of all different aspects play an important role on a comprehensive
analysis. A profound effect on the nose can be possible by operating on the
seven areas on the nose and achieve a superior result rather than an average
one.
The progression from primary to secondary cases to full reconstructions
is essential for fully understanding the entire concept of structural
reconstruction and septal extension grafts.
There are hidden factors that play a role in the mechanics of cases
depending on the materials and techniques used. Unification and stability of
the crura were first controlled by the usage of columellar grafts. Caudal
extension grafts were introduced next for modifying the position of the
columella relative to the nostril rims. Next, stabilization of the tip’s position
and projection were accomplished by septal extension grafts. Challenges
are faced while handling the upwardly rotated or foreshortened nose as
there were rarely primary cases. Simple pennant grafts’ use in primary
cases included limitation of structural weaknesses to overcome the forces of
contracture in heavily scarred noses. The concept of structural
reconstruction was pioneered in [54], perfected in [55], and extended to the
destroyed nose in [56]. The surgeon must provide a rigid framework for
expansion and stabilization against the forces of contraction [57].
Such cases require careful handling in aesthetic reconstructive
rhinoplasty. Noting the mechanics of thick, contracted skin sleeve, the
https://t.me/medicina_free
alternative of a subtle closed augmentation procedure would have been
minimally effective. Contracture forces can be overcome by totally
mobilizing the skin and creating a rigid structure.
9 Conclusion and Future Works
Physiological and transplantation-related elements’ marriage in the head
region gives birth to ever-changing biomechanical properties of this region.
As outlined throughout this work, soft tissue is one of the elements that play
an important role in the facial region. Finite element analysis is by far the
most utilized technique in biomechanical observations. Implant designs and
biomechanical considerations in the literature included, but not limited to,
the following based on our review in this work:
Mechanical analysis of forces, loads, stresses, strains, compressions,
tensions, shears, Young’s modulus values, fatigue damages, and shear
loading within the region.
Physiological material properties determined for bone and craniofacial
skeleton under normal and pathological conditions.
Plantation material properties used for fixation such as wires, screws, and
plates and the impact of integrated mechanisms such as screws and
plates, locking plates, lag screws, and external fixators on physiological
and functional outcomes.
Tertiary factors impacting biomechanics of craniofacial surgeries such as
osteogenesis and radiation.
Computational mechanical analysis tools such as finite element method
for analysis.
Virtual surgical planning, cutting guides, and intra-operative navigation.
Mathematical formulations for attaining optimal design and performance
for plate fixation.
There are numerous shortcomings that are determined upon research.
For instance, a craniofacial application of virtual surgical planning (VSP) is
conducted in [98] on 10 patients with complex defects. During this
application, VSP has impact on the planning and, therefore, several
biomechanical factors, such as repositioning the bone segments and
designing fixation plates, so that screws can avoid key neurovascular
structures. However, VSP does not include soft tissue constraints; therefore,
https://t.me/medicina_free
it cannot incorporate soft tissue responses into surgical planning. Noting
this fact, surgical planning may have to be altered based on mismatch of
reality and planned tasks due to unforeseen physiological occurrences. One
advancement in this area can be a way to determine soft tissue along with
hard tissue elements into surgical planning.
This work has a similar nature to [25–37, 66, 99–119]. As pointed out in
[31] for total hip arthroplasty applications, an optimized combination of
plates, screws, and other elements needs to be determined in applications;
however, given the complexity of each individual’s case-based surgery, the
optimization of such mechanisms is uneasy for plastic surgeries in the head
and neck area. Similar to the psychological factors pointed out in [25–36],
we recommend measuring the impact of psychological factors. In fact, the
impact of psychological treatment on patients that do not have to undertake
a plastic surgery prior to their surgical procedures may be assessed to help
them prevent such surgeries for their well-being. As pointed out previously,
externally caused factors for treating head and neck malignancies, such as
radiation therapy, can change the physical, biological, and biomechanical
properties of the bone significantly. Radiation therapy can decrease the
ultimate tensile stress by a factor of four while reducing the elastic modulus
in tension by fivefold even in demineralized bone [91]. The bone’s ability to
heal fractures and vascularity dramatically reduces upon radiation treatment
[92, 93].
References
1. van Eijden, T. (2000). Biomechanics of the mandible. Critical Reviews in Oral Biology and
Medicine, 11(1), 123–136.
2. Keaveny, T. M., Morgan, E. F., Niebur, G. L., & Yeh, O. C. (2001). Biomechanics of trabecular
bone. Annual Review of Biomedical Engineering, 3, 307–333. https:// doi. org/ 10. 1146/ annurev.
bioeng. 3. 1. 307
[Crossref]
3. Vallabh, R., Zhang, J., Fernandez, J., et al. (2020). The morphology of the human mandible: A
computational modelling study. Biomechanics and Modeling in Mechanobiology, 19, 1187–
1202. https:// doi. org/ 10. 1007/ s10237-019-01133-5
[Crossref]
4. Arendts, F. J., & Sigolotto, C. (1989). Standardabmessungen, Elastizitatskennwerte und
Festigkeitsverhalten des Human-Unterkiefers, ein Beitrag zur Darstellung der Biomechanik der
Unterkiefer-Teil 1. Biomedizinische Technik, 34, 248–255.
https://t.me/medicina_free
5.
Arendts, F. J., & Sigolotto, C. (1990). Mechanische Kennwerte des Human-Unterkiefers und
Untersuchung zum “in vivo”-Verhalten des kompakten Knochengewebes, ein Beitrag zur
Darstellung der Biomechanik des Unterkiefers-Teil 11. Biomedizinische Technik, 35, 123–130.
6. Ashman, R. B., & Van Buskirk, W. C. (1987). The elastic properties of a human mandible.
Advances in Dental Research, 1, 64–67.
7. Ashman, R. B., Rosinia, G., Cowin, S. C., Fontenot, M. G., & Rice, J. C. (1985). The bone
tissue of the canine mandible is elastically isotropic. Journal of Biomechanics, 18, 717–712.
8. Bacon, G. E., Bacon, P. J., & Griffiths, R. K. (1980). Orientation of apatite crystals in relation
to muscle attachment in the mandible. Journal of Biomechanics, 13, 725–729.
9. Dechow, P. C., Schwartz-Dabney, C. L., & Asman, R. B. (1992). Elastic properties of the
human mandibular corpus. In S. A. Goldstein & D. S. Carlson (Eds.), Bone biodynamics in
orthodontic and orthopedic treatment. Vol. 27. Craniofacial growth series (pp. 299–314).
University of Michigan.
10. Dechow, P. C., Nail, G. A., Schwartz-Dabney, C. L., & Asman, R. B. (1993). Elastic properties
of human supraorbital and mandibular bone. American Journal of Physical Anthropology, 90,
291–306.
11. Nail, G. A., Dechow, P. C., & Ashman, R. B. (1989). Elastic properties of mandibular bone in
rhesus monkeys (abstract). I Dent Res 68(Spec Iss):294.
12. Schwartz-Dabney, C. L., & Dechow, P. C. (1997). Variations in cortical material properties
from throughout the human mandible (abstract). I Dent Res 76(Spec Iss):249.
13. Zapata, U., & Wang, Q. (2020). Material properties of the skull layers of the primate parietal
bone: A single-subject study. PLoS One, 15(3), e0229244. https:// doi. org/ 10. 1371/ journal. pone.
0229244. PMID: 32126093; PMCID: PMC7053767.
[Crossref]
14. Sassouni, V. (1969). A classification of skeletal facial types. American Journal of Orthodontics,
55(2), 109–123.
15. Richmon, J. D., Sage, A., Wong, V. W., Chen, A. C., Sah, R. L., & Watson, D. (2006).
Compressive biomechanical properties of human nasal septal cartilage. American Journal of
Rhinology, 20(5), 496–501.
16. Zhang, Z., Yu, Z., & Song, B. (2022). Septal extension graft for correcting short nose in East
Asians: Review of autologous cartilage grafts and postoperative stability. The British Journal of
Oral & Maxillofacial Surgery, 60, 1159.
17. Byrd, H. S., Andochick, S., Copit, S., & Walton, K. G. (1997). Septal extension grafts: A
method of controlling tip projection shape. Plastic and Reconstructive Surgery, 100(4), 999–
1010.
18. Richmon, J. D., Sage, A. B., Wong, V. W., et al. (2005). Tensile biomechanical properties of
human nasal septal cartilage. American Journal of Rhinology, 19(6), 617–622.
19.
Mow, V. C., & Hayes, W. C. (1997). Basic Orthopaedic biomechanics (2nd ed., p. 514). Raven
https://t.me/medicina_free
Press.
20. Ho, T. V. T., Cochran, T., Sykes, K. J., Humphrey, C. D., & Kriet, J. D. (2017). Costal and
auricular cartilage grafts for nasal reconstruction: An anatomic analysis. The Annals of Otology,
Rhinology, and Laryngology, 126(10), 706–711.
21. Alkan, Z., Acioglu, E., Yigit, O., Bekem, A., Azizli, E., Unal, A., & Sahin, F. (2012).
Determining the most suitable costal cartilage level for rhinoplasty: An experimental study.
Otolaryngology – Head and Neck Surgery, 146(3), 377–381.
22. Lawson, W., & Kinberg, E. C. (2022). Treatment of the middle third and septal deformity: A
Trizonal approach. Facial Plastic Surgery, 38(01), 007–012.
23. Vishwakarma, K., & Shukla, B. (2021). Biomechanics of the maxillofacial skeleton (In
Maxillofacial trauma (pp. 21–29)). Springer.
24. Harle, F., Champy, M., & Terry, B. C. (1999). Bone repair and fracture healing. In Atlas of
craniomaxillofacial osteosynthesis (1st ed., pp. 8–14). Thieme Stuttgart.
25. Truden, A., & Tokgöz, E. (2022). Surgical approaches used for Total hip arthroplasty. In Total
hip arthroplasty: Medical and biomedical engineering and science concepts. ISBN #:
9783031089268. Springer.
26. Truden, A., & Tokgöz, E. (2022). Preexisting conditions leading to Total hip arthroplasty. In
Total hip arthroplasty: Medical and biomedical engineering and science concepts., ISBN #:
9783031089268. Springer.
27. Truden, A., & Tokgöz, E. (2022). Surgical approach comparisons in Total hip arthroplasty. In
Total hip arthroplasty: Medical and biomedical engineering and science concepts., ISBN #:
9783031089268. Springer.
28. Truden, A., & Tokgöz, E. (2022). Perioperative patient Care for Total hip Arthroplasty. In Total
hip arthroplasty: Medical and biomedical engineering and science concepts. ISBN #:
9783031089268. Springer.
29. Truden, A., & Tokgöz, E. (2022). Complications of total hip arthroplasty. In Total hip
arthroplasty: Medical and biomedical engineering and science concepts., ISBN #:
9783031089268. Springer.
30. Truden, A., & Tokgöz, E. (2022). Medical improvement suggestions for Total hip arthroplasty.
In Total hip arthroplasty: Medical and biomedical engineering and science concepts., ISBN #:
9783031089268. Springer.
31. Tokgöz, E., & Truden, A. (2022). Biomechanics of total hip arthroplasty. In Total hip
arthroplasty: Medical and biomedical engineering and science concepts., ISBN #:
9783031089268. Springer.
32. Tokgöz, E., & Truden, A. (2022). All-inclusive impact of robotics applications on THA:
Overall impact of robotics on total hip arthroplasty patients from manufacturing of implants to
recovery after surgery. In Total hip arthroplasty: Medical and biomedical engineering and
science concepts., ISBN #: 9783031089268. Springer.
33.
https://t.me/medicina_free
Tokgöz, E., & Truden, A. (2022). Biomechanical success of traditional versus robotic-assisted
total hip arthroplasty, total hip arthroplasty: Medical and biomedical engineering and science
concepts., ISBN #: 9783031089268. Springer.
34. Tokgöz, E., & Truden, A. (2022). Optimization for total hip arthroplasty applications, total hip
arthroplasty: Medical and biomedical engineering and science concepts., ISBN #:
9783031089268. Springer.
35. Tokgöz, E., & Truden, A. (2022). Artificial intelligence, deep learning, and machine learning
applications in total hip arthroplasty, total hip arthroplasty: Medical and biomedical
engineering and science concepts., ISBN #: 9783031089268. Springer.
36. Tokgöz, E. (2022). Advancing engineering of total hip arthroplasty, total hip arthroplasty:
Medical and biomedical engineering and science concepts., ISBN #: 9783031089268.
Springer.
37. Sosa, D., Carola, N., Levitt, S., Patel, V., & Tokgöz, E. (2023). Surgical approaches used for
total knee arthroplasty. In Total knee arthroplasty: Medical and biomedical engineering and
science concepts. Springer. ISBN #: 978-3-031-31099-7.
38. Draper, E. R. C. (1998). Sciences basic to orthopaedics. In H. SPF & I. D. McCarthy (Eds.),
Basic biomechanics (pp. 201–212). WB Saunders.
39. Maclennan, W. D. (1977). Fractures of malar (zygomatic) bone. Journal of the Royal College
of Surgeons, 22, 187.
40. Daegling, D. J., & Hylander, W. L. (2000). Experimental observation, theoretical models and
biomechanical inference in the study of mandibular form. American Journal of Physical
Anthropology, 112, 541–551.
41. Dechow, P. C., & Hylander, W. L. (2000). Elastic properties and masticatory bone stress in the
macaque mandible. American Journal of Physical Anthropology, 112, 553–574.
42. Dechow, P. C., Nail, G. A., Schwartz-Dabney, C. L., & Ashman, R. B. (1993). Elastic
properties of human supraorbital and mandibular bone. American Journal of Physical
Anthropology, 90, 291–306.
43. Niederdellmann, H., Uhlig, G., & Joos, U. (1981). Das elastischeormverhalten der mandibular
unterfunktionellerbelastung. Die Quintessenz, 32, 113.
44. Champy, M., et al. (1976). Osteosynthesis mandibulariesselon la technique de Michelet. Bases
Biomechanics, 77, 569.
45. Castanˇo, M. C., Zapata, U., Pedroza, A., Jaramillo, J. D., & Rolda’n, S. (2002). Creation of a
three dimensional model of the mandible and the TMJ in vivo by means of the finite element
method (abstract). International Journal of Computerized Dentistry, 5, 87–99.
46. Choi, A. H., Ben-Nissan, B., & Conway, R. C. (2005). Three-dimensional modeling and finite
element analysis of the human mandible during clenching. Australian Dental Journal, 5, 42–
48.
47.
Meyer, U., Vollmer, D., Homann, C., Schuon, R., Benthaus, S., Vegh, A., Felszegi, E., Joos, U.,
https://t.me/medicina_free
Соседние файлы в папке Библиотека им академика М.И. Перельмана