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_4421_Библиотеки_им_академика_М_И_Перельмана.pdf
486
R. Movahed and J. W. Ivory
29
b
Preoperative Position
Postoperative Position
. Fig. 29.10 (continued)
Virtual Surgical Planning and Digital Workow for Concomitant Temporomandibular Replacement…
c
487
29
. Fig. 29.10 (continued)
29
ab
488
R. Movahed and J. W. Ivory
d
1.00 mm 7.00 mm
. Fig. 29.10 (continued)
1.00 mm
. Fig. 29.11 Postoperative lateral cephalometric
Virtual Surgical Planning and Digital Workow for Concomitant Temporomandibular Replacement…
a
489
29
b
. Fig. 29.12 Preoperative photography
29
490
R. Movahed and J. W. Ivory
. Fig. 29.13 In panoramic view, it is evident that the inammatory pannus caused by the JIA has resulted in complete destruction of the
TMJs
Virtual Surgical Planning and Digital Workow for Concomitant Temporomandibular Replacement…
491
. Table 29.2 Virtual surgical planning was engineered to gain proper facial balance. Decision was made to move 32mm at the
pogonion in addition to 7mm movement at the midline of the upper incisors
Point Name Anterior/Posterior Left/Right Up/Down
ANS Anterior Nasal Spine 0.46mm Posterior 2.00mm Left 2.61mm Up
A A Point 0.98mm Anterior 2.00mm Left 2.00mm Up
ISU1 Midline of Upper Incisor 7.00mm Anterior 2.00mm Left 3.00mm Up
U3L Upper Left Canine 6.77mm Anterior 2.00mm Left 1.46mm Up
U6L Upper Left Anterior Molar (mesiobuccal cusp) 4.87mm Anterior 2.65mm Left 4.63mm Down
U3R Upper Right Canine 6.08mm Anterior 2.46mm Left 1.15mm Up
U6R Upper Right Anterior Molar (mesiobuccal cusp) 4.90mm Anterior 1.85mm Left 4.59mm Down
ISL1 Midline of Lower Incisor 9.56mm Anterior 2.00mm Left 4.00mm Up
L6L Lower Left Anterior Molar (mesiobuccal cusp) 6.56mm Anterior 2.00mm Left 5.84mm Down
L6R Lower Right Anterior Molar (mesiobuccal cusp) 6.55mm Anterior 2.00mm Left 6.36mm Down
B B Point 18.34mm Anterior 2.00mm Left 2.00mm Down
Pog. Pogonion 31.70mm Anterior 2.00mm Left 2.31mm Down
29
. Fig. 29.14 3D rendering
of preoperative and
postoperative position
29
492
R. Movahed and J. W. Ivory
. Fig. 29.15 Pre- and postoperative CBCT take with i-CAT FLX V series. Airway imaging analysis by TX STUDIO for Anatomage imag-
ing software
ab
Virtual Surgical Planning and Digital Workow for Concomitant Temporomandibular Replacement…
493
29
. Fig. 29.16 Pre- (left) and postoperative (right) airway analyses showed minimal axial area improved from 29.8mm2 to 204mm
29.5 Conclusion
touring of the rami and fossae in the simulated environment in an accurate fashion, eliminating the requirement
Using CASS technology for CTOS cases, the surgeon
superimposes the orthognathic computer-simulated
surgery into the production of the STL model, hence
decreasing the margin of error that can occur with
hands-on positioning of the mandible on the STL
model. Furthermore, this technique decreases the time
taken by the surgeon in the laboratory by 3D Systems
for splint fabrication and by TMJ Concepts for the fab-
for the acquisition of dental models by using laser
scanning technology, and performing accurate maxillary segmentation and equilibration using CASS technology. Further research is necessary to achieve these
goals and to move the workow directly from the CASS
environment to the fabrication of custom-tted prostheses, without requiring the surgeon to have “hands-on”
involvement in the process (.
Fig.29.17).
rication of prostheses, and for setting the STL model
with increased accuracy in the process (. Table29.3).
The remaining areas in which improvement can be
made in CASS technology include performing recon-
2
494
R. Movahed and J. W. Ivory
. Table 29.3 Protocol comparison
29
New protocol for CTOS using CASS Traditional protocol for CTOS
preparation
CT scan of entire mandible, maxilla, and TMJs (1-mm
overlapping cuts)
Processing of DICOM data to create a computer model in
the CASS environment
Correction of dentofacial deformity, including nal
positioning of the maxilla and mandible, with
computer- simulated surgery
STL model constructed with jaws in nal position and sent
to surgeon for condylectomy and rami and fossae
recontouring if indicated
Model sent to TMJ Concepts for prostheses design,
blueprint, and wax-up
Surgeon evaluation and approval using the Internet
TMJ prostheses manufactured and sent to hospital for
surgical implantation
Acquisition of nal dental models 2weeks prior to surgery
(2 maxillary, 1 or 2 mandibular models if dental,
equilibrations are required); 1 maxillary model is
segmented, and models equilibrated if indicated to
CT scan, including the entire
mandible, maxilla, and TMJs
Fabrication of STL model with the
mandible separated
Surgeon positions the mandible in
its nal position and xates it
Removal of condyles and
recontouring the lateral aspect of
the rami and fossae if indicated
Model sent to TMJ Concepts for
prostheses design, blueprint, and
wax-up
Approval of total joint prostheses
blueprint and wax-up by the
surgeon
Manufacture of custom-tted total
joint prostheses
Prostheses sent to hospital for
surgical implantation
maximize the occlusal t; models sent to medical modeling
Models incorporated into computer-simulated surgery for
construction of intermediate and nal palatal splints
Surgeon receives models, splints, and printouts for
computer-simulated surgery
Traditional protocol for CTOS
intermediate and palatal splint
fabrication
Acquisition of dental models
Mounting maxillary and
mandibular dental models on
an articulator
Repositioning the mandibular
dental model, duplicating the
positional changes acquired on
the STL model
Fabrication of intermediate
splint
Repositioning maxillary dental
models with segmentation if
indicated
Construction of palatal splint
Ready for surgery
. Fig. 29.17 One algorithmic
approach to virtual surgical
planning (VSP) by Efanov etal.
(2018) [43] illustrating a stepwise
approach for the planning of
orthognathic cases (left) and an
approach to free osseous aps
(right).
Orthognathic
Teeth in Final orthodontic
position?
YES
CT Scan <1mm cuts
Condyles in centric
occlusion?
Dental models intact?
YES
Proceed with VSP
Verify plan
Ensure all cuts and
cutting guides are low
prole and accurate
Algorithmic approch to virtual
surgical planning for orthognathic
surgeries and free osseus aps
NO
Wait for nal
position
NO
Re-scan and re-send
new models
or
Use CT scan of teeth
for nal occlusion
If unstable
movements
planned, print
spacer splints
Design cutting guides with
incremental cutting slots
Use standardized bone
ap, verify vascularity with
physical exam, proceed
Proceed with VSP and
ensure cutting guides do
not necessitate excessive
YES
or
Abandon VSP
NO
with VSP
YES
dissection
Free Osseus Flap
Anatomic changes since
intial CT scan?
NO
Scan of lower extermity?
YES
3 vessel leg?
NO
Consider contralateral
side or other ap
Virtual Surgical Planning and Digital Workow for Concomitant Temporomandibular Replacement…
495
29
References
1. Wolford LM, Cassano DS, Goncalves JR.Common TMJ disorders: orthodontic and surgical management. Temporomandibular
Disorders Orofacial Pain Separating Controversy Consensus.
2009;46:159–98.
2. Hatamleh M, Turner C, Bhamrah G, Mack G, Osher J.Improved
virtual planning for Bimaxillary orthognathic surgery. J
Craniofac Surg. 2016;27(6):e568–73. https://doi.org/10.1097/
SCS.0000000000002877.
3. Papadopoulos MA, Christou PK, Christou PK, Athanasiou AE,
Boettcher P, Zeilhofer HF, etal. Three-dimensional craniofacial
reconstruction imaging. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod. 2002;93(4):382–93.
4. Xia J, Ip HH, Samman N, Wang D, Kot CS, Yeung RW, etal.
Computer-assisted three-dimensional surgical planning and
simulation: 3D virtual osteotomy. Int J Oral Maxillofac Surg.
2000;29(1):11–7.
5. Gray R, Gougoutas A, Nguyen V, Taylor J, Bastidas N.Use of
three-dimensional, CAD/CAM-assisted, virtual surgical simulation and planning in the pediatric craniofacial population.
Int J Pediatr Otorhinolaryngol. 2017;97:163–9. https://doi.
org/10.1016/j.ijporl.2017.04.004.
6. Ho CT, Lin HH, Liou EJ, Lo LJ. Three-dimensional surgical
simulation improves the planning for correction of facial prognathism and asymmetry: a qualitative and quantitative study. Sci
Rep. 2017;7:40423. https://doi.org/10.1038/srep40423.
7. Xiao Y, Sun X, Wang L, Zhang Y, Chen K, Wu G.The application of 3D printing Technology for Simultaneous Orthognathic
Surgery and Mandibular Contour Osteoplasty in the treatment of
craniofacial deformities. Aesthet Plast Surg. 2017;41(6):1413–24.
https://doi.org/10.1007/s00266-017-0914-z.
8. Zhang S, Gui H, Lin Y, Shen G, Xu B.Navigation-guided correction of midfacial post-traumatic deformities (Shanghai experience with 40 cases). J Oral Maxillofac Surg. 2012;70(6):1426–33.
https://doi.org/10.1016/j.joms.2011.03.068.
9. Rotaru H, Stan H, Florian IS, Schumacher R, Park YT, Kim SG,
et al. Cranioplasty with custom-made implants: analyzing the
cases of 10 patients. J Oral Maxillofac Surg. 2012;70(2):e169–76.
https://doi.org/10.1016/j.joms.2011.09.036.
10. Gateno J, Xia JJ, Teichgraeber JF, Christensen AM, Lemoine
JJ, Liebschner MA, et al. Clinical feasibility of computer-aided
surgical simulation (CASS) in the treatment of complex craniomaxillofacial deformities. J Oral Maxillofac Surg. 2007;65(4):728–
34. https://doi.org/10.1016/j.joms.2006.04.001.
11. Sugahara K, Katsumi Y, Koyachi M, Koyama Y, Matsunaga
S, Odaka K, et al. Novel condylar repositioning method for
3D-printed models. Maxillofac Plast Reconstr Surg. 2018;40(1):4.
https://doi.org/10.1186/s40902-018-0143-7.
12. Di Blasio C, Anghinoni ML, Di Blasio A.Virtual planning of
a complex three-part Bimaxillary osteotomy. Case Rep Dent.
2017;2017:8013874. https://doi.org/10.1155/2017/8013874.
13. He D, Du W, Li J, Liu L, Luo E.Clinical feasibility and efciency
of a 3-dimensional printed surgical template for mandibular angle
osteotomy and mandibular angle splitting osteotomy. Br J Oral
Maxillofac Surg. 2018;56(7):594–9. https://doi.org/10.1016/j.
bjoms.2018.06.008.
14. Sato FR, Asprino L, Noritomi PY, da Silva JV, de Moraes
M. Comparison of ve different xation techniques of sagittal
split ramus osteotomy using three-dimensional nite elements
analysis. Int J Oral Maxillofac Surg. 2012;41(8):934–41. https://
doi.org/10.1016/j.ijom.2012.03.018.
15. Li B, Zhang L, Sun H, Yuan J, Shen SG, Wang X.A novel method
of computer aided orthognathic surgery using individual CAD/
CAM templates: a combination of osteotomy and repositioning
guides. Br J Oral Maxillofac Surg. 2013;51(8):e239–44. https://
doi.org/10.1016/j.bjoms.2013.03.007.
16. Movahed R, Teschke M, Wolford LM.Protocol for concomitant
temporomandibular joint custom-tted total joint reconstruction
and orthognathic surgery utilizing computer-assisted surgical
simulation. J Oral Maxillofac Surg. 2013;71(12):2123–9. https://
doi.org/10.1016/j.joms.2013.07.024.
17. Movahed R, Wolford LM. Protocol for concomitant temporomandibular joint custom-tted total joint reconstruction and
orthognathic surgery using computer-assisted surgical simulation.
Oral Maxillofac Surg Clin North Am. 2015;27(1):37–45. https://
doi.org/10.1016/j.coms.2014.09.004.
18. Valente TW, Rogers EM.The origins and development of the
diffusion of innovations paradigm as an example of scientic
growth. Sci Commun. 1995;16(3):242–73.
19. Rogers EM.Lessons for guidelines from the diffusion of innovations. Jt Comm J Qual Improv. 1995;21(7):324–8.
20. Resnick CM, Inverso G, Wrzosek M, Padwa BL, Kaban LB,
Peacock ZS. Is there a difference in cost between standard
and virtual surgical planning for orthognathic surgery? J Oral
Maxillofac Surg. 2016;74(9):1827–33. https://doi.org/10.1016/j.
joms.2016.03.035.
21. Zinser MJ, Sailer HF, Ritter L, Braumann B, Maegele M, Zoller
JE. A paradigm shift in orthognathic surgery? A comparison
of navigation, computer-aided designed/computer-aided manufactured splints, and "classic" intermaxillary splints to surgical transfer of virtual orthognathic planning. J Oral Maxillofac
Surg. 2013;71(12):2151 e1–21. https://doi.org/10.1016/j.
joms.2013.07.007.
22. Steinhuber T, Brunold S, Gartner C, Offermanns V, Ulmer H,
Ploder O. Is virtual surgical planning in orthognathic surgery
faster than conventional planning? A time and workow analysis of an ofce-based workow for single- and double-jaw surgery. J Oral Maxillofac Surg. 2018;76(2):397–407. https://doi.
org/10.1016/j.joms.2017.07.162.
23. Shaheen E, Shujaat S, Saeed T, Jacobs R, Politis C. Threedimensional planning accuracy and follow-up protocol in orthognathic surgery: a validation study. Int J Oral Maxillofac Surg.
2018; https://doi.org/10.1016/j.ijom.2018.07.011.
24. Hsu SS, Gateno J, Bell RB, Hirsch DL, Markiewicz MR,
Teichgraeber JF, etal. Accuracy of a computer-aided surgical
simulation protocol for orthognathic surgery: a prospective multicenter study. J Oral Maxillofac Surg. 2013;71(1):128–42. https://
doi.org/10.1016/j.joms.2012.03.027.
25. Liebregts J, Xi T, Timmermans M, de Koning M, Berge S,
Hoppenreijs T, et al. Accuracy of three-dimensional soft tissue
simulation in bimaxillary osteotomies. J Craniomaxillofac Surg.
2015;43(3):329–35. https://doi.org/10.1016/j.jcms.2014.12.012.
26. Holzinger D, Juergens P, Shahim K, Reyes M, Schicho K,
Millesi G, et al. Accuracy of soft tissue prediction in surgeryrst treatment concept in orthognathic surgery: a prospective
study. J Craniomaxillofac Surg. 2018;46(9):1455–60. https://doi.
org/10.1016/j.jcms.2018.05.055.
27. Metzler P, Geiger EJ, Alcon A, Ma X, Steinbacher DM.Threedimensional virtual surgery accuracy for free bula mandibular reconstruction: planned versus actual results. J Oral
Maxillofac Surg. 2014;72(12):2601–12. https://doi.org/10.1016/j.
joms.2014.07.024.
28. Rustemeyer J, Sari-Rieger A, Melenberg A, Busch A.Comparison
of intraoperative time measurements between osseous reconstructions with free bula aps applying computer-aided designed/
computer-aided manufactured and conventional techniques. Oral
Maxillofac Surg. 2015;19(3):293–300. https://doi.org/10.1007/
s10006-015-0493-6.