A craniomaxillofacial surgical assistance workstation for enhanced single-stage reconstruction using patient-specific implants

Ryan J. Murphy, Peter C. Liacouras, Gerald T. Grant, Kevin C. Wolfe, Mehran Armand, Chad R Gordon

Research output: Contribution to journalArticle

Abstract

Background: Craniomaxillofacial reconstruction with patient-specific, customized craniofacial implants (CCIs) is ideal for skeletal defects involving areas of aesthetic concern—the non-weight-bearing facial skeleton, temporal skull, and/or frontal-forehead region. Results to date are superior to a variety of ‘‘off-the-shelf’’ materials, but require a protocol computed tomography scan and preexisting defect for computer-assisted design/computerassisted manufacturing of the CCI. The authors developed a craniomaxillofacial surgical assistance workstation to address these challenges and intraoperatively guide CCI modification for an unknown defect size/shape. Methods: First, the surgeon designed an oversized CCI based on his/her surgical plan. Intraoperatively, the surgeon resected the bone and digitized the resection using a navigation pointer. Next, a projector displayed the limits of the craniofacial bone defect onto the prefabricated, oversized CCI for the size modification process; the surgeon followed the projected trace to modify the implant. A cadaveric study compared the standard technique (n¼1) to the experimental technique (n¼5) using surgical time and implant fit. Results: The technology reduced the time and effort needed to resize the oversized CCI by an order of magnitude as compared with the standard manual resizing process. Implant fit was consistently better for the computer-assisted case compared with the control by at least 30%, requiring only 5.17 minutes in the computer-assisted cases compared with 35 minutes for the control. Conclusion: This approach demonstrated improvement in surgical time and accuracy of CCI-based craniomaxillofacial reconstruction compared with previously reported methods. The craniomaxillofacial surgical assistance workstation will provide craniofacial surgeons a computer-assisted technology for effective and efficient single-stage reconstruction when exact craniofacial bone defect sizes are unknown.

Original languageEnglish (US)
JournalJournal of Craniofacial Surgery
Volume27
Issue number8
DOIs
StatePublished - Oct 27 2016

Fingerprint

Operative Time
Bone and Bones
Technology
Computer-Aided Design
Forehead
Esthetics
Skull
Skeleton
Tomography
Surgeons

Keywords

  • CCI
  • Computer-assisted surgery
  • Cranial reconstruction
  • Craniofacial surgery
  • Craniomaxillofacial
  • Cranioplasty
  • Customized cranial implants
  • Patient-specific implant

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

A craniomaxillofacial surgical assistance workstation for enhanced single-stage reconstruction using patient-specific implants. / Murphy, Ryan J.; Liacouras, Peter C.; Grant, Gerald T.; Wolfe, Kevin C.; Armand, Mehran; Gordon, Chad R.

In: Journal of Craniofacial Surgery, Vol. 27, No. 8, 27.10.2016.

Research output: Contribution to journalArticle

@article{eff2b53bace34439bda702998ddd873c,
title = "A craniomaxillofacial surgical assistance workstation for enhanced single-stage reconstruction using patient-specific implants",
abstract = "Background: Craniomaxillofacial reconstruction with patient-specific, customized craniofacial implants (CCIs) is ideal for skeletal defects involving areas of aesthetic concern—the non-weight-bearing facial skeleton, temporal skull, and/or frontal-forehead region. Results to date are superior to a variety of ‘‘off-the-shelf’’ materials, but require a protocol computed tomography scan and preexisting defect for computer-assisted design/computerassisted manufacturing of the CCI. The authors developed a craniomaxillofacial surgical assistance workstation to address these challenges and intraoperatively guide CCI modification for an unknown defect size/shape. Methods: First, the surgeon designed an oversized CCI based on his/her surgical plan. Intraoperatively, the surgeon resected the bone and digitized the resection using a navigation pointer. Next, a projector displayed the limits of the craniofacial bone defect onto the prefabricated, oversized CCI for the size modification process; the surgeon followed the projected trace to modify the implant. A cadaveric study compared the standard technique (n¼1) to the experimental technique (n¼5) using surgical time and implant fit. Results: The technology reduced the time and effort needed to resize the oversized CCI by an order of magnitude as compared with the standard manual resizing process. Implant fit was consistently better for the computer-assisted case compared with the control by at least 30{\%}, requiring only 5.17 minutes in the computer-assisted cases compared with 35 minutes for the control. Conclusion: This approach demonstrated improvement in surgical time and accuracy of CCI-based craniomaxillofacial reconstruction compared with previously reported methods. The craniomaxillofacial surgical assistance workstation will provide craniofacial surgeons a computer-assisted technology for effective and efficient single-stage reconstruction when exact craniofacial bone defect sizes are unknown.",
keywords = "CCI, Computer-assisted surgery, Cranial reconstruction, Craniofacial surgery, Craniomaxillofacial, Cranioplasty, Customized cranial implants, Patient-specific implant",
author = "Murphy, {Ryan J.} and Liacouras, {Peter C.} and Grant, {Gerald T.} and Wolfe, {Kevin C.} and Mehran Armand and Gordon, {Chad R}",
year = "2016",
month = "10",
day = "27",
doi = "10.1097/SCS.0000000000003106",
language = "English (US)",
volume = "27",
journal = "Journal of Craniofacial Surgery",
issn = "1049-2275",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - A craniomaxillofacial surgical assistance workstation for enhanced single-stage reconstruction using patient-specific implants

AU - Murphy, Ryan J.

AU - Liacouras, Peter C.

AU - Grant, Gerald T.

AU - Wolfe, Kevin C.

AU - Armand, Mehran

AU - Gordon, Chad R

PY - 2016/10/27

Y1 - 2016/10/27

N2 - Background: Craniomaxillofacial reconstruction with patient-specific, customized craniofacial implants (CCIs) is ideal for skeletal defects involving areas of aesthetic concern—the non-weight-bearing facial skeleton, temporal skull, and/or frontal-forehead region. Results to date are superior to a variety of ‘‘off-the-shelf’’ materials, but require a protocol computed tomography scan and preexisting defect for computer-assisted design/computerassisted manufacturing of the CCI. The authors developed a craniomaxillofacial surgical assistance workstation to address these challenges and intraoperatively guide CCI modification for an unknown defect size/shape. Methods: First, the surgeon designed an oversized CCI based on his/her surgical plan. Intraoperatively, the surgeon resected the bone and digitized the resection using a navigation pointer. Next, a projector displayed the limits of the craniofacial bone defect onto the prefabricated, oversized CCI for the size modification process; the surgeon followed the projected trace to modify the implant. A cadaveric study compared the standard technique (n¼1) to the experimental technique (n¼5) using surgical time and implant fit. Results: The technology reduced the time and effort needed to resize the oversized CCI by an order of magnitude as compared with the standard manual resizing process. Implant fit was consistently better for the computer-assisted case compared with the control by at least 30%, requiring only 5.17 minutes in the computer-assisted cases compared with 35 minutes for the control. Conclusion: This approach demonstrated improvement in surgical time and accuracy of CCI-based craniomaxillofacial reconstruction compared with previously reported methods. The craniomaxillofacial surgical assistance workstation will provide craniofacial surgeons a computer-assisted technology for effective and efficient single-stage reconstruction when exact craniofacial bone defect sizes are unknown.

AB - Background: Craniomaxillofacial reconstruction with patient-specific, customized craniofacial implants (CCIs) is ideal for skeletal defects involving areas of aesthetic concern—the non-weight-bearing facial skeleton, temporal skull, and/or frontal-forehead region. Results to date are superior to a variety of ‘‘off-the-shelf’’ materials, but require a protocol computed tomography scan and preexisting defect for computer-assisted design/computerassisted manufacturing of the CCI. The authors developed a craniomaxillofacial surgical assistance workstation to address these challenges and intraoperatively guide CCI modification for an unknown defect size/shape. Methods: First, the surgeon designed an oversized CCI based on his/her surgical plan. Intraoperatively, the surgeon resected the bone and digitized the resection using a navigation pointer. Next, a projector displayed the limits of the craniofacial bone defect onto the prefabricated, oversized CCI for the size modification process; the surgeon followed the projected trace to modify the implant. A cadaveric study compared the standard technique (n¼1) to the experimental technique (n¼5) using surgical time and implant fit. Results: The technology reduced the time and effort needed to resize the oversized CCI by an order of magnitude as compared with the standard manual resizing process. Implant fit was consistently better for the computer-assisted case compared with the control by at least 30%, requiring only 5.17 minutes in the computer-assisted cases compared with 35 minutes for the control. Conclusion: This approach demonstrated improvement in surgical time and accuracy of CCI-based craniomaxillofacial reconstruction compared with previously reported methods. The craniomaxillofacial surgical assistance workstation will provide craniofacial surgeons a computer-assisted technology for effective and efficient single-stage reconstruction when exact craniofacial bone defect sizes are unknown.

KW - CCI

KW - Computer-assisted surgery

KW - Cranial reconstruction

KW - Craniofacial surgery

KW - Craniomaxillofacial

KW - Cranioplasty

KW - Customized cranial implants

KW - Patient-specific implant

UR - http://www.scopus.com/inward/record.url?scp=85047571211&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047571211&partnerID=8YFLogxK

U2 - 10.1097/SCS.0000000000003106

DO - 10.1097/SCS.0000000000003106

M3 - Article

VL - 27

JO - Journal of Craniofacial Surgery

JF - Journal of Craniofacial Surgery

SN - 1049-2275

IS - 8

ER -