Preliminary development of a workstation for craniomaxillofacial surgical procedures

Introducing a computer-assisted planning and execution system

Chad R Gordon, Ryan J. Murphy, Devin O'Brien-Coon, Ehsan Basafa, Yoshito Otake, Mohammed Al Rakan, Erin Rada, Sriniras Susarla, Edward Swanson, Elliot K Fishman, Gabriel Santiago, Gerald Brandacher, Peter Liacouras, Gerald Grant, Mehran Armand

Research output: Contribution to journalArticle

Abstract

Introduction: Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation and other related craniomaxillofacial procedures. Methods: We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. RESULTS: Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. Conclusions: The initial development of the CAPE workstation demonstrated that integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution for numerous types of craniofacial and orthognathic surgical procedures.

Original languageEnglish (US)
Pages (from-to)273-283
Number of pages11
JournalThe Journal of craniofacial surgery
Volume25
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Facial Transplantation
Computer-Assisted Surgery
Swine
Tomography
Transplants
Orthognathic Surgical Procedures
Plastics
Dental Esthetics
Cephalometry
Miniature Swine
Workflow
Operating Rooms
Jaw
Tooth

Keywords

  • Computer-assisted planning
  • computer-integrated surgery
  • craniofacial
  • craniomaxillofacial surgery
  • cutting guides
  • face transplant
  • maxillofacial transplant
  • swine facial transplant
  • swine study

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery
  • Medicine(all)

Cite this

Preliminary development of a workstation for craniomaxillofacial surgical procedures : Introducing a computer-assisted planning and execution system. / Gordon, Chad R; Murphy, Ryan J.; O'Brien-Coon, Devin; Basafa, Ehsan; Otake, Yoshito; Al Rakan, Mohammed; Rada, Erin; Susarla, Sriniras; Swanson, Edward; Fishman, Elliot K; Santiago, Gabriel; Brandacher, Gerald; Liacouras, Peter; Grant, Gerald; Armand, Mehran.

In: The Journal of craniofacial surgery, Vol. 25, No. 1, 01.2014, p. 273-283.

Research output: Contribution to journalArticle

Gordon, Chad R ; Murphy, Ryan J. ; O'Brien-Coon, Devin ; Basafa, Ehsan ; Otake, Yoshito ; Al Rakan, Mohammed ; Rada, Erin ; Susarla, Sriniras ; Swanson, Edward ; Fishman, Elliot K ; Santiago, Gabriel ; Brandacher, Gerald ; Liacouras, Peter ; Grant, Gerald ; Armand, Mehran. / Preliminary development of a workstation for craniomaxillofacial surgical procedures : Introducing a computer-assisted planning and execution system. In: The Journal of craniofacial surgery. 2014 ; Vol. 25, No. 1. pp. 273-283.
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