Embed Size (px)
Citation preview
program & abstracts
Saturday - TuesdayJune 28 – July 1, 2008
3rd International Conference ofADVANCED DIGITAL TECHNOLOGYIN HEAD AND NECK RECONSTRUCTION
Cardiff, Wales, UK
Synthes Ltd.20 Tewin Road,Welwyn Garden City, Herts.+44 (0) 1707 332212www.synthes.com
PSI Patient Specific Implants.Patient Specific Implants are intended for thereplacement of bony voids in the cranial and thecraniofacial skeleton.
Impact and fracture resistent for optimal brain protection.
Better anatomic fit versus conventional fixation/reconstruction methods.
Satisfying aesthetic results for surgeon and patient.
Choice of two biocompatible materials: PEEK Optima-LT (polyetheretherketone) and commercially pure titanium.
�
Virtual surgery planningPatient-specific surgical guides
Stress-Free Surgery
Visit us at booth 2
�
The Centre for Applied Reconstructive Techn
jointly established by Abertawe Bro Morgannjointly established by Abertawe Bro Morgann
at Morriston Hospital and the National Centre
Research (PDR) at the University of Wales In
The Centre, was launched on the 9th Februa
collaboration between the PDR and Morriston
This exciting new development combines the
partners to effectively transfer the latest tech
aided design, computer-aided planning, and
medical applications used in reconstructive s
our successful collaboration and provides a p
CARTIS welcomes the interest of other
who would like to collaborate on projec
w w w . c a
nologies in Surgery (CARTIS) has been
wg University NHS Trust’s Maxillofacial Unitwg University NHS Trust s Maxillofacial Unit
e for Product Design and Development
nstitute, Cardiff (UWIC).
ary 2006 after many years of successful
n Hospital.
e medical and technical expertise of both
hnologies, such as 3D scanning, computer-
rapid prototyping technology to complex
urgery. This formal partnership builds on
platform for future development and growth.
groups, institutions and individuals
cts in this exciting field.
r t i s . o r g
�
contentsWelcome Addresses 10
Acknowledgements 1�
Conference Sponsors/Industry Partners/Subscribers 16
Supporting Organizations 18
Scientific Advisory Group/Program Committee/Moderators 19
Conference Venue 21
Social and Elective Activities 22
Conference programme 2�
Keynote and Invited Speaker Biographies ��
Keynote and Invited Speakers Abstracts ��
Oral Presentations Abstracts �7
Poster Presentation Abstracts 8�
Index by Author 12�
Exhibitor Contact Information 126
Workshops 129
�
Abertawe Bro Morgannwg University NHS Trust
Providing comprehensive hospital and community health
services for the coastal city and county of Swansea; Neath;
Port Talbot; Bridgend and the western Vale of Glamorgan, and
a wide range of specialist services for Wales and its regions.
ABM University NHS Trust is pleased to be involved as a host
group and sponsor of the Advanced Digital Technology in Head
and Neck Reconstruction Conference, 2008.
ABM University NHS Trust,71, Quarella Road,Bridgend,CF31 1YE
Chief Executive Paul Williams Chairman Win Griffithswww.abm.university-trust.wales.nhs.uk
On behalf of Abertawe Bro Morgannnwg University NHS Trust, I would like to welcome you to the 3rd International Conference on Advanced Digital Technologies in Head and Neck Reconstruction.
The ABM University NHS Trust is proud to be associated with our clinicians and researchers in the Maxillofacial Unit of Morriston Hospital in Swansea. Their collaborations with other clinicians in the UK and around the world, as well as their well established work with the engineers in PDR in the University of Wales Institute Cardiff, have resulted in the formation of CARTIS, the Centre for Applied Reconstructive Technologies in Surgery. These partnerships have already been of immense benefit to our patients.
We recognise the importance of this conference to those working in this field. The challenge of applying new technologies to patient care is one we all have to meet. We are proud to support you and this conference which brings together the pioneers in this field from industry, academia and patient care.
I hope you have a fruitful time in the conference and an enjoyable time in Wales.
Calum Campbell Assistant Chief Executive (West)
Chairman/Cadeirydd: Win Griffiths; Chief Executive/Prif Weithredydd: Paul Williams OBE; DMS; CIHM; CCMI; FRSA Trust Headquarters, 71, Quarella Road, Bridgend, CF31 1YE Tel: (01656) 752752, Fax: (01656) 665377
9
10
Honorary Conference Chair Welcome Address
Surgery and especially Head and Neck surgery cannot be constrained by its physical definition. The art of the hand improves daily thanks to new technologies which allow one at each level of the procedure to enter less invasively into the body, to bring vision to unpredictable situations and to cure with high precision.
The surgical hand, extended by the instrument, has now reached the limits of its capabilities. Today surgery alone should not be the only tool of exploration allowing the signature of the surgeon to be as discreet and hidden as it can be.
To ignore this technological dimension would be to block all improvement in the delivery of our art; furthermore the surgeon should be in constant close relationship with researchers and industrialists, acting as the motor of innovations, not the passive victim but the master and guide!
Looking to the human dimension of surgery, the surgeon should never be afraid that he or she could be substituted by the machine. The surgeon will always dominate the technology and only employ it for precision and expedience.
That is the true purpose of this Third International Conference in Advanced Digital Technologies in Head and Neck Reconstruction. After Banff and its extraordinary Fairmont Banff Springs Hotel, we invite you to meet together in a friendly spirit exchanging ideas in all aspects of our specialty in this great capital of Wales.
Without doubt we will leave Cardiff with lots of new projects and innovative ideas.
Prof. Bernard Devauchelle
Conference ChairsWelcome AddressIt is our great pleasure to welcome you to Cardiff and to Wales for this �rd Conference, the first to be held in spring/summer. Our previous two events were held in the cold and beauty of the Canadian winter, in Edmonton and then in Banff. The Hilton Hotel and the surrounding major public buildings of the Wales capital, all of them within walking distance, offer a striking venue for us in 2008.
This conference is unique in bringing together all those interested in the research, development and use of advanced digital technologies in head and neck surgery especially for reconstruction, rehabilitation and deformity correction. The principal beneficiary is and has to be the patient for whom we seek the proceeds of technological advancement. When the story of this conference began more than 6 years ago, many of the advancements were in their infancy, some had yet to be trialled on patients and others had yet to find their application. Edmonton and Banff sent out a loud message, clearly stated by your co-chairs in a guest editorial in the International Journal of Oral and Maxillofacial Surgery, that we needed to grasp these new technologies, develop them to suit the needs of our patients and adopt them in our routine clinical practise. The program we put before you at this meeting demonstrates just how far we have come towards that goal.
We have for you 7 Keynote Speakers, 8 Guest Speakers, a choice of 2 out of � hands-on Workshops, �6 Oral Papers and 60 Posters. We are indebted to all those who have submitted their work for presentation and to the members of the Scientific Committee who have worked so hard to produce this program and the Organising Committee and Conference Planners (RES Seminars) for putting the whole meeting together. We acknowledge the support and participation in this conference of surgeons, clinicians, associations, academics, industry, government and academic as well as clinical institutions. We thank them all.
This conference is for you the participants. We hope you enjoy it, find some good ideas and have the desire and energy subsequently to apply them yourself.
Dr Adrian Sugar Dr. Johan Wolfaardt
12
Program & Advisory Group Chairs
Welcoming AddressThe Conference on Advanced Digital Technology in Head & Heck Reconstruction has found a definitive space within a great variety of scientific congresses. Focussing on the spearheads of digital technology in medicine and the latest achievements in biotechnology, the conference will cover many fields of interest with special attention on clinical application and innovation.
This conference has developed a “tradition” of presenting interdisciplinary and synergistic work involving different specialities in the fields of surgery, reconstruction, imaging and planning techniques. In a wonderful way this meeting is supported by numerous world renowned scientists and industrial partners. We would like to thank all parties who made this conference possible and as interesting as it is now.
The program includes hands-on workshops in order to demonstrate the applicability of innovations in daily work. Without the support of enthusiastic industrial partners and foundations these workshops would not have been possible. Poster presentations give us the opportunity to add valuable information that could not be included in the general program due to time constraints and will no doubt provoke lively discussion.
We wish to thank the Scientific Advisory Committee for their support. Their work in reviewing the abstracts was sincerely appreciated. In particular, we wish to express our thanks to all the presenters and participants for sharing our vision of advanced digital technologies improving the care we deliver to our patients.
We are sure that the Cardiff conference will add to the great success of the Edmonton and Banff meetings and that we can introduce exciting new topics to this rapidly progressing area. We all are very much looking forward to an exciting collaboration in an atmosphere of friendship and mutual exchange of ideas. We are very excited that the torch will be passed to Freiburg to host the next meeting in 2011.
Prof. Rainer Schmelzeisen, MD,
DDS FRCS (London)Chair, Scientific Advisory Committee
Dr. Jana Rieger
Vice Chair, Scientific Advisory Committee – Program Development
Dr. Richard Bibb
Vice Chair, Scientific Advisory Committee – Program Development
Chair, Scientific Advisory Committee
Vision 2020
Caritas Health Group will become Canada’s
leading faith-based provider of health care by
positively influencing the health of the community
through compassionate care for all and innovative
service to those in greatest need.
Caritas Health Group in
Edmonton, Alberta is one of
Canada's largest faith-based
provider of health care, providing
compassionate, quality care at the
Misericordia and Grey Nuns Community
Hospitals and the Edmonton General
Continuing Care Centre for over 100
years. Our programs and services
combine leading edge science with a
commitment to the values of dignity,
respect, care, concern for all, community
responsiveness, and responsible
stewardship. Building on a strong team
approach to care, Caritas strives to create
an environment of hope and healing for
both caregivers and the people we serve.
www.caritas.ab.ca
H e a l i n g t h e B o d y E n r i c h i n g t h e M i n d N u r t u r i n g t h e S o u l
atcaritas
work
Philips BV Pulsera with 3D imaging." Intraoperative Imaging is an indispensible aid in many surgical procedures. It gives us the freedom to perform on-site procedures such as real-time navigation and modern CAD/CAM procedures as well as immediate-controlled implants and osteosynthesis insertion.
Intra OR 3D imaging definitely leads to a higher surgical quality. It therefore defines a new gold standard."Dr. Dr. Marc Metzger, University Hospital Freiburg, Freiburg, Germany
www.philips.com/healthcare
1�
Acknowledgements
The orgabising committee would like to thank the following oganisations for the contribution they have made to facilitate this conference.
Dell Computer Systems UK for the setting up and provision of the Internet Café
Doug Neil, Medical Illustrator, for his time and expertise in the production of the conference programme.
AO Foundation-Cranio Maxillofacial for financially supporting two conference Speakers.
AO Foundation- Education for supplying conference bags.
Eben Yancey and the RES Seminars Team for their hard work and profesionalism as Conference Organisers.
Judith Jones and Alex Palmer, for their help with organisation and administration.
The Hilton Hotel administration and staff.
The National Museum of Wales and their staff.
16
Sponsorship & Support
We wish to thank our sponsors and supporting organizations who made this conference possible through their generous contributions.
17
Conference (Platinum) Sponsors
Sponsors
Industry Partners Gold
Synthes Limited
Contact: Richard Bourne20 Tewin RoadWelwyn Garden City Hertfordshire AL7 1LG P: �� 1707 �� 22 12 F: �� 1707 �� 8� 0� Email: [email protected]: www.synthes.com
Materialise NV
Contact: Catherine Cober, Communication Specialist MedicalTechnologielaan 1��001 Leuven, BelgiumP: �2 16 �9 66 11F: �2 16 �9 66 00Email: [email protected]: www.materialise.com
Silver
Imaging Sciences International1910 North Penn Road Hatfield, PA 19��0 USAEmail: [email protected] Website: www.i-CAT.com
Nobel Biocare AB
Box �190SE-�02 26 Göteborg SwedenP: �6 �1 81 88 00F: �6 �1 16 �1 �2Email: [email protected]: www.nobelbiocare.com
Welsh Assembly GovernmentBrunel House, 2 Fitzalan Road Cardiff, Wales, CF2� 0UYEmail: [email protected]: www.wales.gov.uk
Stryker UKContact: Vanessa GoodallHambridge RoadNewbury, West Berkshire RG1� �EG UKWebsite: www.stryker.co.uk
Dimensional Imaging1 Ainslie Road, Glasgow, Scotland G�2 �RU UKEmail: info@di�d.comWebsite: www.di�d.com
Codman - Johnson & Johnson Medical LtdCoronation Road, Ascot, BerkshireSL� 9EY EnglandEmail: [email protected]: www.codman.com
Philips HealthcareThe ObservatoryCastlefield RoadReigate, Surrey RH2 0FYEmail: [email protected]: www.philips.com/healthcare
Bronze
Dolphin Imagining and Management Solutions26 Village Farm, BonvilstonCardiff, Wales CF� 6TYEmail: [email protected]: www.dolphinimaging.com
BrainLAB AGRegus House 1010 Cambourne Business Park Cambridge, CB� 6DP UKEmail: [email protected]: www.brainlab.com
�dMDVicarage House�8-60 Kensington Church Street London W8 �DB, UK Email: info@�dmd.comWebsite: www.�dmd.com
Majenta SolutionsMajenta House, Coptfold RoadBrentwood, Essex, CM1� �BSEmail: [email protected] Website: www.majentasolutions.com
Cochlear Europe Ltd.9 Weybridge Business ParkAddlestone RoadAddlestone, Surrey, KT1� 2UF UKEmail: [email protected]: www.cochlear.co.uk
18
Supporting OrganizationsSupporting Associations
British Association of Oral and Maxillofacial Surgeons
Association for Osteosynthesis Craniomaxillofacial (AOCMF)
International Society for Maxillofacial Rehabilitation
American Academy of Maxillofacial Prosthetics
International College of Prosthodontists
Swedish Association of Otorhinolaryngology, Head and Neck Surgery
European Association for Cranio-Maxillofacial Surgery
Government SupportTechnology & Innovation, Welsh Assembly Government (DEIN)
Host Group Supporting Health Care InstitutionsAbertawe Bro=Morgannwg University NHS Trust, Wales, UK
Caritas Health Group, Edmonton, Alberta, CA
InstitutionsCleft and Maxillofacial Unit Morriston Hospital, Swansea, Wales, UK
University of Wales Institute, Cardiff (UWIC)
The National Centre for Product Design & Development Research (PDR)
The Centre for Applied Reconstructive Technologies in Surgery (CARTIS)
School of Medicine, Swansea University, Swansea Wales, UK
Capital Health, Edmonton, Alberta, CA
Institute for Reconstructive
Sciences in Medicine (iRSM), Edmonton, Alberta, CA
19
Honorary Conference ChairProfessor Bernard Devauchelle,Amiens, France
Conference ChairsDr Adrian Sugar, UKDr Johan Wolfaardt, Canada
Conference Organizer RES SeminarsPO Box 99119��2� Cass Street, Suite A San Diego, CA 92109 US
Program Committees
Prof Ashraf Ayoub, UKMr Peter Ramsay-Baggs, UKDr M. Anwar Bamber, UKMs Sjerstin Bergstrom, SEDr John Beumer, USDr Richard Bibb, UKMr Alan Bocca, UKMr Pierre Boulanger, CADr Lawrence Brecht, USDr John Brunski, USDr Daniel Buchbinder, USDr Karen Calhoun, USMr Trevor Coward, UKDr Michael Crary, USMr Jan De Cubber, BEDr Betsy Davis, USProf Bernard Devauchelle, FRDr Walter Dobrovolsky, CAMr Steven Dover, UKMr Nick Drage, UKProf Michael Ehrenfeld, DEDr Harald Eufinger, DEMr Peter L Evans, UKProf Rolf Ewers, ATDr Scott D. Ganz, USProf Nils Gellrich, DEAss Prof Sabine Girod, USProf Gösta Granström, SEDr Simonas Grybauskas, LTProf Piet Haers, UKProf Bo E.V. Hakansson, SEProf Beat Hammer, CHDr Jeffrey Harris, CADr William Hodgetts, CAMr Peter Jeynes, UKDr Yasuhiro Kizu, JPProf Jeremy Knox, UKMr David Koppel, UKProf J.Thomas Lambrecht, CHDr Marc Metzger, DEProf Friedrich Neukam, DEDr Devin Okay, USDr Jules Poukens, NLProf Joachim Prein, CHDr Donald Raboud, CADr Jana Rieger, CA
Dr Harry Reintsema, NLDr David Riesberg, USDr Eleni Roumanas, USProf Robert Sader, DEDr Ralf Schoen, DEProf Alexander Schramm, DEMs Rosemary Seelaus, USDr Hadi Seikaly, CADr Christoph Sensen, CADr Joacim Stalfors, SEDr Brad Strong, USMr Adrian Sugar, UKProf Hishashi Taniguchi, JPDr Jonathon Trites, CADr Wesley Turner, USDr Mark Urken, USDr Robert P. van Oort, NLDr Henk Verdonck, NLMs Suzanne Verma, USMr Fraser Walker, UKDr Anders Westermark, SEDr Gordon Wilkes, CADr John Winder, IEProf Johan Wolfaardt, CAMr Steve Worollo, UKProf James Xia, US
Scientific Advisory GroupChair: Professor Rainer Schmelzeisen Freiburg, Germany
Program Schedule
20
Conference Moderators
Sunday
Welcome:Adrian Sugar, Swansea, Wales, UKJohn Wolfaardt, Edmonton, Alberta, CARainer Schmelzeisen, Freiburg, DEBernard Devauchelle, Amiens, FR
Session Subject: Planning (1) Lecture by Honorary Conference Chair Planning for Transplant and Reconstructive Surgery
Chair: Rainer Schmelzeisen and Gordon WilkesLecturer: Bernard Devauchelle
3D Planning for Facial Deformity/Head and Neck Reconstruction and Rehabilitation Chairs: Rainer Schmelzeisen and Gordon Wilkes Core Presenter: Daniel Buchbinder, US and Devin Okay, US
Session Subject: Planning (2) Chairs: Richard Bibb and Jules Poukens Session Subject: Endoscopy and Planning (�) Chairs: Richard Bibb and Jules Poukens
Lecture: Endoscopic Skull Base Surgery Chairs: Adrian Sugar and Nils-Claudius Gellrich Core Presenter: Carl Snyderman Invited Speaker: Moni Kuriakose, IN Invited Speaker: Ralf Schöen, DE
Session Subject: Planning (�) Chairs: Paul D’Urso and Alan Bocca
Monday Session Subject: Navigation Lecture: Navigation in Head and Neck Surgery Chairs: Bernard Devauchelle and John Wolfhaardt Core Presenter: Rolf Ewers, AT Invited Speaker: Nils-Claudius Gellrich, DE
Session Subject: Imaging Lecture: State of the Art Image Acquisition in the Head and Neck Chairs: Rolf Ewers and Christoph Sensen Core Presenter: Stephen Golding, UK
Invited Speaker: Beat Hammer, CH Invited Speaker: Marc Metzger, DE
Tuesday Session Subject: Virtual Reality Lecture: Virtual Reality in Planning Surgery and Education in Head and Neck Surgery Chairs: Henk Verdonk and Hadi Seikaly Core Presenter: Hans-florian Zeilhoffer Invited Speaker: Pierre Boulanger, CA Invited Speaker: Robert Sader, DE
Session Subject: Haptics, Color and Tissue Engineering Chairs: Rosemary Seelaus and Robert Van Oort
Conference Summation Adrian Sugar John Wolfhaardt Rainer Schmelzeisen Bernard Devauchelle
21
Conference Venue
Photos courtesy of Dominic Eggbeer
The history of what is now Cardiff began with a Roman fort on the site, built in 75 AD. Later, the Normans developed a keep within the fort and the castle has been the centre of Cardiff ever since. The 2nd Marquess of Bute is credited with developing ‘modern’ Cardiff by building Cardiff Docks, ready for the industrial revolution, which transformed the small town into a thriving international city (status awarded in 1905). Located on the banks of the River Taff, Cardiff is the capital and largest city of Wales with a population of approximately 318,000. Today it boasts busy commercial, maritime and university areas and is one of the fastest growing cities in the United Kingdom.
Since the 1990s, Cardiff has been transformed into a true European capital city, having undergone significant development. The new waterfront area at Cardiff Bay contains notable and award winning modern architecture, such as The Senedd (the Welsh Assembly Government Building) and the Wales Millennium Centre mixed with contemporary cafes, restaurants, museums and other tourist attractions. The city centre mixes a modern shopping experience with Victorian arcades, markets, cafes and restaurants.
Cardiff has a long association with sport. In 1958, the city hosted the Commonwealth Games. The iconic Millennium Stadium was completed in 1999 to host the Rugby World Cup and has since hosted a number of international sporting events including the FA Cup Final and Wales Rally GB. The stadium again made sporting history in 2005, when Wales won the Six Nations Grand Slam Championship for the first time in over 20 years a feat repeated again this year! Cardiff will also host an Ashes cricket Test match in 2009, and football matches during the 2012 London Olympic Games.
Today, Cardiff is increasingly associated with film and media. Cardiff is one of the most-visited locations in the popular television shows Doctor Who and Torchwood and the programs are produced by BBC Wales. Cardiff’s most famous sons and daughters include author Roald Dahl, after whom the plaza outside the Millennium Centre is named, renowned songwriter Ivor Novello and singer Dame Shirley Bassey.
22
Social & Elective Activities
Saturday, June 28th
Registration & Welcome ReceptionHilton Cardiff Hotel �:00pm - 7:00pm
Make your travel arrangements to arrive late Saturday afternoon and come join us for light appetizers at the conference site. This is a wonderful opportunity for meeting your colleagues and to pick up your credentials. A cash bar will be available for your enjoyment.
Dress: Casual
Sunday, June 29th
Conference LuncheonHilton Cardiff Hotel 12:00pm - 1:�0pm
Lunch is provided on-site and ample time is provided for our colleagues to stop by the exhibit booths to review the latest in technology and services.
Dress: Conference attire
Poster Session, Exhibit Reception & BuffetHilton Cardiff Hotel 7:�0pm - 9:�0pm
We encourage all delegates to support your colleagues who are presenting posters. Poster presenters should set-up their posters at 7:1�pm.
Our exhibits will be on display and have generously supported this evening with a variety of food. A cash bar will be available for your enjoyment.
Dress: Conference attire
Monday, June �0th
Conference LuncheonHilton Cardiff Hotel 12:00pm - 1:�0pm
Lunch is provided on-site and ample time is provided for our colleagues to stop by the exhibit booths to review the latest in technology and services.
Dress: Conference attire
ADT Reception and BanquetNational Museum Wales 7:�0pm-10:00pmElective: $110/person
Everyone should attend this gala event. Our banquet will take place in the grand hall. The National Museum of Wales is unique amongst British museums and galleries in its range of arts and science displays. The elegant Art Galleries house dazzling works of art by some of the worlds most famous artists and includes one of the best collections of French Impressionists paintings in Europe.
Wine will be included with our Reception and Dinner. A string ensemble will provide entertainment.
Dress: Lounge suits with ties, and evening dresses.
Sunday, June 29th
Cardiff and surrounding areaPrice: $80.00 USD per personIncludes: tour guide, transportation, admission tickets. Does not include lunch
10am - 11:�0am A tour of Cardiff Castle. The fully restored Cardiff Castle contains nearly 2,000 years of history within its mighty walls and was once residence to the richest man of the 19th Century – �rd Marquess of Bute. It has been beautifully restored to its past grandeur and is the main attraction of Cardiff and deservedly so.
11.�0am – 2.�0pm Following a 10 minute drive we will visit the Museum of Welsh Life at St Fagan’s. The Museum of Welsh Life is one of Europe’s biggest and most exciting open-air museums. Wales’ journey from rural tradition to industrial powerhouse is traced throughout extensive galleries and 100 acres of beautiful parkland. From the recreated Celtic village to the 21st Century house for the future, you can enjoy over forty buildings that have been transported and rebuilt to recreate �00 years of Wales’ history, plus an events program and craft demonstrations that run throughout the year.
�:00pm – �:00pm To finish the day we will take you to cosmopolitan Wales, at Cardiff Bay. The previously run down Cardiff Docks has been totally revamped to provide some examples of the most modern structures in the United Kingdom. We will take you to the Welsh Assembly, The Millennium Centre (Wales’ opera house), and stroll along the chic Mermaid Quay. We will have opportunity to enjoy ice cream, coffee or beer overlooking the sea.
Monday, June �0th
Wye and Usk Valley experience Price $90 USD per personIncludes: tour guide, transportation, admission tickets. Does not include lunch
10:00am – �:00pm Today we will head east out of Cardiff and take you to the fabulous sights of the Wye and Usk Valleys, a place of breathtaking natural scenery. With awesome castles, bustling market towns, fresh-farm produce, an artisan tradition, generous hospitality, the Wye Valley is a captivating experience that treats the senses. It is an area on the English border where the Welsh clashed with the English Lords over control of the land resulting in, possibly, more castles per square mile than anywhere else in the world.
First stop will be Caerleon. It is considered one of the most significant Roman sites in the UK, and there is much of the Roman past to see here, most notably its amphitheatre. Next we will head onto Chepstow, a historic walled town where Britain's first stone built castle is perched on the edge of a bluff above a loop in the River Wye.
North of Chepstow the wooded Wye Valley reaches from Tintern to Monmouth. Tintern Abbey, our next stop, in a remote area of the Valley - now designated an Area of Outstanding Natural Beauty - was founded by the Cistercians in 11�1, the first Cistercian abbey in Wales. From here we will meander away north into Brecon Beacons National park before heading back to Cardiff
Tuesday, July 1st
Conference Social Outing- We encourage all to attend!Castles and Pubs Price $�0.00 USD per personIncludes: tour guide, transportation, admission tickets. (Does not include lunch)
1:00pm-2:00pm
First stop will be Castell Coch. A late nineteenth-century 'fairytale' castle, built on medieval remains, designed for the third Marquees of Bute by William Burges. Lavishly decorated and restored in the Victorian Gothic style; a romantic vision of the Middle Ages.
2:00pm – �:00pm
Next stop is Caerphilly Castle. Caerphilly Castle is one of the great medieval castles of Western Europe. Several factors give it this pre-eminence - its immense size (1.2h), making it the largest in Britain after Windsor, its large-scale use of water for defense and the fact that it is the first truly concentric castle in Britain. At the time of its building in the late 1�th century it was a revolutionary masterpiece of military planning.
�:00pm onwards
We will take you to a 16th century traditional pub. This rustic, thatched roof pub, has amazing views, offers starters, snacks and pub classics – all very reasonably priced. Here you can sample the best beers that Wales has to offer whilst relaxing in charming surroundings. Optional - There are also a number of short walks to enjoy.
Elective Activities
2�
2�
Wednesday, July 2nd - July 4th
Post Conference � Day TripSouth Wales Coastal TourPrice $�1�.00 USD per personDeparts: Wed. July 2nd 9:00am from CardiffReturns: Fri. July �th 7:00pm to CardiffIncludes: B&B, lunches, driver/guide and transport
Day 1
We'll leave Cardiff at 9am bound for the National Waterfront Museum (Wales' newest museum) in Swansea. This museum charts the history and importance of Wales during the industrial revolution. Wales was one of the earliest and most heavily industrialized nations on earth.
Following lunch we'll head for The Gower, UK's first designated area of outstanding natural beauty. We'll visit a number of places on this peninsula including Port Eynon and Rhossilli. Here you'll have time to wander the stunning coastline and learn about Arthurian legend. From here we'll head to Tenby, in Pembrokeshire National Park, and our accommodation for the night. Free night for you to enjoy.
Day 2
You will have a couple of hours this morning to explore the castle-walled town of Tenby. Beguilingly old-fashioned, with narrow streets that duck and wind downhill from the medieval centre to the harbor and the island-studded seascape, this small town is the principal tourist centre of Pembrokeshire National Park.
Next we will head to Stackpole, where you will have the opportunity to walk a small section of the 186-mile Pembrokeshire Coastal Path. The route will take you past UK's best beach at Barafundle and end up at St Govan's Head and a visit to a 6th century hermit church built into the cliffs. This area of the coastline is as impressive as anywhere in Europe, with tall cliffs interspersed by small sandy beaches.
Next it’s onto Pembroke Castle before heading for our accommodation for the evening at St David’s. The night is yours to enjoy.
Day �
The morning will be spent at one of the 'most enchanting and evocative spots in Britain'. St David’s, founded by the patron saint of Wales in the 6th century is a miniature city clustered around its huge cathedral. We will have lunch in this city (the smallest city in the UK) before heading to a �000 yr old burial chamber in the Preseli Mountains of North Pembrokeshire. As we head back to Cardiff we will stop at Laugharne, previous home to Welsh poet and writer Dylan Thomas. This town is the inspiration to his most famous piece of work - Under Milk Wood. We aim to arrive back in Cardiff by 7pm
Elective Activities
Sunday, 29th June 2008 Hilton Hotel Cardiff
8:00am Conference Registration
9:00 AM OPENING CEREMONY The Rt Hon Rhodri Morgan AM, First Minister, Wales Assembly Government
Plenary Session 1 - Planning 1
Abstract # Presentation Title
Keynote Speakers K01 9:1� AM Bernard Devauchelle Planning for Facial Transplant and Reconstructive Surgery
K02 9:�� AM Daniel Buchbinder / Devin Okay �D Planning for Facial Deformity : Head and Neck Reconstruction and Rehabilitation 10:�0 AM Exhibitor Break
Plenary Session 2 - Planning 2
L01 11:00 AM Claudio Marchetti Maxillo-Facial Surgery Simulation from �D CT Images
L02 11:10 AM Mans Eeg-Olofsson Virtual Planning for Safe Insertion of a Long Titanium Fixture in the Mastoid
L0� 11:20 AM Jan DeCubber “Closing the Circle” (Where Advanced Computer Technology and the Production of Cranio Facial Epitheses Meet)
L0� 11:�0 AM Dominic Eggbeer Conclusions on the Application of Digital Technologies in Soft Tissue, Extra-Oral Prosthetics
L0� 11:�0 AM Muriel Brix Towards a three-dimensional software model of the oral cavity for tongue surgery planning
L06 11:�0 AM Horacio Zenha Free Flaps for Mandible Reconstruction Designed by �-D Biomodeling Technology - Experience of �� Cases
12:00 PM Discussion
12:2� PM Conf. Lunch / Exhibition Break
Plenary Session 3 - Endoscopy
Keynote Speaker K0� 2:00 PM Carl Snyderman Endoscopic Skull Base Surgery Invited Speakers K0� 2:�0 PM Abraham Kuriakose The Case for Open Skull Base Surgery
K0� 2:�0 PM Ralf Schön Endoscopy for Maxillofacial Surgery L07 �:10 PM Sabine Goldhahn Patient Benefit from Endoscopically Assisted Fixation of Condylar Neck Fractures- Results of a Randomized- Controlled Trial
Program Schedule
Abstract # Presentation TitleSaturday 28th June 2008 Hilton Hotel Cardiff
�:00pm-7:00pm Welcome Reception
2�
26
Plenary Session 4 - Planning 3 L08 �:20 PM Lucia Cervidanes �D Superimpostion to Assess Treatment Outcomes of Craniofacial Surgery
L09 �:�0 PM Christoph Sensen Touring into Human Anatomy for Virtual Head and Neck Surgery
L10 �:�0 PM Hadi Seikaly Bone Impacted Fibula a New Technique of Increasing Bone Density for Placing Dental Implants
�:�0 PM Discussion
�:10 PM Exhibitor Break
Plenary Session 5 - Planning 4
L11 �:�� PM Stephen Rouse Rapid Manufacture of Titanium Porous Mesh Cranioplasties using the Electron Beam Melting (EBM) Technique: Application to Battlefield Injuries
L12 �:�� PM Jules Poukens Rapid Manufacturing of Medical Implants: An Overview
L1� �:�� PM Andy Chrsitensen The Electron Beam Melting (EBM) Rapid Manufacturing Method: Application To Alloplastic Head And Neck Reconstruction
L1� �:0� PM J. Thomas Lambrecht Three Dimensional Individual Models Based on Digital Volumetric Data
L1� �:1� PM Pravin Patel A Virtual Approach to Craniosynostosis Reconstruction
L16 �:2� PM Simonas Grybauskas Accuracy of Surgery of Maxillofacial Deformities after �D Planning and Simulation on SL Models
�:�� PM Discussion
6:00 PM Exhibitor break 7:�0 - 9:�0 PM Poster Session, Exhibit Reception & Buffet
Monday, 30th June 2008 Hilton Hotel Cardiff
8:�� AM Opening remarks
Plenary Session 6 - Navigation
Keynote Speaker K06 9:00 AM Rolf Ewers Navigation in Head and Neck Reconstruction Invited Speaker K07 9:�0 AM Nils Gellrich Quality Control in the Treatment Process of the Severely Deformed Patient: From Planning to Post-Op Evaluation
L17 9:�0 AM Alexander Schramm Virtual Models in Computer Assisted Maxillofacial Surgery
L18 10:0� AM Shilei Zhang Establishment and Clinical Application of �D Navigation Technique Used in Craniofacial Deformity Reconstruction (China Experience)
L19 10:1� AM Suzanne Verma Applications of Surgical Navigational Systems in Extra-Oral Implant Placement
10:2� AM Discussion
Abstract # Presentation Title
Sunday, 29th June 2008 Continued
Abstract # Presentation Title
10:�� AM Exhibitor Break
L20 11:00 AM Harald Essig Precision of Posttraumatic Primary Orbital Reconstruction Using Individually Bent Titanium Mesh with and without Navigation
L21 11:10 AM Ralf Schön Advanced Orbital Reconstruction using Pre-Formed Titanium Mesh, Computer-Assisted Guidance and Intraoperative Imaging
L22 11:20 AM Shakir Mustafa Orbital Reconstruction using Custom-made Titanium Mesh and Sheets using �D Imaging and Planning Technologies
L2� 11:�0 AM Jeffrey Marcus Use of CT-based Virtual Anthropometry to Develop a Normative Database of Paediatric Craniofacial Morphology
11:�0 AM Discussion
12:00 PM Conf. Lunch
12:�0 PM Elective Workshop (working lunch included)
Virtual Reality meets Medicine: CAVEman demonstration Prof. Dr. Christoph W. Sensen and Dr. Jung Soh, University of Calgary
Plenary Session 7 - Imaging
Keynote speaker K08 1:�0 PM Stephen Golding State of the Art of Image Acquisition in the Head and Neck Invited speakers
K09 2:00 PM Beat Hammer Intra-Operative Imaging: The Hirsland Experience
K10 2:1� PM Marc Metzger Intra-Operative Imaging: The Freiburg Experience
L2� 2:�0 PM Gösta Granstrom Use of the Scanora® Technique for Longitudinal Evaluation of Extraoral Osseointegrated Implants
L2� 2:�0 PM Rosie Seelaus Evaluation of Three Dimensional (�D) Digital Data Acquisition Methods for Use in Facial Prosthetic Reconstruction
L26 2:�0 PM Ashraf Ayoub Three Dimensional (�D) Analysis of Craniofacial Morphology
L27 �:00 PM Henk Verdonk Assessment of Vascularity in Irradiated and Non-irradiated Alveolar Bone by Laser Doppler Flowmetry
�:10 PM Discussion
�:�0 PM Session close
�-6:00 PM Elective Workshop: Three concurrent workshops
Workshop 1 - �D Cranio-Maxillofacial Surgery Simulation with SurgiCase CMF (Materialise)
Workshop 2 - Preoperative Planning and Intraoperative Navigation for Head & Neck Reconstructive Surgery (BrainLAB AG)
Workshop 3 - Digital Maxillofacial Reconstruction: SensAble Freeform (Majenta Solutions)
7:�0 PM Reception & Banquet - National Museum of Wales
Program Schedule Cont’dAbstract # Presentation TitleAbstract # Presentation Title
27
28
Tuesday, 1st July 2008
8:��AM Announcements
Plenary Session 8 - Virtual Reality
Keynote Speaker
K11 9:00AM Hans-florain Zeilhofer Virtual Reality in Planning Surgery and Education in Head and neck Surgery
Invited Speakers
K12 9:�0AM Pierre Boulanger From �D Sensors to Virtual Reality: A Continuum of Technologies for Head and Neck Surgical Training
K1� 9:�0AM Robert Sader Innovative CMF Imaging: From �D to �D
L28 10:10AM Jana Rieger
Development of a Customizable and Functional �D Jaw Model
L29 10:20AM Kurt Schicho Augmented Reality and �D-Steriolithography for the Correction of Large Bone Defects
10:�0AM Discussion
10:�0AM Comfort Break
L�0 10:�0 AM Marc Metzger Manufacturing Dental Splints for Orthognathic Surgery Using a �D Printer
L�1 11:00 AM Farid Taha Toward Maxillo-Facial Haptically Enhanced Surgical Simulator
L�2 11:10 AM Rosie Seelaus Computerised Colour Formulation for Black African, British and Caribbean People
L�� 11:20 AM Anke Korfage Exploring Volume Reflectivity of Skin: Towards Colour Formulation of Facial Prosthesis
L�� 11:�0 AM Ettore Ramin Optimised Biomimetic Design of Ingrowth Scaffolds in Craniofacial Implants
L�� 11:�0 AM Sebastian Sauerbier Rapid Prototyping and Mesenchymal Stem Cells for the Regeneration of Hard Tissue
11:�0 AM Discussion 12:0� PM Conference Summation
Professor Joachim Prein, Davos, Switzerland
12:20 PM Future Conferences Ranier Schmelzeisen
12:�0 PM Final Announcements Adrian Sugar / Johan Wolfaardt
12:�� PM Conference Closes 1:00 PM Social Outing- Castles & Pubs
Plenary Session 9 - Haptics, Colour and Tissue Engineering
Reardon Smith Lecture Theatre - National Museum Of Wales
Abstract # Presentation TitleAbstract # Presentation Title
Colour
Table Presenter / Abstract Title P01 Nacher-Garcia
A Protocol for Skin Colour Matching of Silicone Elastomers for Facial Prostheses at King’s College Hospital (KCH) Using Advance Digital Colouring Technology
P02 Seelaus Clinician Opinion of a Computer-Defined
Colour Match in Silicone for Black- African, British & Caribbean People
P0� van Oort A Reproducible Pigment Dispensing System
Applicable in the Production of Facial Prosthesis
Function P0� Gehl New Material and New Method for Reshaping
Lost Tissue in Situ P0� Minami The Use of Newly-developed Monitoring
System to Evaluate the Stress of Dental Treatment
P06 O'Connell The Effect of Nerve Reconstruction on
Swallowing Function in Head and Neck Surgery
P07 Seikaly Functional Outcomes Measurements Following
Treatment of Oral and Oropharyngeal Cancer: A Review of Literature
P08 Swain The Osstell and Periotest: What are these
Devices Really Measuring? P09 Marcus Contrasting Aspects of Orbital Floor Fractures
in the Setting of Zygomaticomaxillary Complex Injuries Versus Isolated Orbital Injury
Imaging
P10 Bryant Can You Trust Your I-CAT? P11 Jayaratne Application of �-D Photogrammetry for
Planning Surgery in Hemifacial Microsomia P12 Krarup Precision of Surface Scans in Head and Neck
Surgery P1� Metzger Atlas Segmentation of the Human Skull for
Computer Assisted Surgery P1� Mirzaey 8F-FDG PET and CT/MRI in Oral Cavity
Squamous Cell Carcinoma
P1� Mustafa The Role of Cone Beam CT and �D Facial
Soft Tissue Scanning in the Assessment, Planning and Continued Evaluation of Patients Undergoing Orthognathic Surgery
Program Schedule Cont’d
29
Poster sessionSunday 7:30 - 9.30pm Exhibit Reception & Buffet
Program Schedule
�0
P16 Seikaly Volumetric and Multi-dimensional Analysis of
Oral Cavity and Oropharyngeal Defects: A Cadaveric Study
P17 Sladinia Validity of Digital Panoramic Radiographs for
Identifying Risk of Osteoporosis P18 Winder �D Surface Variation of The Human Face: A
Pilot Study P19 Yoshioka Preprosthetic Consultation by Visualizing Facial Prosthesis Using �D Modeling System Navigation
P20 Barth Computer-Assisted Treatment of Oral and
Maxillofacial Tumours P21 Serafin Implant Reconstruction of the Jaws with Computer-Guided Implant Navigation P22 Toyohiko
Collecting The Depressed Sub-nasal In Cleft Lip Patient Using Computer-assisted Navigation System
Planning
P2� Bodard A New, Simple, Non Invasive Surgical Guide
for Implant Placement in Oral Cancer Patients
P2� Cote Free Tissue Transfer Flap Reconstruction of
Parotidectomy Defects: A Paired Outcomes Analysis Using Three Dimensional Laser Surface Scans
P2� Evans Transferring Digital Planning Imaging into the
Operating Theatre P26 Katsoulis Combined Computer Guided, Flapless Surgery
and Bone-Split Procedures in the Narrow Maxilla: A Case Report
P27 Regunathan A Comparison Study: “Proposed Digital
Position” of Auricular Implant Retained Prostheses Using Computer Aided Design Versus the ‘Final Position’ of Fitted Prostheses.
P28 Marchetti Maxillo-facial Surgery Simulation from �D CT
Images P29 Mehrotra Correction of Postankylotic Deformity Through
Distraction Osteogenesis P�0 Metzger �D Simulation of Soft Tissue in Preoperative
Planning for Computer Assisted Surgery P�1 Morris Applying Virtual Orthognathic Surgery: Lesson
Learned and Challenges that Remain P�2 Neelakandan Indigenous Technologies in Redefining
Distraction for Mandibular Reconstruction in India
Table Presenter / Abstract TitleTable Presenter / Abstract Title
Photo courtesy of Christoph Sensen, Sun Center of Excellence for Visual Genomics, Calgary, Alberta, CA
�1
P�� Miyamoto An Integrated System for Three-Dimensional
Data Utilization in Maxillectomy Model Applications: Three-Dimensional Scanning, Solid Modeling and Finite Element Analysis
P�� Sharp Surgical guides for Cleft Distraction Osteotomy,
a Simple Technique to Assist Surgery P�� Veyre-Goulet Three-Dimensional Surface Reconstruction in
the Management of Impacted Maxillary Canines using Minimum Invasion Surgery
P�6 Ozawa Three-dimensional Finite Elemental Analysis of
Craniofacial Bone after Hemimaxillectomy and Planning Designs of Maxillary Prostheses with Zygomatic Implants
Prosthetic Rehabilitation
P�7 Brom Surgical- Prosthetic Rehabilitation of a Large
Mid-Face Defect P�8 Klein Using Interactive Flash Multimedia for Medical
Education of Osseointegration Procedures in Facial Prosthetic Treatment
P�9 Raboud Development of Impact Test for Oral Implants
with Fixed Prostheses P�0 Yasuhiro Immediate Loading Implant Therapy Using the
Computer Guided System RP&M Clinical
P�1 Bibb Direct fabrication of Custom-Fitting Stainless
Steel Surgical Guides P�2 Bodard Placement of Posterior Maxillary Implants Using
CAD/CAM Guidance to Avoid Sinus Grafting
P�� Grosvenor Pectus Excavatum: Construction of a Silicone
Implant Utilizing MRI/CT Data Acquisition and Three-Dimensional (�D) Digital Technology: A Technique Report.
P�� Casey Stereolithographic Models in Treatment Planning
Reconstruction After Maxillectomy Using Bone Graft and Dental Implants
P�� Christensen RP Anatomical Modeling for Head And Neck
Reconstruction: Survey Results Summary for Over 2�0 Patient Cases
P�6 Ghazali The Use of Stereolithographic Models and
Conventional Craniofacial Laboratory Technology in Simulation and Transfer of Maxillary Distraction with the Trans-Sinusoidal Maxillary Distractor: A Technical Note
P�7 Jeynes Manufacture of Facial Burns Conformer Splints
using �D Technologies P�8 Jeynes Bespoke Neo-Condyle and Mandibular
Reconstruction Plate Using �D Technologies P�9 Lambrecht The History of Rapid Prototyping P�0 Okay Application of CT Derived Surgical Templates in
Head and Neck Reconstruction. P�1 Seikaly Stereolithographic Biomodelling in Mandibular
Reconstruction
�2
RP&M Research
P�2 Christensen Cone-Beam CT Imaging for Anatomical Modeling
Using RP Technologies: Challenges and Applications
P�� Inohara Establishing a New Standardized Method for
Reconstructing �-D Human Vocal Tract Model by Using CT Images
P�� Storey-Bishoff Fabrication of Realistic Nasal Airway Replicas for
Aerosol Deposition Experiments P�� Williams Reconstruction of an Orbital Blowout Fracture
Using An Aerospace Six Axis Laser Sinter
P�6 Glaum Tissue Engineering of Composite Grafts: First
Steps Towards a Directly Fabricated Co-culture Graft for Oral Reconstruction
P�7 Khidr
New Trend in the Management of Ameloblastoma
P�8 Marzook A New Index for Rating Gummy Smile - The Gummy Smile Index
Keynote and Invited Speakers
��
��
Dr. Boulanger graduated from Laval University in Engineering Physics. He also received his Masters in Physics from the same university and his Ph.D. in Electrical Engineering from the University of Montreal. He worked for 18 years at the National Research Council of Canada as a senior research officer where his primary research interest were in �D computer vision, rapid product development, and virtualized reality systems. Since July 1st 2001, he is working as a professor at the Department of Computing Science at the University of Alberta doing research and teaching on virtualized reality systems. He is also the scientific director of the Servier Virtual Heart Center currently building one of the largest immersive CAVE dedicated to real-time medical imaging and visualization. He also has a joint appointment as a professor with the University of Alberta`s Faculty of Medicine Radiology and Diagnostic Imaging Department. He is an adjunct scientist and principal investigator for new media at TRLabs. In 200�, Dr. Boulanger was awarded an iCORE industrial chair in Collaborative Virtual Environment.
He has published more than 200 scientific papers in various Journals and Conferences. He is on the editorial board of two major academic journals. Dr. Boulanger is also on many international committees and frequently gives lectures on rapid product development and virtualized reality. He is the Director of the Advanced Man Machine Interface Laboratory. On the commercial side, Dr Boulanger is the president of PROTEUS Consulting Inc., an Alberta-based consulting firm specialized in Virtual Reality Applications.
Dr. Daniel Buchbinder is a graduate of University of Montreal School of Dental Medicine (DMD) and the Mount Sinai School of Medicine (MD). He received his certificate in Oral, Maxillofacial Surgery from the Mount Sinai School of Medicine and is a Diplomate of the American Board of Oral, Maxillofacial surgery . Dr. Buchbinder is the former chairman of the department of Dentistry and Oral, Maxillofacial Surgery at Mount Sinai Medical Center. He is currently Professor and chief of the division of Maxillofacial Surgery, Department of Otolaryngology- Head and Neck Surgery at Beth Israel Medical Center, New York, N.Y. and Continuum Cancer Centers of New York where he is also the director of the post graduate maxillofacial surgery training program. Dr. Buchbinder has published over 70 peer reviewed articles and has lectured extensively on cranio-maxillofacial trauma management, reconstruction and the use of osseointegration. He is a member of the multidisciplinary team at the Institute for Head and Neck & Thyroid Cancer and serves on the board of directors and the scientific advisory board for the Thyroid & Head and Neck Cancer (THANC) Foundation. Dr. Buchbinder also serves as chairman of the mandible expert group of the AO technical commission as well as on the board of trustees of the AO ASIF foundation, a non-profit organization based on a network of surgeons who are committed to the study, practice and teaching of AO principles and their advancement in the field of trauma and musculoskeletal surgery.
Dr. Pierre Boulanger,
Prof. Dept. of Computing Science,University of AlbertaEdmonton, Alberta, Canada
Dr. Daniel Buchbinder, DMD, MD
Professor , Clinical Maxillofacial Surgery
Chief, Division of Maxillofacial Surgery
Department of Otolaryngology
Beth Israel Medical Center, New York, N.Y.
Prof. Ewers was born in Litzmannstadt-Warthegau (Lodz-Poland) − He gained his degrees in Medicine and Dental Medicine in Freiburg, Breisgau, Germany. One Year Surgical Residency at Downstate-Medical University Center Brooklyn New York − 9 years Deputy Chief of the Hospital for Oral and Maxillofacial Surgery and Regional Plastic Surgery at the University Hospital of Kiel, Germany.
Since 1989 Chairman of the University Hospital of Cranio Maxillofacial and Oral Surgery of the Medical University of Vienna Austria
− 2004 he was President of the International Society for Computer Aided Surgery
− 2005 International Vice President of the International Congress on Oral Implantologistics
− 2005 Oral and Maxillofacial Surgery Foundation Research Recognition Award
− 2006 Mercure-Award for Processin Inovation for CMF-Institute of CranioMaxillofacial and Oral Rehabilitation for �D-Implantatnavigation and Telenavigation from the Austrian Federal Economic Chamber of Vienna
Prof. Rolf Ewers, M.D., D.M.D., Ph.D.
Chairman of the University Hospital of Cranio Maxillofacial and Oral Surgery Medical University of Vienna Austria
��
Starting in 1982, Nils-Claudius Gellrich studied both dentistry and medicine at the Christian-Albrechts-University in Kiel, Germany, with study periods in Bangor, (North Wales, Great Britain, 2 months), Montgomery and Birmingham (Alabama, USA, � months) and Zurich (Switzerland, � months). After acquiring his license as D.M.D. in 1987 and as M.D. in 1989, he started his specialist training in Oral and Maxillofacial Surgery at the Ruhr-University Bochum, Germany, in 1990. He obtained his board certification for Oral and Maxillofacial Surgery in January 199� and the qualification in Regional Plastic Surgery in 1996. In 1997 he became the Deputy Chairman at the Department of Oral and Maxillofacial Surgery at the Albert-Ludwigs-University Freiburg, rising to the position as Associate Professor in 2001. He is holding a chairman position at Hannover Medical School, Department of Oral and Maxillofacial Surgery, in Hannover, Germany, since October 200�.
In the course of his career Prof. Gellrich was always very active in research. His major research interests focus on tissue engineering, traumatic optic nerve lesion, neuroprotection, computer-assisted planning using virtual models in craniofacial surgery and intraoperative navigation using non-invasive registration for reconstructive surgery. He was given several grants, mainly by the German National Research Foundation, for research in these fields. His work has been rewarded with several awards, for example the Hans-Pichler-Award of the Austrian Association for Oral and Maxillofacial Surgery in 2000, the German Skull Base Society Poster Award in 200� and the award of the DÖSAK (German-Austrian-Swiss Working Group of Head and Neck Tumors) in 200�.
Prof. Gellrich is an experienced lecturer and teacher. Apart from giving lectures for dental and medical students, he is a skilled instructor in oral and maxillofacial surgery, first at Bochum and Freiburg, now at Hannover Medical School, Germany. He has been invited speaker at numerous scientific meetings and conferences and faculty member and chairman at multiple national and international workshops and courses, especially on osteosynthesis, reconstructive craniofacial surgery, microvascular reconstruction and dental implantology.
Prof. Nils-Claudius Gellrich, MD, DMD
Chairman, Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
�6
Stephen Golding qualified from Guy’s Hospital Medical School, London in 1972. After initial training posts in surgery he undertook general training in radiology at Guy’s Hospital in 197� proceeding to a Senior Research Fellowship at the Institute of Cancer Research in 1980 and has since specialised in high technology imaging.
In 1982 he was appointed to the University of Oxford and the Oxford Radcliffe Hospitals, with the task of setting up the first general purpose CT service in Oxford. He subsequently planned, commissioned and directed the Oxford MRI Centre, which opened in 1990.
His clinical interests centre on high technology imaging applied to cervicofacial, oncological and gynaecological disease, disorders of deglutition, image data processing, radiation protection, radiological history and resource management. He is currently Chairman of Radiology for the Oxford Radcliffe Hospitals.
He heads the radiology research group of the University, the research programme concentrating on cervicofacial disease and radiation protection.
Dr Golding was President of the British Institute of Radiology in 1996/7 and then successively Chairman and President of the UK Congress of Radiology. He is a founder member of the International Society for Strategic Studies in Radiology and of the EC Working Group on quality criteria in CT. He is currently President of the European Society of Head and Neck Radiology and also Clinical Guardian for MRI for the Department of Health.
He is a University Trustee in the Chalet Trust, an organisation which provides summer student reading parties in the French Alps.
Dr. Stephen J Golding, MBBS, LRCP MRCS, MA, DMRD, FRCR
Lecturer in Radiology, University of OxfordHonorary Consultant Radiologist and Directorate Chairman, Oxford Radcliffe Hospitals, UK
�7
�8
Prof. Beat Hammer is a maxillofacial surgeon at the interdisciplinary Craniofacial Centre (cfc) Hirslanden. Close collaboration between experts from a variety of specialist disciplines permits the best possible all-round care for patients and their treatment of diseases, injuries, and malformations of the jaw, face, skull, and brain.
The Cranio Facial Centre Hirslanden, located in Aarau, Switzerland, belongs to Hirslanden, a Swiss private hospital group, which is well known for its modern infrastructure; internationally recognised state-of-the-art medicine and patient orientated service.
1970 – 1980 Dental and Medical School, University Zürich1976 Graduation in Dental Medicine1980 Graduation in Medicine
1980 – 1982 Maxillofacial surgery residency, Zürich (Prof. H. Obwegeser)1982 – 198� General surgery residency, Kiel (Prof. H. Hamelmann)1986 Maxillofacial surgery residency, Basel (Prof. B. Spiessl)1987 Plastic surgery residency, Basel (Prof. N. Lüscher)1988 Maxillofacial surgery resideny, Basel (Prof. J. Prein)1988 – 200� Staff member, Maxillofacial Unit, University Hospital Basel (Head: Prof. J. Prein)Since 200� Cranio-Facial Center Hirslanden, Aarau, Switzerland
Fellowships1989 Plastic surgery fellowship (2 months), Baltimore (Prof. P. Manson) and Toronto (Dr. J. Gruss)1999 Craniofacial fellowship (6 months), Adelaide (Prof. D. David)
Core Competence Orbital Surgery, Orthognatic Surgery, Skull Base Surgery
Prof. Beat Hammer
Interdisciplinary Craniofacial Centre (cfc) Hirslanden Aarau, Switzerland
Dr. Moni Abraham Kuriakose is the professor and chairman of head and neck institute of Amrita hospital, Cochin. He graduated in Dentistry from Manipal and Medicine from University of Bristol. He underwent general surgery training at University of Bristol, Maxillofacial Surgery at St. Lawrence Hospital, Chepstow and Newcastle Hospitals and head and neck surgical oncology at Roswell Park Cancer Institute, New York. He is a fellow of Royal College of Surgeons of England, Ireland and Edinburgh. He is also American board certified.
Prior to joining Amrita hospital, he was a consultant in head and neck surgery and director of head and neck oncology translational research program of New York University. He continues to serve NYU as a part-time faculty. In addition he is a visiting professor at Roswell Park Cancer Institute, New York.
Marc Metzger gained his academic degree MD in 2001 and his DMD in 200� at the University Freiburg. His clinic experience in craniomaxillofacial surgery is concentrated on primary and secondary reconstructions supported by preoperative planning, computer assisted surgery and intraoperative imaging.
His expertise compass anatomical preformed implants, real time soft tissue simulations and orthodontic planning procedures.
Dr. Moni Abraham Kuriakose
Professor and Chairman Head and Neck Institute of Amrita hospital, Cochin, India
Dr. Marc Metzger
Department of Craniomaxillofacial Surgery, University Hospital Freiburg, Germany
�9
�0
Dr. Devin Joseph Okay, DDS
Director of Prosthodontics, Department of Otolaryngology - Head and Neck Surgery Beth Israel Medical Center, NY, New York, USA
Dr. Devin J. Okay is a graduate of Columbia University-School of Dental and Oral Surgery. He received his certificate in Prosthodontics from the V. A. Medical Center/ University of California at San Francisco. Dr. Okay completed his Fellowship in Maxillofacial Prosthodontics and Oncologic Dentistry at the University of Texas/ M.D. Anderson Cancer Center and is currently Director of Prosthodontics in the Department of Otolaryngology- Head and Neck Surgery at Beth Israel Medical Center, New York, N.Y.
He maintains a private practice and is a member of the multidisciplinary team at the Institute for Head and Neck & Thyroid Cancer at Beth Israel Medical Center. Dr. Okay serves on the Board of Directors for the Thyroid & Head and Neck Cancer (THANC) Foundation, a private organization involved in funding research and grants.
�1
Joachim PREIN, W.G., M.D., D.M.D.,
Professor of Maxillofacial Surgery AO Foundation, Switzerland
April 21, 19�8 born in Hamburg, Germany.196� Medical Degree, Hamburg, Germany.196� Dental Degree, Berlin, Germany.196� - 196� Residencies at: - Nordwestdeutsche Kieferklinik, Hamburg. - University Clinic, Berlin.1966 - 1967 Rotating Internship and Surgical Residency at Flower Hospital, Toledo, OH, USA.1968 - 1969 Residency at Institute of Pathology, University Clinic Basel, Switzerland.1969 - 197� Residency at Clinic of Plastic and Reconstructive Surgery, Division Maxillofacial Surgery, University Clinic Basel, Switzerland.1972 Special degree in Maxillofacial Surgery197� - 1981 Chief Resident at the above-mentioned Clinic1981 Assistant Professor for Maxillofacial Surgery, University Clinic Basel, Switzerland.1986 - 2001 Professor for Maxillofacial Surgery, Head of Clinic for Reconstructive Surgery, Department of Surgery, University Clinic Basel, Switzerland. 1986 - 199� Chairman of AO/ASIF- (Arbeitsgemeinschaft für Osteosynthesefragen) Maxillofacial Technical Commission (Worldwide)
1991 - 199� President of the Swiss Association of Maxillofacial Surgery 1997 - 2000 Member of Cranio-Maxillofacial Education and Steering Comittee of AO International for Europe and worldwide2000 - 200� Chairman International Cranio-maxillofacial Education and Steering Committee of AO International
since 2001 Honorary Trustee of the Board of Trustees of the AO Foundationsince 200� President of Foundation Bone Tumor Reference Center, University Institute of Pathology, University Basel
June 200� – June 200� Vice-President AO InternationalJune 200� – Aug. 2006 President AO InternationalSince September 2006 Vice-Director AO Education
�2
Prof. Robert SaderProf.Dr.Dr.Dr. (M.D., D.D.S., Ph.D.)
Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery Frankfurt, Germany.
Prof. Robert Sader graduated in 1987 in Medicine and 1991 in Dentistry. Afterwards, he completed his training in Oral and Maxillofacial Surgery in Munich until 199�, specialisation in facial plastic and reconstructive surgery followed in 1998. In 1999 he achieved the state doctorate and lecture qualification. 2002 he moved to Basel/Switzerland as deputy head of the University department. Since December 200� he was appointed professor, director and chair of Oral, Cranio-Maxillofacial and Facial Plastic Surgery at the Johann Wolfgang Goethe-University in Frankfurt.
The personal clinical focus of Prof. Sader is based on interdisciplinary treatment strategies, especially for skeletal malformations, and use of modern surgical technologies. His department offers the whole field of OMFS surgery ranging from implantology, trauma and tumor care to craniofacial surgery. He presides over one of the largest cleft centers in Europe. Correspondingly his main research topics are development and use of innovative technologies ranging from �D-simulation, material sciences to molecular medicine. The outcome of more than �00 scientific publications proves the high standard of the research projects. He is member of numerous national and international associations and has won several outstanding scientific awards. Membership of several scientific boards of associations, foundations and journals shows also a sound standing political work.
Since 200�, Prof. Sader is also deputy head of the new founded Hightech-Research Center – Center for Transdisciplinary Research in Cranio-Maxillofacial Surgery in Basel, Switzerland. Here, in a close interdisciplinary cooperation between mathematics, physicists, biologist, engineers, medicines and many other disciplines innovative technologies for next generation surgery are developed.
��
Dr. Dr. Ralf Schön MD, DDS, PhD
University Hospital FreiburgDepartment of Oral and Cranio-Maxillofacial SurgeryFreiburg, Germany.
Dr. Dr. Ralf Schön attended the Dental and Medical School at Heinrich-Heine University Düsseldorf, Germany. He received his OMS training at the University of Hannover and since 1997 University of Freiburg, Germany.
As a research fellow he spend two years at the Showa University in Tokyo, Japan to evaluate osseointegration in microsurgically revascularized bone grafts for mandibular reconstruction and performed experimental studies on distraction osteogenesis for his PhD.
He has studied overseas in Japan, USA and Australia. In 200� he worked as a staff specialist and guest lecturer for four months at the University of Queensland, Royal Brisbane Hospital, Brisbane, Australia.
Since 200� he has held the position as assistant Professor in the Department of Oral and Cranio-Maxillofacial Surgery at the University Hospital of Freiburg.
His interest is in the fields of reconstructive cranio-maxillofacial surgery in head and neck oncology and craniofacial trauma with special considerations to minimal invasive endoscopic techniques in maxillofacial trauma management and computer assisted orbital and craniofacial reconstruction and microsurgery.
Carl Snyderman, MD
Professor of Otolaryngology UPMC Center for Cranial Base SurgeryPittsburgh, USA
Dr. Snyderman graduated from the University of Chicago- Pritzker School of Medicine in 1982 and completed a residency in otolaryngology at the University of Pittsburgh Medical Center (UPMC) from 1982-87. This was followed by a fellowship in cranial base surgery at UPMC from 1987-89 with Ivo Janecka, MD (otolaryngology) and Laligam Sekhar, MD (neurosurgery). He is a past recipient of a Clinical Oncology Career Development Award from the American Cancer Society and a FIRST Award from the National Cancer Institute. Dr. Snyderman is currently a tenured professor of otolaryngology (clinician-educator) with a secondary appointment in neurosurgery.
Dr. Snyderman is Co-Director of the UPMC Center for Cranial Base Surgery. With his colleagues in neurosurgery (Dr. Kassam) and otolaryngology (Dr. Carrau), the Center for Cranial Base Surgery has become the world’s leader in the development of new minimally invasive surgical techniques for skull base pathology. Dr. Snyderman is a recipient of a Distinguished Service Award from the American Academy of Otolaryngology – Head and Neck Surgery Foundation, and a Presidential Citation from the American Head and Neck Society.
Prof. Hans-florian ZeilhoferProfessor MD DDS PhD Head of Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Switzerland.
Born 16th November 19�2 in Freising, Germany, graduated in Munich, Germany, as a foundationer of Studienstiftung des Deutschen Volkes, from Ludwig-Maximilians-University and from University of Technology of Munich in Medicine and Dentistry and from Jesuit College of Munich in Philosophy. 198� Residency in Oral and Maxillofacial Surgery at the German Central Military Hospital in Koblenz, 1989 completion to specialist MD DDS at the Department of Oral and Maxillofacial Surgery, University of Technology Munich. 1992 senior physician, from 1997 to 2002 vice head at the Department of Oral and Maxillofacial Surgery of Technical University Munich, from 1998 to 2002 assistant professor at the University. 2001 external clinical research manager at “caesar - center of advanced european studies and research” in Bonn/Germany. In the same year nomination for Visiting Professor at University of Medicine and Pharmacy “Iuliu Hatieganu“, Cluj-Napoca/Romania.
Since June 2002 Professor and Head of the Department of Maxillofacial Surgery at University of Basel, Switzerland, University Hospital Basel, Switzerland. Since 2002 also Head of the Department of Maxillofacial Surgery, Kantonsspital Aarau, Switzerland. Since October 2002 also Lecturer for New Technologies in Craniofacial Surgery and Head of the Center of Advanced Studies in Cranio-Maxillofacial Surgery at the University of Technology in Munich, Germany. May 2002 – July 200� Chair of the Bavarian Research Cooperation for Tissue Engineering and Rapid Prototyping FORTEPRO.
200� Foundation of the Hightech-Research-Center of Cranio-Maxillo-Facial Surgery at University Hospital Basel. Since 200� project leader of "Systems Face" at National Center of Competence in Research, NCCR, Switzerland. Since 200� Member of Management Committee for Computer Aided and Image Guided Medical Interventions (CO-ME) at NCCR.
200� Inaugural President of “International Bernd-Spiessl-Symposium for Innovative and Visionary Technologies in Cranio-Maxillofacial Surgery”, Basel. Since 200� Member of Comprehensive Expert Group for Cranio-Maxillo-Facial Surgery of International AO Foundation, Davos, Switzerland. Since 200� Spokesman of the Research Coalition “Clinical Morphology & Biomedical Engineering, CMBE”, of the Medical Faculty of Basel, Switzerland. November 200� Congress President of Swiss Society of Maxillo-Facial Surgery, SSMFS. Since September 2006 Councillor for Switzerland at the European Association for Cranio-Maxillofacial Surgery, EACMFS. Since 2007 Member of Scientific Advisory Board of the Graduate School in Advanced Optical Technologies (SAOT), University Erlangen-Nürnberg, Germany. 2007/2008 President of DÖSAK (German Austrian Swiss Association for Tumours of the Head and Neck).
Keynote and Invited Speaker Abstracts
��
�6
The facial allo-tranplantation (facial graft) is not really a problem of surgical procedure (even if some questions are still not solved) but more a problem of management. That is to say two different realities:
- the organisation of the teams when the sites of organs and facial procurement and the facial transplantation are not on the same place.
- the prior evaluation of the shape ,the size and the deepness of the requested transplant.
On this latter point, it is very interesting to notice that despite the numerous nowadays possibilities of imaging or simulations (realistic visualisation, materialisation by prototyping), there is still a free spatial and temporal space for a part of immediacy and unforeseen work of the surgeon.
From the example of the first case of facial transplant they realised in Amiens and from the numerous indications the received from other teams, the authors still feel that the improvement to the technologies they liked to participate will be always a very useful mean and never a substitute to the surgical work.
The combination of Medical Imaging and Rapid Prototyping is an expanding field with a large application potential in Cranio-maxillofacial reconstructive surgery. Typical applications include the making of three-dimensional models for treatment planning, the production of custom designed prostheses and the replication of segmental anatomical objects to guide the surgical and prosthodontic reconstructive efforts. When �D visualisation is combined with �D surgery simulation and intra-operative navigation it becomes a powerful tool for precise and accurate surgical planning and execution of the restorative treatment plan. The use of CT derived surgical templates for implant placement have shown promise for restoring function within months after surgical reconstruction of acquired post-oncologic defects. A major advantage for CT derived surgical templates is the accuracy of implant placement into the greatest bone volume. This technique has demonstrated success in the edentulous population but has yet to be applied to management of the reconstructed mandible or maxilla with microvascular free flaps. We have found that implants can be placed into the neo-ridge without raising the soft tissue off the bony reconstruction or stripping the periosteal blood supply.
A review of these techniques will be presented to demonstrate real value of computer assisted planning on the contemporary management of the patients with acquired and congenital caraniomaxillofacial defects.
Bibliography: Urken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg. 1998 Jan; 12�(1):�6-��.Okay DJ, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the maxilla: A classification system of defects. JPD 2001; 86:��2-6�.Genden E, Okay D, Stepp M, Rezee R, Mojica J, Buchbinder D, Urken M. Comparison of functional and Quality of Life Outcomes in patients with and without maxillary reconstruction. Arch Otolaryngol Head Neck Surg 200�; 129:77�-780.
K01 Planning For Facial Transplant and Recontructive Surgery
B Devauchelle*, F Taha*, S Dakpe* S Testelin*, B Lengele**,JM Dubernard***
* Departement Of Maxillofacial Surgery Chu Amiens **Morphologic and Experimental Anatomy Laboratory and Plastic Surgery Ucl Brussels***Transplantation And Immunology Departement Hcl Lyon
K02 3D Planning for Facial Deformities: Head and neck Reconstruction and Rehabilitation:
Devin Joseph Okay*, DDS, Daniel Buchbinder*, DMD, MD
Beth Israel Medical CenterNew York, NY USA
Abstract
Abstract # & Title
Authors
Notes
The endonasal endoscopic approach provides access to the entire ventral skull base from the frontal sinus to the 2nd cervical vertebra in the sagittal plane and from the midline to the infratemporal skull base in the coronal plane. Key concepts of endoscopic skull base surgery are: (1) use of the endonasal corridor to provide the most direct access to pathology without manipulation of neural and vascular structures, (2) team surgery, and (�) endoscopic visualization to provide improved illumination and access. Endoscopic skull base surgery requires a thorough understanding of endonasal skull base anatomy, adequate instrumentation and resources, and mastery of endoscopic surgery techniques: tumor dissection, hemostasis, and reconstruction. Large dural defects are effectively reconstructed with a vascularized septal mucosal flap. Advantages of endonasal endoscopic skull base surgery are improved visualization, decreased morbidity, and improved outcomes. A training program for the acquisition of endoscopic skills is proposed.
K03 Endoscopic Skull Base Surgery
Carl Snyderman, MD
Professor of Otolaryngology UPMC Center for Cranial Base SurgeryPittsburgh, USA
Notes
�7
�8
K04 Skull-Base Surgery: Case for Open Approach
Moni Abraham Kuriakose MD, FDSRCS, FFDRCS, FRCS Ed., FRCS
Professor and Chairman, Head and Neck Institute, AIMS Hospital, Cochin, India
Surgical approaches for a procedure depends on various factors- foremost among them are the ability to provide adequate exposure to facilitate oncologically sound resection. This is dependent on pathological nature and location of the lesion. The approach also should have acceptable morbidity and offer satisfactory functional and aesthetic outcome. As traditional open skull base approaches have several limitations newer techniques have been developed during the past two decades. Notable among them is the endoscopic approaches to skull base. However it is important to recognize that several novel modifications have been developed in the open approach, retaining its established oncological safety and considerably improving the aesthetic or functional outcome. The argument to choose endoscopic approach to improve aesthetic and functional result does no longer hold true. One of the developments in the open approach is the concept of modular disassembly of face to gain access to the tumor and then reassemble the facial skeleton following the completion of the tumor resection, therefore preserving aesthesis and function. The disassembly can be performed in a modular fashion based on the aesthetic and embryologic sub-units of the face therefore offering a tailored approach to specific site and extent of skull base exposure. The procedure also allows resection of the tumors with minimum brain retraction and allows precise reconstruction of dura and the skull base defects. The presentation will review some of the recent advances in open skull base approaches.
K05 Endoscopy for Maxillofacial Surgery
Dr. Dr. Ralf Schön (MD, DDS, PhD)
University Hospital FreiburgDepartment of Oral and Cranio-Maxillofacial SurgeryHugstetter Str. ��79106 FreiburgGermany
Endoscopic techniques such as TMJ arthroscopy, maxillary sinus surgery and sialoendoscopy are well established for minimal invasive surgery in the cranio maxillofacial area.
In the recent literature an increasing number of articles on endoscopic techniques for the treatment of maxillofacial trauma patients is noted. However, the indication of endoscopic surgery for the treatment of the trauma patient remains controversial.
The indication for endoscopic maxillofacial trauma surgery with special considerations to the treatment of fractures of the midface, the orbit and the frontal sinus will be discussed and critically evaluated. Surgical approaches in oral and maxillofacial trauma with invisible scars for reduction and fixation of fractures will be compared to endoscopic approaches.
Special considerations will be given to controversially discussed strategies for the management of condylar and subcondylar fractures. The indication for non surgical and surgical management of condyle fractures including functional treatment following non surgical management will be discussed. A minimal invasive endoscopic assisted transoral approach for the treatment of condylar and subcondylar fractures by will be presented using intraoperative endoscopic video demonstrations.
Endoscopic assisted transoral treatment has been routinely performed in the University Hospital of Freiburg since 1998 and proved to be a reliable, less invasive alternative for the treatment of condylar fractures compared to extraoral approaches.
Endoscopic techniques in other areas of maxillofacial trauma are considered until now as experimental approaches.
Notes
�9
K06 Navigation in Head and Neck Surgery
Ewers R*, Schicho K
Medical University of ViennaUniversity Hospital of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria,
This lecture provides a survey of current developments in computer assisted navigation with special focus on applications in head and neck surgery. Their common base is the well established augmented reality principle.
In contrast to the so called “first generation of navigation”, where intraoperative positions of surgical instruments are displayed relatively to 2-and �-dimensional representations of anatomical structures (usually calculated from CT- and MR-data), the “second generation of navigation” additionally comprises the integration of stereolithographic models (e.g. of the skull) in the navigation workflow. Treatments can be planned on these models and by means of navigation the preoperative plan can be transferred to the patient intraoperatively. This technical approach allows for a variety of applications, such as osteotomies and corrections of zygomatic deformities. Stereolithographic models are planned on the base of �-dimensional - stl data. The software used in stereolithography can also be utilized to simulate complex surgical interventions, for example the reconstruction of large bone defects. We have successfully applied this method for the transplantation of hip bone to reconstruct the mandible in tumor patients after (hemi-) mandibulectomy. The central characteristic of this concept is the combination of computer based visualization with haptic information (i.e. providing something that can also be “touched” by the surgeon).
Recently there is also a strong trend towards the utilization of rapid prototyping methods to manufacture surgical templates for dental implantology. Such approaches combine the advantages of computer assisted planning with the easy and comfortable intraoperative handling of templates. In an innovative workflow (Camlog GuideTM) recently developed at our clinic each step of the treatment refers to the bone, not to the soft tissue, which is an important aspect for the accuracy. To improve the overall efficiency many parts of the workflow are fulfilled in the course of the preparation in the laboratory of the dental technician.
Our clinical experiences with this approach show that the bone-borne drilling templates provide sufficient accuracy for immediate restoration with the definite prosthesis at the end of the operation.
�0
K07 Quality Control in the Treatment Process of the Severely Deformed Patient: From Planning to Post-op Evaluation
Nils-Claudius Gellrich* and Alexander Schramm
Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
K08 State of the Art of Image Acquisition in the Head and Neck
Stephen J Golding
University of Oxford, UK
The surgical treatment process of the severely deformed patient will always include metric changes in the facial skeleton that lead to visible alteration in appearance. Whether these changes occur in the originally symmetrical face e.g. due to trauma, tumors or other acquired deformities, or whether they address congenital deformities the aim of reconstruction is to harmonize as far as possible a deformed facial skeleton with overlying soft tissues.
A unique problem in comparing the pre- and postoperative hard tissue changes is to evaluate dimensions within the same xyz-coordinate-system at different time points.
Interactive imaging analysis based on modern planning platforms allows to quantify datatsets via image fusion. Furthermore �D-photographs including color and texture of the scanned area as WRL-files can be matched with any voxel-based dataset either, so that soft tissue quantification can be timeindependently included in the pre-/post- or post-/postoperative assessments.
Quality control may give evidence to hypotheses like that true to original reconstructions are required to prevent postoperative hard and soft tissue deformities. On the other hand myths like “fat atrophy” in postoperative orbital reconstruction have to be validated instead of accepting these theories as just given vs. as an excuse for improper orbital reconstruction.
In different fields of indications the workflow of complex reconstructive craniomaxillofacial surgery is demonstrated fulfilling a quality control circle ranging from preoperative assessment, CAD with virtual ideal model fabrication, intraoperative accuracy control and postoperative quality control in terms of hard- and soft tissue changes, including the long-term follow-up for the soft-tissue situation.
The overall benefit of using such quality control approaches is that surgical treatment becomes transparent, learning curves for complex surgical procedures could be shortened and education of the institutions´ teams is in- and not exclusive
The last two decades have seen dramatic expansion in the digital techniques applied to facial imaging. Initial programmes were based almost exclusively on CT and commonly restricted to simple reformatting in three dimensions, and limited to specialist institutions. Readily available computing power has permitted extension of the field into volume rendering, image fusion, virtual reality and robotic guidance programmes. Many of these are now used for education and training in addition to patient management and although the field varies greatly, some form of digital technology is now almost universally applied to facial imaging.
Initial programmes were based on computer tomography (CT) alone. It is now possible to incorporate information from ultrasound, MRI and PET-CT. Physical forms of display such as lathe milling and stereolithography have demonstrated clinical value. These approaches are now used in a wide range of conditions, notably neoplasms, trauma, anomalies and dental disease. Head and Neck imaging now requires a coordinated approach exploiting available technology to the full.
Although clinical management is enhanced by advancing technology, it remains important that the investigation of patients continues to be justified by clinical need and implied management change. This is particularly important in the case of CT, which can deliver significant radiation exposure and this is of particular concern when investigation is carried out for benign lesions or those in young patients, in whom the life-time risk of radiation-induced problems is more significant. In considering the modern approaches used in imaging to support digital technology applications, this presentation includes strategies to reduce the radiation burden. Work is presented to show how the data necessary for digital programmes may be provided by imaging techniques which do not employ ionising radiation, notably MRI. Issues of spatial resolution and signal content of image data are explored.
It is important that digital techniques applied to facial imaging are subject to verification and quality assurance programmes. This approach extends to the imaging used to support these techniques.
Notes
�1
K09 Intraoperative Imaging in CMF Surgery: The Hirslanden experience
Beat HammerCranio-Facial Center (cfc) Hirslanden, Schanzweg 7, CH-�000 Aarau, Switzerland
Intraoperative imaging in cranio-maxillo-facial surgery : a new technology looking for indications or a useful tool we missed for years. In 2006 a prototype of the Philips PULSERA �D C-arm was installed in the Hirslanden Clinic Aarau for clinical evaluation. It has since been used in many operative situations. Indications for intraoperative imaging have been orbital reconstruction after trauma and tumor resection, localisation of a foreign body in the infratemporal fossa, segmental osteotomies, analysis of a bad sagittal split, intraoperative control after 2-wall decompression in thyroid eye disease, and others.
Image quality allows reliable identification of even fine osseous structures, soft tissue structures however cannot be identified. In contrast to OR based CT devices ( e.g. TOMOSCAN ) the C-arm is operatedby OR personnel and therefore is available on short notice. Handling is sufficiently simple.
The release version, available since 2008 allows for export of data in DICOM format, thus enabling to connect the device with planning and navigation systems.
Intraoperative imaging has become an almost indispensable tool in many clinical situations. Coupling with virtual planning and navigation will create an even more powerful tool to increase precision and quality of our clinical work.
�2
K11 Virtual Reality in Planning Surgery and Education in Head and neck Surgery
Hans-florian Zeilhofer
Head of Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Switzerland.
Surgical interventions in the cranio-maxillo-facial area and even their planning make high demands on the spatial sense of the surgeon. This is on one hand due to the close proximity of highly vulnerable anatomical structures and on the other hand due to the comlex morphology of the region. Modern image-guided techniques are the basis for diagnostics, therapy and documentation. These technologies enable us to produce an individual anatomical picture of the patient´s specific situation. They give us the possibility to perform accurate planning and transfer the to the operation theatre.
Three-dimensional visualisations of datasets, even multimodal datasets, are very suitable for the display of complex structures of the facial skeleton and of the skull base. These technologies are therefore used to display cranio-facial deformities, tumour- growth and location and delicate anatomical situations. Another application for these technologies can be the display of tumorous lesions or the prediction of post-operative soft tissue appearance after corrective surgery of the facial skeleton.Apart from visualisation, �D-operation planning is one of the main applications of the currently available software systems. Accurate planning is a precondition for a successful treatment in reconstructive and cranio-facial surgery.
To bring the planning data to the operation theatre with a high degree of accuracy is the logic consequence of improved planning systems. In the future the navigation systems will on one hand guide the surgeon in delicate clinical situations as well as they will become systems for quality control to check whether the planning was correctly transferred into the OR.
Virtual reality has already entered medical and dental schools. Complex anatomical structures now are displayed in �D — to improve the spatial sense of the students. Soon virtually performed surgeries will become part of the training for residents. Also in this field a lot of innovation potential can be found by imagination of combining VR-technologies with e-learning applications.
K10 Intra-Operative Imaging
Dr. Marc Metzger
Department of Craniomaxillofacial Surgery, University Hospital
Freiburg, Germany
Computer Tomography (CT) is an accepted standard for preoperative diagnostic and planning, intraoperative navigation and postoperative control of midface trauma. However, postoperative controls out of the operation room are too late if instantaneous corrections are necessary.
Intraoperative 2D-fluoroscopy with a mobile C-arm system is well-established in many surgical fields such as orthopedics and neurosurgery, but it is hardly used for craniomaxillofacial surgery, due to projection fluoroscopy not revealing the complex three-dimensional structures of the filigree midface bones and cavities.
With regard to high-contrast structures, cone beam computed tomography (CBCT) offers an alternative imaging modality to CT imaging. Based on the principle of CBCT, modern C-arm systems have made this modality available for intraoperative use. The C-arm provides �D reconstructions that are acquired by a rotation around an isocentric point. Panning the C-arm over the surgical field, no repositioning of the patient is necessary.
A fast intraoperative update of the actual or final surgical situation can be evaluated. Through this the postoperative control is shifted into the operation room raising the level of on-site quality control and coevally decreasing complications, logistic expense and costs.
In this presentation the experience of intraoperative imaging in combination with computer assisted surgery procedures shall be demonstrated.
Notes
��
K12 From 3D Sensors to Virtual Reality: A Continuum of Technologies for Head and Neck Surgical Training and Planning
Dr. Pierre Boulanger,
University of Alberta Edmonton, Alberta, Canada
The need to create a comprehensive system where the progress of a patient can be monitored and treated rigorously is great. At the outset, the patient’s head and neck reconstruction needs must first be assessed by the use of modern medical imaging modalities such as: CT, MRI and �D scanners. Using sensor fusion techniques and image processing, a �D digital mock-up of a patient can be created to plan a course of action for various treatments and to record an accurate model of his/her original state. Using this digital mock-up one can also plan for corrective procedures and even train virtually if unfamiliar procedures must be used. Using similar �D modeling techniques, the patient progress can also be monitored accurately and if the reconstructive procedure was not successful other procedures can be planned to remedy to the situation. In this presentation, we will describe various systems that allow the creation of digital mockup and how they can be used for virtual procedure planning and training. In addition, we will cover how �D mock-up can be used to monitor a patient’s progress and to plan for further treatments.
��
K13 Innovative CMF Imaging: From 3D to 4D
Robert Sader, Prof.Dr.Dr.Dr. (M.D., D.D.S., Ph.D.)
Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt, Germany, GER
Humankind receives more than 90 % of its environmental information by the visual sense. Consequently, acquiring visual information by imaging procedures has gained increasing importance in medical diagnostics (radiology) or therapy (intraoperative scanning, endoscopic-assisted surgery).
As functional parameters plays an essential role in surgical planning, preoperative simulation of postoperative function will also have an increasing influence on surgical planning and will be one of the future challenges in medicine.
In evaluation of the musculoskeletal system, a breakthrough was achieved by �D-representation of the imaging data. New possibilities of CMF surgery have been achieved like individual �D-planning of osteotomies including soft tissue outcome or manufacturing individual custom implants for skull reconstruction. But by modern multi-detector scanner and the rapid evolution of computer multiprocessor technology it was possible not only to improve the spatial �D-image resolution but also to fasten scanning time and to achieve real-time online imaging, so called �D-imaging.
New possibilities of �D-imaging in CMF surgery will be presented like realtime-MRI (�0 images/second) for pre- and postoperative control of eye movements after orbital reconstruction or representation of muscle function in speech before and after surgery. Planning of facial expressions after aesthetic surgery will be possible by �D-surface scanning and �D-computertomography of the facial skull enables not only real-time representation of the TMJ movements of condyle and disc but also representation the muscle functions.It will be shown that these new diagnostic imaging tools can directly lead to surgical innovations like development of new surgical devices.
��
Notes
�6
�7
Oral Abstracts
�8
L01 Maxillofacial Surgery Simulation from 3D CT Images
Marchetti, C.*, Bianchi, A., Bassani L.
Oral and Maxillofacial Surgery Unit, University of Bologna, Bologna, Italy
PurposeThe purpose of the project is to analyze Simplant CMF® software (Materialise, Leuven, Belgium) for planning the aesthetic impact of the more frequent osteotomies used to correct dentoskeletal malocclusions, such as maxillary hypoplasia and mandibular prognathism. The software allows the surgeon to plan treatment accurately and to predict the soft tissue behavior realistically to evaluate the aesthetic results.
Methods & MaterialsMulti-slice imaging data were obtained preoperatively using a CT unit. The data were imported into Simplant CMF® and were processed, cleaned of artifacts, and the hard and soft tissues were segmented to create a hard and soft tissue �-D virtual models. Osteotomy lines can be traced on the �-D skeletal CT image and any anatomical region can be moved and relocated. After the surgical planning, a hypothesis for the new bone geometry is put forward. Simplant CMF® computes the soft tissue deformation caused by the new bone geometry using a physically based simulation kernel. The patient’s new facial appearance can be visualized using the same graphical interface. The first step of the validation process is to register the postoperative tissues on the preoperative tissues. The second step will be to calculate the errors by comparing the distance to the preoperative soft tissue for each point of the postoperative soft tissue.
Results10 patients had been previously studied with a �D CT scan before and 6 months after the surgical correction. Before surgery hard and soft tissues orthognathic surgery simulation �D CT images had been performed and now it is possible to observe the post-operative surgical outcome and the quality of the surgical simulation. The mean error comparing preoperative simulation and postoperative CT was less than 1 millimeter.
Conclusion�DCT surgery simulation is a feasible tool, capable of being perfected, which could allow the surgeon to simulate the real (hard and soft tissues) outcome of orthognathic surgery procedures.
PurposeA Bone Anchored Hearing Aid (BAHA®) stimulates the cochlea with a transducer attached to a �-� mm long titanium fixture on the skull surface. If the stimulation position is moved closer to the cochlea sound transmission improves. Implanting a transducer in the mastoid is assumed to be complicated and an easier solution could be to implant a longer titanium fixture from the mastoid surface down to the bony capsule surrounding the cochlea. The purpose of this study was to describe a method to achieve this using virtual planning.
Methods & MaterialsFrom a CT scan a virtual model of a dry human temporal bone was constructed (SimPlant Pro, Materialise) to decide the required length and the appropriate insert position and angle of a titanium fixture to reach the target position avoiding delicate structures. Using this information a drilling guide was designed for exact insertion of the fixture. Finally, another CT scan was made for evaluation of the result.
ResultsA �0 mm long titanium fixture was required to reach the otic bony capsule and the titanium fixture was positioned in the correct place according to the postoperative CT scan. The drilling guide facilitated insertion and vital structures such as the dura, the sigmoid sinus, the facial nerve, the semicircular canals and the cochlea were identified and preserved.
ConclusionVirtual preoperative planning is a feasible method to insert a long titanium fixture from the skull surface to the cochlea without damaging delicate structures in the mastoid part of the temporal bone.
L02 Virtual Planning for Safe Insertion of a Long Titanium Fixture in the Mastoid
Eeg-Olofsson, M.*, Stalfors, J., Granstrom, G.
ENT Department, University of Göteborg, Göteborg, Sweden
Notes
�9
L03 “Closing the Circle” (Where Advanced Computer Technology and the Production of Cranio Facial Epitheses Meet)
De Cubber, J.*, Verdonck, H.
Centre for Craniofacial Epithetics, Academisch Ziekenhuis van Maastricht, Zaventem, Belgium
PurposeThe implementation of Rapid Prototyping and Medical Imaging has drastically changed the field of anaplastology. New production protocols, for instance the CAMP Protocol (Computer Aided Maxillofacial Prostheses) were developed and presented at international forums. Despite all efforts we still face an important hiatus today. In this presentation, we developed new tools for the anaplastologist, so that �-D technology will be an attainable reality for everyone.
Methods & MaterialsThe impression taking or �-D acquisition using surface scanners or cone beam (CBCT) allows us to work on our patient in a virtual environment. The pre-operative planning is done using CMF (Materialise) software. In collaboration with Materialise, new developments allow us to design the supra-structure, taking into account the shape of the patient's soft tissue and implant positions. This supra-structure (Dolder bar or magnetic retention) can be produced in titanium with layered manufacturing techniques such as Selective Laser Sintering or Electron Beam Melting. By mirroring, repositioning of objects or the import of older CT-data prior to resection of the defect organ, a virtual prosthesis is designed. This virtual model will be reduced in shape, adapted to the original defect side and produced by layered manufacturing techniques. The anaplastologist will cover the reduced layer manufactured model with a calendared layer of high consistency individual colored silicone of which the thickness corresponds with the reduction of the model. The definitive sculpting of the surface texture and the extrinsic coloring are performed by the skilled anaplastologist on the non-vulcanized silicone.
ResultsSoftware for the design of the supra-structure, layer manufacturing techniques for the production of the supra-structure in Titanium, software for the design of the virtual prosthesis, software for the reduction of the virtual prosthesis, manipulation technique (Calendaring) for the production of a individual colored sheet of silicone.
ConclusionThis technique can be considered as the missing link between conservative production protocols and the state of the art in virtual manipulation. It allows the anaplastologist a more intense participation of his artistic skills in the creation of the facial prosthesis for the benefit of our patients.
60
L04 Conclusions on the Application of Digital Technologies in Soft Tissue, Extra-Oral Prosthetics
Eggbeer, D.*, Evans, P., Bibb, R., Bocca, A., Sugar, A.
Centre for Applied Reconstructive Technologies in Surgery (CARTIS), University of Wales Institute Cardiff, Cardiff, UK and the Maxillofacial Unit of Morriston Hospital, Swansea, UK
PurposeThis presentation will summarize conclusions of doctoral research into the application of digital technologies in soft tissue, extra-oral prosthetics. Extra-oral maxillofacial prosthesis design remains a relatively small profession, lacking in significant technological innovation. There is a need to evaluate the effectiveness of advanced technologies in order to direct development towards the needs of this profession and the overall healthcare system.
Methods & MaterialsCase study and action research methods were applied to evaluate the current capabilities of digital technologies and identify limitations in terms of quality, economics and clinical implications. Five cases including orbital, nasal and auricular prostheses were undertaken; each designed to evaluate a specific area of technology. Technologies evaluated included laser / light based non-contact �D scanning, �D photogrammetry, FreeForm Computer Aided Design (CAD) and various Rapid Prototyping (RP) methods.
ResultsThe current, clinically viable state of the art has been identified. In addition, technological limitations in scanning, CAD, RP methods and materials have been identified. The current economic and clinical viability of using digital technologies to streamline the fabrication process has also been demonstrated.
ConclusionA target specification for technology developers and an ideal workflow for the application of digital technologies will be presented. This is required to ensure the clinical viability of digital technologies in soft tissue prosthesis design.
L05 Towards a Three-Dimensional Software Model of the Oral Cavity for Tongue Surgery Planning
Buchaillard, S., Brix, M.*, Perrier, P., Payan, Y.
ICP-GIPSA-lab, Grenoble, France
PurposeTongue resections, consequent to a cancerous tumor, can cause strong impairments of the patients’ ability to speak, even when followed by a reconstruction. Though the biomechanical properties of the flap used for tongue reconstruction impact its mobility, they are usually not considered as critical factors for their choice, the priority being given to their volume and bulk. We explore the contribution of a biomechanical model of the oral cavity in the planning of tongue resection surgeries, with some focuses on the influences of flap stiffness.
Methods & MaterialsWe exploit a �D biomechanical Finite Element model of the tongue in which major lingual muscles are represented and implemented. This model is inserted in the oral cavity including jaw, palate, pharyngeal walls, as well as the hyoid bone. Two common tongue excisions with reconstruction are modeled: a hemiglossectomy and an enlarged mouth floor resection. The impact of the flap mechanical properties on tongue mobility and the production of vowels i, a, u are evaluated in the absence of any compensatory strategy.
ResultsThe first simulations revealed a desymmetrisation of the tongue movements after a hemiglossectomy, resulting in a deviation pronounced of the tongue apex on the flap or healthy tissues side according to the vowels simulated. The impact of the flap choice was non-negligible on tongue deformations but also on its kinematics, essential for speech production, a rigid flap leading to slower motion. For the mouth floor resection, the nature of the flap had a strong impact on tongue movements, especially on protraction, a high stiffness flap facilitating strongly the advancement of the tongue in the oral cavity.
ConclusionFirst results showed an important impact of the flap’s stiffness on tongue mobility in terms of tongue position, shaping and kinematics, dependent on the kind of exeresis. They were globally in agreement with observations usually made on patients, suggesting that this model could be a significant improvement in planning tongue surgery systems. Further improvements would include algorithmic aspects aiming at a significant decrease of the computation time and mesh matching methods to design patient specific oral cavity models, allowing a quantitative evaluation of the model.
61
L06 Free Flaps for Mandible Reconstruction Designed By 3-D Biomodelling Technology: Experience of 34 Cases
Zenha, H.*, Azevedo, L., Rios, L., Riobom, F., Guimarães, J., Cardoso, A., Pinto, A., Luz Barroso, M., Cunha, C., Santos, J., Costa, H.
Plastic, Reconstructive and Maxillofacial Surgery Unit, Centro Hospitalar Vila Nova Gaia, Gaia, Portugal
PurposeThe �-D biomodelling associated with rapid prototyping has become a fundamental tool in reconstructive surgery in recent years. The advantages in the medical field are enormous: surgeons can dispose of a physical �-D visualization model of the pre-operative patient status with anatomic defect details; the anatomic defect to be reconstructed can be physically created in a �-D model in order to guide the reconstructive procedure; custom-made prosthesis to be implanted can be fabricated with the exact �-D characteristics of the defect and overall surgical planning is optimized enabling significant risk reduction. In complex head and neck reconstruction using free flaps, the exact �-D characteristics of the free flap to be used are decisive criteria to restore symmetry and structural integrity enabling good functional and aesthetic results. The main disadvantage usually appointed to this technique is its economical burden. This work reports an analysis of our department’s experience with the application of an innovative �-D biomodelling approach for the calculation of the exact contours, angles, length and general morphology of iliac crest and fibula free flaps for maxillary and mandibular reconstruction.
Methods & MaterialsBetween 200� and 2007, �� patients, 19 male and 1� female, age range from 16 to 79 (median – �1), were submitted to head and neck reconstructive procedures. The etiology was neoplastic in 29 cases, osteoradionecrosis in � cases, traumatic in 1 case and reconstruction plate exposure in 1 case. Methods – the free flaps selected were 2� fibula and 9 iliac crest, transferred as osseous and osteocutaneous flaps. From Computer Tomography (CT) scans, virtual �-D images of the patient’s anatomy were converted into �-D physical models using first Biobuild™ software and then stereolithography (SLA) technology. These �-D models exactly mimicked the anatomical structures of interest. These models were used as �-D guides for bone-shaping osteotomies of the free flaps in order to obtain the best possible match between them.
ResultsFree flaps modelling, based on the SLA �-D models, accomplished an almost anatomical reconstruction of all head and neck defects treated, such as, hard palate, mandible body, mandible body and symphysis, mandible body and ramus, mandible arch and hemi-mandible. There was a total flap necrosis by haematoma. Results were at least satisfactory in �1 cases, 2� of which were considered good or very good.
ConclusionFibula and iliac crest free flaps are primary choice procedures in mandible and maxillary reconstruction where good anatomical reconstruction is difficult to achieve. A personalized �-D biomodelling technology designing of free flaps in complex head and neck reconstruction enables optimization of pre-operative planning, reduces operative time and significantly improves the aesthetic and bio-functional outcome
62
L07 Patient Benefit from Endoscopically Assisted Fixation of Condylar Neck Fractures: Results of a Randomized-Controlled Trial
Goldhahn S.*, Schön, R., Cienfuegos, R., Cheng, C. T., Cunningham, L., Schmelzeisen, R.
AO Clinical Investigation and Documentation, AO Foundation, Davos, Switzerland
L08 3D Superimposition to Assess Treatment Outcomes of Craniofacial Surgery
Cevidanes, L. H. S*., Phillips, C., Oliveira, A. E. F., Li, Y., Styner, M.
Department of Orthodontics, University of North Carolina, Chapel Hill, North Carolina, USA
PurposeTo localize and quantify stability of surgical correction for Class III, using cranial base surface superimpositions of �D virtual models
Methods & Materials�D surface models for �0 Class III patients (20 treated by maxillary advancement only and 20 by two-jaw surgery) were built from Cone-Beam CT images taken pre-surgery, at splint removal (~6 weeks post-surgery) and at the completion of orthodontic treatment (~1-year post-surgery). Surface models were superimposed through a fully automated voxel-wise method using the cranial base of the pre-surgery scan as reference. Closest point surface distances were computed to quantify condylar surface remodeling during the post-surgical orthodontic treatment. Color maps were used to visualize rotational displacements and localize the regions of surface remodeling.
ResultsThe condylar surface remodeling was significantly smaller for maxillary surgery only compared to two-jaw surgery patients (p< .01 for both condyles). For maxillary surgery only patients, if the maxillary vertical position changed, the mandibular condyles (left condyle r= 0.77, p <0.001; right condyle r=0.62, p<0.01�) tended to rotate anteriorly around the long axis with slight remodeling on the superior surface of the condyles. For patients who had two-jaw surgery the condyles rotated transversely with the medial pole positioned more forward and laterally. In contrast to the maxillary only group, post-surgical surface remodeling in the two jaw group tended to occur on the medial pole and the posterior surface of the condyles.
Conclusion: Condylar surface remodeling occurs following orthognathic surgery for treatment of skeletal class III regardless of whether a maxillary advancement only or two-jaw procedure is used. However, the amount, location and direction of condylar surface remodeling differs. Future studies are needed to investigate whether condylar remodeling occurs as a physiological adaptation during post-surgical orthodontic treatment or whether it can lead to long term relapse. Supported by NIDCR DE017727, DE00�21� and FAPEMA 128/06.
PurposeEndoscopic assistance for open reduction and fixation of condylar mandibular fractures should be associated with better cosmetics, fewer complications like nerve lesions and possibly better functional recovery. We performed a randomized controlled trial (RCT) to investigate whether patients benefit from endoscopic assistance compared to open approach with respect to patient perceived function, cosmetic result and specific complications.
Methods & MaterialsSeventy-four patients with mono- or bilateral condylar neck fracture in seven study centers were randomized to either endoscopically-assisted transoral open reduction and fixation (ENDO group) or conventional open reduction and fixation (ORIF group). High or intracapsular fractures were excluded. The main outcome measures were Helkimo Dysfunction Index, investigator-rated cosmetic outcome, patient-reported functional and cosmetic outcome and complication rate and pattern in each group assessed after 8-12 weeks as well as after one year.
ResultsFunctional results did not differ between the ENDO group (n=�0) and the ORIF group (n=��) at both time points. However, cosmetic results rated by both, investigators and patients, were better in the ENDO group at 8-12 weeks (p<0.001 and p=0.0��). Patients in the ENDO group had significantly less important alterations of the facial physiognomy than those in the ORIF group (p = 0.001) at 8-12-week. This group revealed no facial nerve damage at the first follow-up in contrast to five cases in the ORIF group. The overall number of complications reported for the ORIF and ENDO group were eleven and six, respectively.
ConclusionPatients may benefit from better cosmetic results and fewer complications when ORIF is assisted by endoscopy in condylar neck fractures.
6�
L09 Touring into Human Anatomy for Virtual Head and Neck Surgery
Sensen, C. W.*1, Soh, J.1, Turinsky, A. L.1, Fanea, E.1, Trinh, Q.1, Wat, S.2, Hallgrímsson, B.�, Dong, X.1, Shu, X.�, Hill, J.�, Edwards, C.�, Grosenick, B.�, Yajima, M.6
1Sun Center of Excellence for Visual Genomics, University of Calgary, Calgary, Alberta, Canada2Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada�Department of Cell Biology and Anatomy, University of Calgary, Calgary, Alberta, Canada�Department of Computer Science, University of Calgary, Calgary, Alberta, Canada�Kasterstener Publications, Inc., Red Deer, Alberta, Canada6Department of Fine Arts, University of Calgary, Calgary, Alberta, Canada
PurposeSurgical planning and training have long been recognized as an immediate application of virtual reality systems. However, technologies for simulation tools that incorporate virtual patient models, movement simulation, audio and tactile feedback are still in their early stages. We have created a software system called the CAVEman for the visual integration and exploration of heterogeneous biomedical data. Being a fully object-oriented and immersive environment, CAVEman allows medical professionals to visualize and virtually manipulate body parts, including head and neck, in a three-dimensional space. Diverse medical data such as MRI of a human head, gene expression profiles, blood sample analysis, and clinical history, can also be integrated onto the digital human body atlas to create a comprehensive knowledge base for the head and neck reconstructive surgery.
Methods & MaterialsThe main component of CAVEman is a three-dimensional digital atlas of the male adult human anatomy, structured according to the nomenclature of Terminologia Anatomica. Three-dimensional medical images can be mapped onto this atlas by spatially registering the images and corresponding atlas organs. The user can then create derivative cross-sections in any orientation, manipulate transparency, extract landmarks, reconstruct surfaces and morph atlas components to match the shape of the person’s organs, while exploring molecular processes within the same or other organs. All the objects comprising an organ can be individually manipulated by our middleware for �D user interface. A virtual head and neck surgery environment needs to have the abilities to: (i) morph patient information onto the high-resolution virtual human head and neck model, including MRI, CT scans, or �D ultrasound measurements; and (ii) simulate movements to model phenomena such as speech, swallowing, and chewing. Additionally, audio and tactile feedback will enhance the reality of surgical simulation. CAVEman is currently capable of morphing relevant patient information to the human atlas and simulating pharmacokinetic movements of drugs inside a human body. The underlying semantic data indexing mechanism uses standard ontologies to map a range of biomedical data types onto the atlas. Existing visual analysis tools such as TIGR MeV for microarray data viewing and Visualization Toolkit for volumetric image processing have also been integrated into the system.
ResultsThe CAVEman system can be used to visualize genetic and physiological processes in the context of the human anatomy and facilitates visual analysis of the data. The use of Java software makes the atlas-based system portable to virtually any computer environment, including personal computers and workstations. From the head and neck surgery standpoint, the novelty of CAVEman lies in its ability to combine the relevant organs from the anatomical atlas and the medical data pertaining to the patient, in order to allow the user to visualize/manipulate the resulting �D virtual objects. We plan to develop a convergent environment based on CAVEman where virtual reality, solid modeling, head and neck surgery and functional outcomes assessment are combined.
ConclusionThe affordability of virtual reality installations has increased dramatically over the last several years. This creates new opportunities for building a virtual reality solution for head and neck surgery. We described CAVEman as a solid basis on which such an environment can be created. The resulting system will have a physiologically responsive high-resolution �D head/neck model as its key component. It can be used for treatment planning and rehearsal in a �D or �D virtual environment with the added benefit of being able to predict likely functional outcomes of the surgical procedure.
6�
L10 Bone Impacted Fibula: A New Technique of Increasing Bone Density for Placing Dental Implants
Seikaly, H.1,2*, Mlynarek, A.1, Swain R.2,�, Hrdlicka, A.1, Rieger, J.2,�, Raboud, D.�, Al-Qahtani, K1, Harris, J. R.1,2, Wolfaardt, J.2,� 1Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada2Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit (COMPRU), Misericordia Hospital, Caritas Health Group, Edmonton, Alberta, Canada�Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada�Department of Speech Pathology and Audiology, University of Alberta, Edmonton, Alberta, Canada�Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
PurposeTo assess the importance of increased bone density at the time of dental endosseous implant placement in fibular free flaps post major head and neck oncological resections.
Methods & MaterialsThis is a prospective cohort study. All patients who underwent maxillary or mandibular reconstruction with fibular microvascular free flaps were included in the study. Fibular bones impacted with autologous bone were compared to unmodified fibular bones. Bone density was measured post-operatively using CT scans and the ease to dental implant placement was assessed by measuring the degree of vibration at the time of the implantation.
ResultsBone impacted fibulas were found to have a higher marrowbone density as compared to the unmodified fibular free flaps. Lower degree of dental implant vibration was observed in the bone impacted fibulas as compared to normal subjects.
ConclusionBone impaction fibula modification of osseous free flaps, presented for the first time in this paper, increases bone density and facilitates the primary osseointegration of dental implants.
6�
L11 Rapid Manufacture of Titanium Porous Mesh Cranioplasties using the Electron Beam Melting (EBM) Technique: Application to Battlefield Injuries
Rouse, S.L.1*, Christensen, A.�, Armonda, R. A.1, Critides, S.2
1Departments of Radiology and Surgery, Walter Reed Army Medical Center, 2National Naval Medical Center, Washington DC, USA�Medical Modeling Inc., Golden, Colorado, USA
PurposePolymethylmethacrylate (PMMA) cranial plates have been used for many years in repairing craniotomy and craniectomy patients. The extensive bone loss resulting from penetrating fragments or improvised explosive devices have required multi-piece implants due to manufacturing requirements. In addition, EtO sterilization is required and not available at most hospitals. Direct manufacture of titanium mesh implants using electron beam melting (Arcam AB, Gothenburg, Sweden) allows building a complex curvature, three-dimensional porous mesh implant with integrated fixation.
Methods & MaterialsComputed Tomography (CT) scans are obtained on the patient and the relevant bony structures segmented using Mimics (Materialise NV). The implant is designed using �Matic (Materialise NV) or Freeform Plus (SensAble Technologies) software and built in an ARCAM S�00, using Electron Beam Melting of Ti6Al�V, medical grade titanium alloy. The resultant three-dimensional mesh is �-�mm in thickness, and has fixation plates integrated. Minimal finishing is required and the implant is sterilizable using standard steam autoclave techniques.
Results:EBM produced custom titanium mesh implants can be produced ready for surgical implantation within seven days of receipt of the scan data. The integrated fixation plates reduce the cost as well as the complexity of the fixation process. Standard surgical times are significantly reduced and the mesh does not negatively impact the use of postoperative CT scans or Magnetic Resonance Imaging (MRI).
ConclusionThree-dimensional mesh structures reduce the weight and temperature transfer characteristics of metal plates, and allow the surgeon placement of a drain between the overlying tissue and the implant resulting in reduction of fluid retention between the implant and the dura during the first few days post implantation. Careful designs result in extremely well fitting implants that are not temperature sensitive, diminish fluid retention and resulting infection and do not impact later imaging needs.
Notes
66
L12 Rapid Manufacturing of Medical Implants: An Overview
Poukens, J.*, Laeven, P., Beerens, M., Koper, D., Weeda, H.
Cranio-maxillofacial Surgery, University Hospital Maastricht, Maastricht, The Netherlands
L13 The Electron Beam Melting (EBM) Rapid Manufacturing Method: Application to Alloplastic Head and Neck Reconstruction
Christensen, A.*, Flannery, N., Kircher, R., Wurth, K.
Medical Modeling Inc., Golden, Colorado, USA
PurposeWith the continued advancement of rapid manufacturing technology, the development of processes capable of producing fully functional metal components has been realized. One such method is Electron Beam Melting (EBM), an additive manufacturing process capable of producing fully dense, fully porous or hybrid geometries in implantable metals such as titanium, titanium alloy and cobalt-chrome alloy. The goal of this study is to investigate how this development in technology can be applied to the head and neck reconstruction field specifically for the production of customized implantable devices for alloplastic reconstruction of the mandible, maxilla, orbits and cranium.
Methods & MaterialsDiscussed is the overview of the technology and application of the EBM rapid manufacturing method for producing patient-specific implants in titanium alloy (Ti6Al�V or Ti6Al�V ELI). Clinical cases have been performed implanting EBM created metallic constructs.
ResultsThe EBM process is capable of producing metallic components that meet the stringent metallurgical conditions of ASTM standards. Complex and accurate titanium constructs for alloplastic reconstruction of the facial skeleton have been created using this technique. The EBM process allows for the production of porous mesh constructs which are unobtainable by conventional production methods. The process also allows for the production of hybrid solid/mesh structures, which can provide the combined benefits of light weight and high strength. Custom constructs which are matched to a patient CT scan can be designed and produced overnight in some instances, truly making Electron Beam Melting a “rapid” manufacturing technique.
ConclusionThe EBM manufacturing process has the ability to produce constructs that meet stringent ASTM standards for metallurgical properties. The resulting implants produced by EBM may have distinct advantages over currently available implants produced by conventional manufacturing techniques because of the flexibility of this manufacturing method. Where alloplastic constructs are required in the cranio-maxillofacial skeleton the process of Electron Beam Melting will become a more and more useful tool for creation of complex geometries in implantable metals.
PurposeCAD-CAM and rapid prototyping and manufacturing are getting more and more attention in the medical sector, especially in cranio-maxillofacial surgery where defects of the face (such as the absence of nose, ear or eye) have a very large psychosocial impact. European funded projects such as PHIDIAS, CUSTOMFIT and CUSTOM-IMD promote the use of these technologies. Reconstruction of complex defects in the face, bony tissue and soft tissue is challenging and requires custom-made treatment modalities. The purpose of this study was to introduce rapid manufacturing in the field of cranio-maxillofacial reconstruction.
Methods & MaterialsFive patients were included in the study. One patient suffered a defect of the mandible due to irradiation for cancer of the floor of the mouth. Four patients suffered from skull defects following trauma or cancer surgery. In all cases, CT scan data were processed with Mimics (Materialise, Belgium). Further processing and implant design was performed with �Matic (Materialise, Belgium). The design data were sent to a CNC milling machine (IDEE, Netherlands) or a rapid manufacturing machine (Electron Beam Melting, Arcam, Sweden).
ResultsAll implants had a clinically acceptable fit without the need for alterations during operation. Functional and aesthetical reconstruction developed as expected in all patients. The operation time was significantly reduced by using this new technology. The new technology enables more patient comfort and patient treatment with a more predictable clinical outcome.
ConclusionIntroduction of CAD-CAM and rapid manufacturing in medicine is a real breakthrough in medicine by introducing treatment modalities to complex cases that we were not able to treat before. The clinical outcome in the treatment of a patient with a cranio-maxillofacial defect becomes more predictable
67
L14 Three Dimensional Individual Models Based on Digital Volumetric Data
Lambrecht, J. T. H.*, Berndt, D., Zehnder, M., Schumacher, R.
Department of Oral Surgery, Oral Radiology and Oral Medicine, University of Basel, Basel, Switzerland Dental School, University of Basel
PurposeThree-dimensional modelling technology in oral and maxillofacial surgery based on computed tomographic data or magnetic resonance imaging data has been in clinical practice almost two decades. Since digital volumetric tomographic (DVT) data are available for clinical use in oral surgery and radiology, the question arose whether they could be used to generate three-dimensional individual patient models. The purpose of this paper is to describe our experiences with the method that was developed in order to generate three-dimensional models based on digital volumetric data.
Methods & MaterialsDICOM formatted data sets were extracted out of the user programme from �D Accuitomo Cone Beam CT (J. Morita Corporation Japan) with a voxel size of 0.12� mm x 0.12� mm x 0.12� mm and a slice width of 0.� mm. These data sets were imported into the planning software Mimics (Materialise, Belgium). A line of so-called masks was projected on single different cuts of the data set to determine definite grey scale values for rough screening of usable structures. Partial manual extraction of anatomical structures like bone, teeth or soft tissue had to be performed, since the grey scale values were not to be associated with specific quality variations of tissues. The extracted data then were three-dimensionally extrapolated. A re-mesh had to be performed in the Magics programme where the surface structures appeared as triangles, with following arithmetic smoothening of the surface. Boolean operations were used to figure out overlaps between the tissues, showing a discrimination of less than 0.1 mm from the original. The smoothed data set was re-imported into the Mimics programme and a three-dimensional data set was calculated for feasibility to feature the different tissues.
ResultsRapid Prototyping technology (Objet EDEN ��0) provided the first three dimensional model. For multiplication of models with separate representation of different tissues (tooth, bone) two lines of fabrication were established. First a hollow body was produced with a negative that later was turned into a positive form by pouring out. The second solution was calculating a separate hollow body in two parts (one cranial, one caudal) that later again was poured out.
ConclusionFabrication of three-dimensional models based on digital volumetric data is possible. Extraction of data sets is extremely time-consuming because of the format of the existing data sets and their software functions. A routine fabrication of models for daily use – like commercially available on CT Data – is too cost intensive for the moment.
Notes
68
L15 A Virtual Approach to Craniosynostosis Reconstruction
Patel, P. K.1,2,�*, Zhao, L.1, Tomita, T.2, DiPatri, A.2, Alden, T.2, Christensen, A. M.�
1Plastic and Craniofacial Surgery, Shriners Hospitals for Children at Chicago, Chicago, Illinois, USA2Division of Pediatric Neurosurgery, Children's Memorial Hospital, Chicago, Illinois, USA�Division of Pediatric Plastic Surgery, Children's Memorial Hospital, Chicago, Illinois, USA�Medical Modeling Inc., Golden, Colorado, USA
L16 Accuracy of Surgery of Maxillofacial Deformities after 3D Planning and Simulation on SL Models
Grybauskas, S.1*, Puisys, A.2, Linkevicius, T.2, Stacevicius, M.2
1Department of Maxillofacial Surgery, Zalgirio Hospital, Vilnius University, Vilnius, Lithuania2Vilnius Implantology Center, Vilnius, Lithuania
PurposeStereolithography (SL) models are indispensable in planning of osteotomies and distraction vectors for patients with maxillofacial deformities. Due to financial considerations SL models are avoided at times and diagnostics is limited to �D CT investigation and on-screen simulation of surgery, therefore a certain degree of error can be borne when the treatment plan is transferred to theatre. The aim of this study was to compare the accuracy of surgery after �D planning and simulation on SL models and �D planning alone in treatment of various maxillofacial deformities.
Methods & MaterialsBoth �D planning and SL models were performed for three patients with TMJ ankylosis (SL group: 1 bilateral, 1 bilateral previously released, 1 unilateral,). �D planning alone was done for another � patients with different maxillofacial pathology (no-SL group: 1 with CF microsomia: Pruzansky 2A, 1 with TMJ bilateral ankylosis, 1 with severe maxillomandibular asymmetry due to condylar hypergrowth). All patients were planned on Simplant 10.0 CMF module (Materialise, Belgium) and precise locations of osteotomies and distraction pin or screw insertion sites were determined with accuracy of 1 mm. SL models (Materialise, Belgium) were fabricated for the three patients in the SL group. Osteotomies were performed and distraction devices were attached according to the �D treatment plan followed by fabrication of acrylic templates that guided the osteotomy lines and distractors into precise locations during surgery. Postoperative lateral and AP cephalograms were superimposed on preoperative computer generated X-rays. Differences between planned and actual positions of distractors were evaluated.
ResultsThe placement of distractor pins or screws was accurate within 1.0 mm in the SL group, whereas it was accurate within 2.0 mm in the no-SL group. It can be explained by distortion of field of view at surgery when performing direct measurements, thus resulting in misplacement of pins or distractor itself in the no-SL group. However, inaccuracies in both groups were clinically insignificant resulting in a change in distractor vector by no more than � degrees from planned position.
ConclusionSL models and prefabricated splints can improve the accuracy at surgery. The accuracy was shown to be lower but clinically acceptable when highly precise �D planning alone with no use of SL models was performed.
PurposeWhile Computerized Tomography is routinely used to establish the diagnosis of premature sutural synostosis in children with cranio-orbital deformity, its' utilization for preoperative planning to more accurately guide the osteotomies and repositioning of the frontal bone and orbits today remains rudimentary. This paper presents our experience in extending commercially available �D software utilized for maxillofacial surgery for cranio-orbital reconstruction.
Methods & MaterialsFive cases (2 metopic synostosis, � unilateral coronal synostosis) were included in this project. Computerized Tomography (CT) scan data were processed using SurgiGuide CMF (Materialise, Leuven, Belgium). The osteotomy and skeletal segment repositioning were simulated virtually. The template(s) to guide the skeletal segment reposition in the operation room was designed virtually and then transferred to CAD/CAM system and manufactured using rapid prototyping techniques.
ResultsWe have found that pre-surgical planning including surgical guide template design using SurgiGuide CMF identified the osteotomy lines, visualized the surgical outcomes and guided the final position of the segments with an overall decreased operative time. Additionally, this ‘virtual’ planning benefited resident training education as well as communication of the complexity of the proposed surgery with the child’s family.
ConclusionOur experience shows that currently available software can be utilized for intraoperative guidance. However, further refinements are needed for user interface and fabrication of intraoperative guides.
69
L17 Virtual Models in Computer Assisted Maxillofacial Surgery
Schramm, A.1*, Heigis, G.1, Barth E. L.2, Gellrich, N. C2.
1Maxillofacial Surgery, Military and Academic Hospital, Ulm, Germany2Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
PurposeCorrecting complex midface deformities remains a challenge firstly in the diagnostic evaluation of the deformity, secondly in setting up the therapeutic schedule and thirdly in the surgical correction itself. Until now, computer-assisted preoperative planning and surgery has not been practiced as part of the surgical routine in the field of facial deformities. Primary diagnostics are indispensable in assessing the mostly combined bony and soft tissue deformities. Advances in imaging techniques and associated technologies have led within the past years to improved preoperative planning for the craniomaxillofacial surgeon.
Methods & MaterialsImaging, planning and navigation techniques in our clinical centers serve for computer assisted preoperative planning and computer assisted surgery. The patient’s individual anatomy was assessed in multiplanar (axial, coronal, sagittal) and three-dimensional views. Virtual correction could be made by either moving segmented bony areas or mirroring of segments for simulation of ideal reconstruction or osteotomies. Intraoperative navigation was done using frameless stereotaxy. The virtual patient and the real patient were correlated with an individual registration system.
ResultsOver �00 reconstructive procedures of the facial skeleton have been performed the last � years using segmentation and mirroring techniques for the creation of virtual models. These were transferred for intraoperative guidance by navigational surgery or CAD-CAM templates. New software developments for automatic bone segmentation of standard CT data sets dramatically reduce the time-period for preoperative planning in virtual facial reconstruction. Combining this tool with mirroring of segmented areas of the facial skeleton achieves instant virtual reconstruction of orbital and midface defects. The resulting virtual model is used for intraoperative navigation, guiding the reconstructive procedure to the desired result. In orthognathic surgery planning, the time for preoperative planning also could be reduced to one third compared to manual bone segmentation procedures.
ConclusionComputer-assisted preoperative planning and surgery techniques have improved operators’ confidence in facial reconstruction. Anatomical structures can be identified intraoperatively and preplanned reconstructions can be realized by means of navigation. In particular, image fusion of pre- and postoperative data enables detailed evaluation of postsurgical outcomes. The first application studies with autosegmentation have now led the computer-assisted cranio-maxillofacial reconstruction to clinical routine due to reduced planning time and even more by erasing the problems of pseudoforamina in orbital wall reconstruction.
Notes
70
L18 Establishment and Clinical Application of 3D Navigation Technique Used in Craniofacial Deformity Reconstruction (China Experience)
Zhang, SL.*, Shen, G. F., Wang, C. T.
Department of Oral and Maxillofacial Surgery, Affiliated Shanghai Ninth People's Hospital Medical School, Shanghai Jiao Tong University, Shanghai, China
L19 Applications of Surgical Navigational Systems in Extra-Oral Implant Placement
Verma, S.N*, Triplett, R. G., Schow,S.R.
Center for Maxillofacial Prosthetics / Department of Oral & Maxillofacial Surgery, Baylor College of Dentistry, Dallas, Texas, USA
PurposeNavigational systems using active technology (Stryker iNtellect ENT, Stryker iNtellect Cranial) allow for virtual pre-operative planning and performance of image-guided surgery. This technology was utilized for placing extra-oral implants for facial prosthetic reconstructions and was compared with conventional implant planning to test for clinical efficiency.
Methods & MaterialsNavigational systems provide the benefit of real time visualizations and offer numerous features to aid in pre-operative planning. By segmenting the soft tissue and bone from radiographic data, the patient’s “non treatment” anatomy can be mirrored on to the skull of the defect side. Mirroring techniques can help visualize the proposed future reconstruction whether it is surgical or prosthetic. Implants can be planned in the anatomical area that would lead to the best cosmetic results. While operating, bone quantity can be assessed at the sites by touching the pointer instrument to the patient while navigating within the virtual planning in real time. Two patients were treated with different methods using navigational technology (Stryker iNtellect ENT). One patient’s treatment combined virtual implant planning with conventional planning techniques using CT templates and surgical guides. The second patient’s implant locations were determined solely by virtual planning using navigational technology, thus eliminating the need for a CT template and surgical guide.
ResultsThe surgeon was able to find the planned implant locations without complications when using the navigational technology alone and when paired with conventional planning techniques. The method, which relied solely on virtual planning and navigational technology saved considerable clinical and laboratory time. Both systems improved the accuracy of implant placement for the oral maxillofacial surgeon, thus leading to a more predictable treatment outcome.
ConclusionWhen utilizing navigational technology in the planning and placement of extra-oral implants, craniofacial teams could enhance clinical efficiency, eliminate the need for traditional or prototyped surgical guides and provide patients with improved treatment outcomes in prosthetic rehabilitation.
PurposeAdvances in the field of computer-assisted surgery enable the surgical procedures to be less invasive and more accurate for the support of diagnosis imaging, pre-operative simulation and intraoperative navigation. Consequently, we aim to establish and evaluate �D navigation technique used in craniofacial deformity reconstruction, which was first used in China.
Methods MaterialsThe �D visual software called TBNAVIS-CMFS was created using Visual C++ 6.0 and Visualization Toolkit (VTK). The required osteotomy and desired bone segment movement were simulated through the software. Based on the Optical Positioning and Tracking System (Polaris, NDI, Canada), we set up a Dell AW-PRECISION ��0DT workstation. Subsequently, we performed Le Fort 1 osteotomy on the rapid prototype model and several craniofacial deformity reconstructions with the guide of the navigation system.
ResultsThe cranio-maxillofacial skeleton �D visualization computer model with the precision less than 0.�mm can present almost every anatomical and pathological structure allowing for viewing from various angles. The interactive manipulation software is allowed for repeated virtual surgical simulation of complex osteotomies and reconstructions. With the guide of real-time and visualization navigation system, the surgical results including the skeleton position relationship and profile are mostly as accurate as the pre-operative simulation and planning. The image registration precision is around 0.�mm-1.�mm.
ConclusionThe initially established method of �D visualization navigation technique will have a considerable effect on the precision of diagnosis, ensuring the accuracy of the pre-operative planning and intraoperative navigation, which will make the craniofacial reconstructive surgery procedures less invasive and more reliable.
Notes
71
L20 Precision of Posttraumatic Primary Orbital Reconstruction Using Individually Bent Titanium Mesh with and Without Navigation
Essig, H.*, Barth, E. L., Stühmer, C., Tavassol, F., Ruecker, M., Gellrich, N. C.
Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
PurposeThe aim of three-dimensional orbital wall reconstruction is the re-establishing of anatomically exact orbital volumes to avoid long-term complications such as enophthalmos and hypophthalmos. The patient population included patients with primary reconstruction of orbital fractures by using individually bent titanium mesh implants. The purpose of this study was to determine whether orbital volumes differ postoperatively from the virtually reconstructed orbital volume which is similar to the unaffected side.
Methods & Materials9� patients with unilateral orbital wall fractures were included. We used an imaging analysis platform (IAP) for preoperative planning, virtual reconstruction and postoperative control. The algorithm for intraoperative reconstruction implied preforming of the titanium mesh on an artificial sterile skull and depending on the extent of reconstruction the use of a navigation system. Based on preoperative CT scan data and postoperative cone beam scan data, we compared the volume of the orbital cavity by using the IAP (VoXim®, IVS Solutions).
ResultsThe volume of the unaffected adult orbital cavity ranged from 27.2 ml ± 2.8 ml in male and 2�.0 ml ± 2.6 ml in female. The average enlargement after trauma was significantly different particularly in fractures involving the posterior third of the orbital floor. The measurement of the orbital volume of the reconstructed side showed no significant differences to the unaffected side. There was a difference of 0.� ml between the cone beam and CT data, based on the measurement of the unaffected side.
ConclusionThe volume of the reconstructed orbital cavity is identically equal to the unaffected side. Our measurements demonstrate that even in severe injuries with vast comminution of the middle and posterior third of the orbital floor as well as of the medial wall, navigation-aided procedures facilitate a true-to-original reconstruction. Cone beam tomography seems to be suitable for postoperative control of orbital volume with reduced radiation.
72
L21 Advanced Orbital Reconstruction using Pre- Formed Titanium Mesh, Computer-Assisted Guidance and Intraoperative Imaging
Schön, R.*, Metzger, M., Schmelzeisen, R.
Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg Germany
L22 The Custom-made Titanium Implant for Post- traumatic Orbital Wall Reconstruction: A Review of 20 Cases
Mustafa, S. F.*, Evans, P. E., Bocca, A. P., Key, S. J., Patton, D. W., Baxter, P. W., Sugar, A. W.
Maxillofacial Surgery, Morriston Hospital, Swansea, UK
PurposeThe use of �D high-resolution Computed Tomography (CT) has provided a better understanding of the three-dimensional structure of the bony orbit. This combined with the use of rapid prototype models from CT data allow the construction of a more accurate individually-made implant for the reconstruction of orbital wall defects. The implant construction technique and clinical results are presented.
Methods & MaterialsThe obtained raw CT information is imported and processed to create a �D image using Mimics® software (Materialise NV, Leuven, Belgium). The image of the maxillary sinus on the unaffected side is processed and mirrored to provide the contour and position of the orbital defect using Freeform® �D manipulation software (SensAble, USA). A rapid prototype model (e.g. Stereolithography or Thermojet) is then constructed. This is used to shape a titanium mesh to the required contours. Alternatively, the model can be used to make an implant of the desired shape and size using 0.2� mm titanium plate.
Results20 patients were treated using this technique from 200� to 2007. Pre-treatment patients’ complaints included double vision, altered appearance, pain, swelling and altered sensation. Indications for using the technique included severe comminution, large defects with no posterior bony support and secondary reconstruction. Postoperatively the majority of patients reported resolution or improvement of their diplopia. No patients developed enophthalmos as a postoperative complication
ConclusionThe use of titanium mesh for orbital floor reconstruction has been shown to be safe and effective. Custom-made titanium implants are easy to manipulate, insert and anchor. They accurately reproduce orbital contours thus restoring orbital volume. This generally leads to reduced operative time and an improvement in functional and aesthetic outcomes of post-traumatic orbital reconstruction surgery.
PurposeDue to the complex orbital anatomy, three-dimensional orbital reconstruction remains a challenge. Superior results in primary and secondary orbital reconstruction are achieved using computer assisted preoperative planning and intraoperative control. A technique to preform titanium mesh implants (Synthes, USA) for orbital wall reconstruction was developed at the University Hospital Freiburg, Germany. We present the results following computer assisted orbital reconstruction using individually preformed titanium mesh in �2 patients.
Methods & MaterialsIn 22 out of the �2 patients, reconstruction of orbital injuries were performed primarily by orbital reconstruction together with repair of dislocated zygomatic complex fractures in 9 patients and with repair of orbital floor and medial orbital wall defects in 12 patients. In 11 patients, secondary correction of posttraumatic enophthalmos deformities including contour defects of the frontal bone were corrected by reosteotomy of dislocated zygomatic complex and supraorbital region.
ResultsThe bony aspects of the inner orbit and periorbital area were reconstructed using individually preformed titanium mesh implants. Exact placement of the titanium mesh implants by transconjunctival incision was controlled intraoperatively by computer-assisted means and �D image analysis of intraoperative cone bean CT scan. Image fusion of the postoperative CT scan, the preoperative planning and the intraoperative CT data demonstrated the precise reconstruction of orbital dimensions with an accuracy of 1mm.
ConclusionUsing preformed titanium mesh implants for orbital reconstruction true to original reconstruction of the orbital cavity was achieved in all patients. The preformed implants allowed for successful and less time-consuming correction of enophthalmos and complex posttraumatic craniomaxillofacial deformities in one operation.
Notes
7�
L23 Use of Computed Tomography-Based Virtual Anthropometry to Develop a Normative Database of Pediatric Craniofacial Morphology
Domeshek, L., Mukundan, S., Marcus, J.*
Interdisciplinary Craniofacial Imaging Lab, Duke University, Durham, NC, USA
PurposeSurgical correction of cranial shape abnormalities requires knowledge of normal skull shape in order to appreciate variations seen in dysmorphology. However, the inability of current anthropometric techniques to adequately characterize three-dimensional cranial morphology severely limits study and comparison of both normal and abnormal. We describe three-dimensional vector analysis (�DVA), a quantitative method that maps the cranial surface from Computed Tomography (CT) data, and use it to develop a normative database of pediatric cranial morphology.
Methods & MaterialsCraniofacial CT datasets from pediatric patients were gathered from the Duke University Picture Archive and Communications System (PACS). Applicable scans were level, motion free, comprehensive from skull base to vertex and displayed no cranial dysmorphology. �DVA was performed on all datasets to produce quantitative contour point clouds. Appropriate point clouds were averaged together to create normative three-dimensional models of �-year-old and �-year-old male and female skulls.
ResultsOne hundred and twenty normal scans were obtained to create a database consisting of normative data for eleven age groups ranging from one to seventy-two months of age. Normative models were used to: 1) provide views of sagittal, coronal, and axial contours, 2) determine averages and standard deviations for datasets and �) compare three-dimensional normative models of different age/gender groups. Length and width dimensions of the �DVA-generated point clouds agreed with previous anthropometric work.
Conclusion�DVA provides an accurate, comprehensive description of cranial morphology, with quantitative graphic output suitable for the development of a pediatric normative database. �DVA can also facilitate: 1) analysis of cranial anomalies to assist with preoperative planning, 2) post-operative analysis following surgical treatment of cranial dysmorphology or trauma and �) development of a refined pediatric head anthropometric test device.
7�
L24 Use of the Scanora® Technique for Longitudinal Evaluation of Extraoral Osseointegrated Implants
Granström, G.1*, Gröndahl, K.2
1Department of Otolaryngology, Head and Neck Surgery, 2Department of Oral and Maxillofacial Radiology, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
L25 Evaluation of Three Dimensional (3D) Digital Data Acquisition Methods for Use in Facial Prosthetic Reconstruction
Lee, E. L., Seelaus, R.*, Zhao, L.
The Craniofacial Center, Department of Maxillofacial Prosthetics and Surgery, University of Illinois in Chicago Medical Center, Chicago, Illinois, USA
PurposeUse of �D digital modeling technology in clinical practice is increasing. However, few reports comparatively assess these technologies for clinical implementation. This study compares accuracy and usability of four �D digital data acquisition (a microscribe, a desktop laser scanner, a portable laser scanner, and a stereo-photographic system) and explores which systems have greater suitability for clinical adaptation. Further, the study aimed to define protocols for use to enable their effective implementation in treatment processes.
Methods & MaterialsA plaster cast of a nose model was scanned using four devices for three-dimensional data acquisition. A computerized milling device was used to produce physical models from the acquired digital �D models. Distance measurements between established facial landmarks on both the physical models and the digital models were used for comparison. Additionally the usability of each system, acquisition time, resolution, range, affordability and appearance of the models produced were compared.
ResultsThe microscribe was the most imprecise digitization method with an error variance of 1.018mm ± .9�7. All other digitization methods had an error variance less than 1.0mm ± 0.�. No one digitization method emerged as superior overall, with each system demonstrating strengths dependant upon its intended purpose.
ConclusionsIt is important to critically evaluate �D digital acquisition methods and consider each device in terms of accuracy and usability prior to clinical application. Information derived from this study will provide a foundation for understanding the application of these technologies in prosthetic fabrication and rehabilitation and in future development of these technologies for clinical application such as virtual modeling of a prostheses and creation of digital records of patients’ impressions and prostheses.
Production of prototyped models provided by Cybrid Systems, Downers Grove, IL; high-resolution laser scanning provided by Digital Clayworks, Morton Grove, IL.
PurposeFor some time, intraoral osseointegrated implants (IOI) have been examined radiographically at follow-up visits. Advantages with a radiological follow-up are early detection of bone loss, loss of osseointegration and mechanical failures. There is limited experience with radiographic follow-ups of extraoral osseointegrated implants (EOI), mainly depending on lack of adequate techniques. This study was undertaken to evaluate the Scanora® technique in the assessment of EOI.
Methods & MaterialsAfter approval of the Ethics Committee at Göteborg University, 20 patients with defects of the orbit, maxilla and nose rehabilitated with EOI were scheduled for pre- and postoperative evaluations. Scanograms were taken with a Scanora multimodal unit (Soredex, Orion Corp., Helsinki, Finland) preoperatively, after 6 months and 1 year and then followed yearly.
Results1� men and 6 women (mean age of �7 years) were followed since 199� with a mean follow-up time of 7 years. Bone resorption was seen during the first year down to the first thread, after which further resorption was limited. Patients who had undergone radiotherapy showed more rapid and advanced resorption. Loss of osseointegration and local resorption including osteoradionecrosis were easily detected.
ConclusionThe Scanora® technique has been shown to be a reliable technique with diagnostic information comparable with radiographic techniques used to evaluate IOI.
7�
L26 Three Dimensional (3D) Analysis of Craniofacial Morphology
Ayoub, A. F.*, Nunu, Y. F., Hajeer, M. Y., Garrahy, A., White, J., Hood, C. A., Millett, D. T., Siebert, P., Bowman, A.
Department of Oral and Maxillofacial Surgery, University of Glasgow, Glasgow, Scotland
PurposeThe purpose of the study was to assess the clinical validity of a three-dimensional (�D) imaging system in analyzing craniofacial morphology, using stereophotogrammetry, a technique developed by the research team at Glasgow University.
Two capture stations, each comprising stereo cameras, took facial images which software processed to produce metrically accurate �D computer graphic models before and after surgery.
Methods MaterialsIn the following three groups of patients, the face was captured before and after surgery:1. Infants with cleft lip and palate (21 UCLP and 7� controls)2. Patients with facial deformities who have had orthognathic surgery (�� cases)�. Patients with facial fractures, which required orbital floor exploration (�2 cases)
�D co-ordinates of anthropometric landmarks were extracted. The reproducibility of the landmarks’ digitization was assessed. Systematic and random errors were calculated using the Dahlberg equation.
ResultsThe method is accurate to 0.� mm. Following cleft repair nasal asymmetry was noted with display of the alar base on the affected side laterally and inferiorly. Midface hypoplasia, short upper lip on the cleft side, and asymmetry of the nostrils were detected.
Soft tissue changes following orthognathic surgery were stable at 6 months following surgery compared with the immediate post-operative appearance. Greater morbidity was associated with transcutaneous approach in comparison with transconjuctival ones.
Conclusion1. �D imaging based on stereophotogrammetry is a reliable method for facial analysis.2. It can be easily utilized in infants and children.�. There is a statistically significant difference between surgically repaired UCLP cases and non-cleft controls.�. �D Imaging is essential for the diagnosis and assessment of surgical results in patients with facial asymmetry.�. There is a broad application for �D assessment in the field of facial trauma and assessment of scarring.
Notes
76
L27 Assessment of Vascularity in Irradiated and Non-irradiated Alveolar Bone by Laser Doppler Flowmetry
Verdonck, H. W. D.*, de Baat, C., Stoelinga, P., Meijer, G.
Oral Maxillofacial Surgery, University Hospital Maastricht, Maastricht, Netherlands
L28 Development of a Customizable and Functional 4D Jaw Model
Rieger, J.1,�, King, B.1, Swain R.1,2, Lam Tang, J.1 1Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit (COMPRU), Misericordia Hospital, Caritas Health Group, Edmonton, Alberta, Canada2Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada�Department of Speech Pathology and Audiology, University of Alberta, Edmonton, Alberta, Canada
PurposePrior to treatment for head and neck defects we attempt to understand as much about patient function as possible. This information allows a comparison between pre and post-intervention function and an indication of treatment efficacy. While this information is useful in directing treatment for future patients, we are unable to predict with any certainty patient outcomes. We believe, in order to advance patient treatment, individualized models of patient function that can be used in predictive environments (i.e., surgical simulation environments) will be necessary. While surgical planning is largely possible from static three-dimensional (�D) images at the current time, four-dimensional (�D) models (i.e. �D plus movement over time) has not yet been incorporated into planning environments. This is largely due to difficulties encountered when attempting to map function onto �D models. The intent of this study was to assess the feasibility of creating a simple �D model of patient function during mastication by mapping functional data onto a �D CT representation.
Methods & MaterialsAn individuals' CT scan was imported into Mimics medical imaging software (Materialise, Belgium). The desired sections of the CT data were exported as STL files and imported into Rhinoceros �D (McNeel & Associates, Washington, USA) for manipulation and alignment. Masticatory function during the chewing of a hard bolus was captured via an electrognathic device (Bio-Research Associates, Inc.) Raw data from masticatory function captured with the electrognathograph were exported into data files and the coordinates were mapped into a grid in Rhinoceros �D producing jaw motion.
ResultsSuccessful mapping of masticatory function onto a �D image resulted in animation of an individual’s jaw movement. Mapping difficulties encountered included establishing accurate mandibular point of rotation. Future work includes production of a fully functional jaw model. Utilizing inverse-dynamics estimating muscle forces it is possible to create a patient specific jaw model to predict how interventions may affect function.
ConclusionIn the future, surgeons may have the ability to perform virtual surgery, predictive of patient functional outcome. Groundwork is needed, firstly to create computational models for physiological movement associated with normal function of the head and neck structures. The rationale is that models from individuals without defects of the head and neck will serve as the base upon which patient information can be morphed. This study served to demonstrate the successful basic mapping of function onto a �D object in order to create �D animation of function on real human data.
PurposeA. Animal study – The purpose of the animal study was
to confirm that Laser Doppler Flowmetry (LDF) is a reproducible method for assessing maxillary and mandibular alveolar bone vascularity and that maxillary and mandibular alveolar bone vascularity is less in irradiated bone when compared to non-irradiated bone.
B Clinical study – To reduce the risk of osteoradionecrosis due to a surgical intervention, such as implant insertion, and to raise implant success rates in irradiated patients, assessing a minimum vascularity level facilitating reliable implant placement is necessary.
Methods & MaterialsAll maxillary and mandibular premolars and molars of six Göttingen minipigs were extracted. After a �-months healing period, three minipigs received irradiation at a total dose of 2� Gy. At �-months after irradiation, five holes were drilled in the residual alveolar ridge of each edentulous site of all minipigs. Local microvascular blood flow around all 120 holes was recorded by LDF, prior to implant placement. In one irradiated and one non-irradiated minipig, an additional hole was drilled in the right edentulous maxillary site in order to be able to perform repeated LDF recordings. The alveolar bone appeared less vascularized in irradiated than in non-irradiated minipigs. The effect of radiation was shown to be more pronounced in the mandible than in the maxilla. LDF was demonstrated to be a reproducible method for assessing alveolar bone vascularity.
Normal values of vascularity of the various alveolar sites in humans have to be measured to come to a standard for bone vascularity. These values may not only vary from person to person, but may also be dependant on the individual amount of local alveolar bone.
ResultsThe symphyseal bone vascularity of twenty edentulous patients was measured. The results presented in this study are clarifying that LDF can be used for measuring mandibular symphyseal bone vascularity at implant sites during implant insertion.
ConclusionsFurther research validating LDF’s use in human beings, especially in those who have undergone radiation therapy for head and neck cancer is necessary.
Notes
77
L29 Augmented Reality and 3D-Stereolithography for the Correction of Large Bone Defects
Schicho, K. *, Klug, C., Nell, C., Watzinger, F., Ewers, R.
University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
PurposeIn this lecture, we present a workflow combining computer-assisted navigation with �D-stereolithography in order to optimize the surgical treatment of large bone defects. The method is demonstrated on a patient who underwent hemimandibulectomy after ameloblastoma and was supplied with a microvascular bone transplant from the iliac crest and free rib cartilage graft.
Methods & MaterialsIn the specific case, the bone could not be taken from the ispilateral side of the hip as usual (due to a pre-operation). Based on computer-based planning the optimum site to take the bone graft was defined at the contralateral part of the hip. �D-stereolithographic models of the complete skull and of the planned bone graft (with the desired shape and geometry) were manufactured to support the intervention by providing additional orientation for the surgeon.
ResultsThe method proved to be advantageous for this indication. The sterilized models were available at the OR-site and therefore allowed for an easy “haptic” guidance by direct comparison of the model with the bone graft. Achievement of the optimum shape of the reconstructed mandible, which is an iterative process, was facilitated and accelerated by the use of the stereolithographic models.
ConclusionThe workflow in its present form is already beneficial for this kind of surgery. In our next advancement, we will focus on the transformation of �D STL data (from the stereolithographic-model fabrication process) into DICOM-datasets to allow their processing and direct integration in the navigation system in order to enable intraoperative image guidance exactly corresponding with the stereolithographic models.
78
L30 Manufacturing Dental Splints for Orthognathic Surgery Using a 3D Printer
Metzger, M.*, Schulze, D., Schwarz, U., Teschner, M., Hammer, B., Schmelzeisen, R.
Department of Craniomaxillofacial Surgery, University Freiburg, Freiburg, Germany
PurposeA new technique for producing dental splints for orthognathic surgery by using a �D printer will be presented.
Methods & MaterialsAfter segmentation of the upper and lower jaws in �D datasets from patients with orthognathic deformations, it is possible to perform virtual surgery planning. For artifact reduction, plaster models of both jaws were scanned either simultaneously with the patient during the �D data acquisition or separately using a surface scanner. Importing these data into the preoperative planning situation allows artifact reduction and increases the image quality with regard to fine anatomical structures. Setting a virtual splint between the tooth rows makes it possible to encode the repositioning. After performing Boolean operations, tooth impressions are subtracted from the virtual splint. The “definitive” splint is then printed using a �D printer.
ConclusionThe presented technique combines the advantages of conventional plaster models, precise virtual �D planning and the possibility of transforming the acquired information into a dental splint.
L31 Toward Maxillofacial Haptically Enhanced Surgical Simulator
Taha, F.*, Gosselin, F., Megard, C., Devauchelle, B.
Sce de Chirurgie Maxillo-Faciale, University Hospital, Amiens, France
PurposeSurgical planning with several techniques has been used in our department for more than fifteen years. Starting from stereolithography prototypes and simulation on virtual models, we describe and explain the whole research process for developing a specific haptically enhanced simulator for maxillofacial surgery (especially for orthognathic surgery).
Methods & MaterialsDue to the limitations of stereolithography models and/or �D virtual models for surgical planning, we started developing an original haptically enhanced simulator. We first describe clinical cases using anatomical hard copy or realistic textured models for surgical planning implants or prosthesis customization. Then, we discuss their advantages and limits. Finally, we introduce the SKILLS project, a European Research program for the acquisition, modelling and transfer of human skills using robotic systems and haptic devices in several fields. For maxillofacial surgery, we plan to fix a standard surgical drill prop at the end point of a haptic interface. The instrument is shared during the manipulation by the student and provides full performances for training during a virtual surgery procedure.
ResultsIf a good knowledge of multi-modal interfaces is needed to develop these haptic tools, the virtual environments and interaction methodologies are as simple and very intuitive to use for beginners as video games.
Conclusion�0 years after the first flight simulators, the development of multi-modal interfaces training systems in surgery provides surgeons an excellent opportunity to enhance their training during their internship increasing and enhancing the learning process particularly their digital skills.
Notes
79
L32 Computerized Color Formulation for Black African, British and Caribbean People
Coward, T. J.1, Seelaus, R. M*.2, Donaldson, N.�
1King's College London Dental Institute, London, UK2Department of Oral Maxillofacial Surgery, The Craniofacial Centre, University of Illinois Medical Centre, Chicago, USA �Department of Surgery & Biomedical Health Information Sciences, University of Illinois Medical Centre, Chicago, USA
PurposeThe aim of the study was to determine whether spectrophotometry used in conjunction with a computerized color formulation system could predict pigment formulae for silicone elastomer to match the skin colour of persons of Black African, Black British and Black Caribbean backgrounds, using Delta E as a measure of colour difference.
Methods & MaterialsSpectral data for �9 subjects were used with a computerized colour formulation system to predict a pigment formula mixed with a silicone elastomer to match each subject’s skin colour. A second sample was produced using a correction procedure. Delta E values were recorded for each silicone sample in comparison to the subject’s original skin measurement.
ResultsThe mean delta-E values for the uncorrected sample and the original skin colour was 1.2 (9�% CI 1.0�, 1.�7) and ranged between 0.�8 – 2.9. The mean delta-E values for the corrected sample and the original skin colour was 0.6 (9�% CI 0.��, 0.77) and ranged between 0.7- �.�2.
ConclusionThere was good agreement between the original skin colour and the corrected pigmented samples. The delta-E values obtained were consistently lower and therefore closer to the original skin colour than those in previous studies. Further investigation will explore the clinical opinion of this computer-defined colour match between silicone and skin with assessors who are familiar with rehabilitating patients requiring silicone prostheses.
80
L33 Exploring Volume Reflectivity of Skin: Towards Colour Formulation of Facial Prostheses
Korfage, A.1*, Borsboom, P. C. F.2, van Oort, R. P.1
1Department of Oral Maxillofacial Surgery, Maxillofacial Prosthetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands2PBSensortechnology & Consultancy BV, NL Westeremden
L34 Optimized Biomimetic Design of Ingrowth Scaffolds in Craniofacial Implants
Ramin, E.*, Harris, R. A.
Wolfson School of Mechanical & Manufacturing Engineering, Loughborough University, Loughborough, UK
PurposeThe design of scaffolds with an intricate and highly variable internal structure represents a challenge for Tissue Engineering. The combined use of Computer-Aided Design (CAD) software and Layer Manufacturing (LM) techniques has been shown by many authors to allow a high degree of control of the scaffold architecture, resulting in tailored and reproducible internal geometries.
This paper describes how the otherwise extremely time consuming process related to the manual CAD of complex and irregular networks of interconnected channels with different pore size and shape on either a cubic or prismatic reference volume, have been overcome by the development of specific software algorithms which enable the automated design of relevant internal geometries within a conventional CAD application. The resultant geometry is automatically generated within minutes in the CAD native format and then exported in both standard and STL file formats. The initial approach, though helpful in drastically reducing the time required, was only applied on regular reference volumes and presents some limitations when integration with irregular anatomical implants is required, due to the shortcomings of Boolean operations. This integration constitutes an essential requirement for TE scaffolds, since they should possess an external shape to fit anatomical defects.
Methods & MaterialsThis work subsequently present a further alternative approach, which allows the automated design of complex networks of interconnected channels with different pore size and shape directly onto a generic anatomical volume. In addition, when applied to bone TE scaffolds, this methodology is able to simulate the natural geometry of porous biological structures.
ResultsTo show the full potential of this technique, a craniofacial implant from a clinical case study is presented.
PurposeAn inconspicuous facial prosthesis demands a good colour match with the surrounding area. To achieve a good colour match the translucency aspect of the skin and the layered skin structures with different scattering and absorption properties form a problem. When applying CIE recommended colour meters, the result is hampered by edge loss, becoming worse when the measuring area is decreased. The aim of this study is to explore volume reflection measurement, used in biomedical optical diagnosis, at different parts of the body in a cohort of Caucasian people.
Methods & MaterialsA Volume Reflection Meter (VRM) was designed for this study. The backbone of the VRM is a small incident light beam, consequently measuring at three different (concentric) distances from the incident beam. To understand the results, we applied a conversion of spectra towards colour coordinates L*, a* & b* analogue with regular CIE colour information. Spectral data of three different skin areas: forehead, hand palm & lower arm were calculated in CIE L*, a*, b* and statistical analyzed by SPSS.
ResultsThe cohort composed of �8 Caucasian individuals during springtime. The mean age was �0.8 (SD 11.7) with a range of 21 and 62 years. The palm of the hand gives a different volume reflection than the forehead and the cheek. Between facial and forearm areas statistical difference in the a* and b* present differences of absorption. As the light path increases from the incident light, the luminosity decreases and a* and b* values increase.
ConclusionThe VRM gives valuable information regarding the scattering and absorption of the different skin depths and layers and provides basic information regarding colour formulation. The disadvantage of the VRM method is that the resulting spectra, due to the forced relative long light path, differ from visual colour observation. To overcome this problem and to avoid the problems of edge loss, a new dedicated colour and translucency measurement (CTM) will be applied.
Notes
81
PurposeAutologous, allogenic and alloplastic materials for the reconstruction of bone and soft tissue have specific applications in the cranio-maxillofacial area. The research for biomaterials and tissue engineering procedures aims at new synthetic and autologeous materials. The plotting of biomaterial with living cells combines both approaches. We suggest that mesenchymal stem cells (MSCs) are the better source because they are able to proliferate under low oxygen tension and differentiate when the oxygen level rises.
Methods & MaterialsPrinciple of �D-Bioplotting: A sodium alginate – tricalcium phosphate-cell mixture is pressed out of a dispenser using gas pressure into calcium chloride solution. Parallel strands are plotted for each layer. The direction of the strands in each layer can be modified to create complex ‘nets’. The plot medium supports the structure by means of buoyancy. In a clinical trial, �8 maxillary sinuses were augmented with MSCs and Bovine Bone Matrix (BBM) and 16 sinuses with BBM and autologeous bone.
ResultsConstructs were kept under culture conditions for one week. Cells stayed viable inside the biomaterial and showed a similar apoptosis line as cultured cells without biomaterial. In the clinical trial, no patient had signs of infection or lost the transplant. All could be treated with dental implants and supra-structure. Biopsies showed lamellar bone formation after � months. The one-year follow up of so far 1� sinuses revealed no loss of implants.
Conclusion�D-Bioplotting of living cells is feasible. MSCs and BBM are suited for the augmentation of the severely atrophied maxillary bone. A combination of both methods is a future perspective in maxillofacial surgery. Other than in current approaches, where cells cover just the surface of a biomaterial, individualized �D-constructs with viable MSCs inside could be used for the reconstruction of larger defects
L35 Rapid Prototyping and Mesenchymal Stem Cells for the Regeneration of Hard Tissue
Sauerbier ,S.1*, Glaum, R.1, Metzger, M.2, Gutwald, R.1, Schmelzeisen, R.1, Mülhaupt, R.2, Carvalho, C.2
1Department of Oral and Maxillofacial Surgery, University Hospital, Albert Ludwigs Universität, 2Freiburg Materials Research Center, Freiburg, Germany
82
Notes
8�
Poster Abstracts
8�
P01 A Protocol for Skin Colour Matching of Silicone Elastomers for Facial Prostheses at King’s College Hospital (KCH) Using Advance Digital Colouring Technology
Nacher-Garcia, C.*, Coward, T.
Craniofacial Prosthetics Unit, Department of Oral and Maxillofacial Surgery, King’s College London Dental Institute, King’s College Hospital (KCH), London, UK
PurposeThe Craniofacial Prosthetics Unit (KCH) provides a referral prosthetics service for the rehabilitation and management of facial deformity patients. In order to provide quality clinical practice to support treatment plans, guidelines and measure ourselves as healthcare practitioners, we need to practice under protocol procedures. The purpose of this protocol is to assess and validate the Spectromach digital computerised colour matching system which is the result of advanced technology research collaboration between King’s College London and Pure Colour Ltd.; versus traditional standard visual colour matching of facial prostheses.
Methods & MaterialsA clinical case outlining the methodology proposed for this protocol is presented. A comprehensive clinical assessment of the patient is undertaken and a diagnosis of the deformity made. The information is recorded systematically in the computer system patient form.
For the colour matching procedure two methods were selected for this case: a) the Spectromatch, computerised colour matching system; and b) a standard visual colour matching procedure by the Prosthetist Practitioner.
The patients’ skin colour was measured and recorded with a spectrophotometer and data collected of the subject skin was processed following the colour formulation protocol. A pigmented silicone sample was produced from data of the target skin area using the computerised colour formulation. For method b) the Prosthetist Practitioner also matched another silicone elastomer sample by visual observation.
ResultsResults of this preliminary case showed that method a) the Spectromatch system enhanced the predictable colouration of facial prostheses and addresses the issue of metamerism. Method b) human visual observation is not scientifically reproducible and judgement of Practitioner expertise and experience needs to be considered for colouring matching procedure. ConclusionThis protocol has showed that the Spectromatch system is a reproducible method to colour matching skin to silicone elastomers. It presents as a rapid and reliable system once the Prosthetist Practitioner becomes familiar with the technology, thus reducing colouring procedure time. The protocol presented is a useful tool to develop methodologies for evidence-based Healthcare practice, which is a key component of our evolution, a clinical discipline in Maxillofacial Prosthetics and Technology practice. We suggest this to be the base for a pilot study with a larger sample.
P02 Clinician Opinion of a Computer-Defined Color Match in Silicone for Black- African, British & Caribbean People
Seelaus, R.1*, Coward, T. J.�, Donaldson, N.2
1Department of Oral Maxillofacial Surgery, The Craniofacial Centre, University of Illinois Medical Centre, Chicago, USA2Department of Surgery & Biomedical Health Information Sciences, University of Illinois Medical Centre, Chicago, USA�King's College London Dental Institute, London, UK
PurposeMultiple computer-driven systems have been defined for colour matching silicone to human skin. Investigators have reported success using these systems by achieving low Delta E values comparing skin and silicone. However, little has been reported on the clinician’s opinion of these matches. Thus, the relationship between the computer-defined colour match and the clinician-defined colour match is not well understood. Understanding this relationship is critical when adopting technology in the clinic. This study investigates this relationship.
Method & MaterialsForty-nine subjects were colour-matched using spectral data from skin measurements and a computerised colour formulation system. Two silicone samples were produced per subject. Using a five-point scale, three expert colourists from the facial prosthetic field judged the colour match of silicone to skin. A mixed regression analysis was used to compare the computer’s and judges’ match of colour. As a baseline comparison subjects’ skin was measured again on the day of the judges’ assessment.
ResultsPreliminary results are presented. Judges made a total of ��1 assessments. When comparing subjects’ skin with the second silicone sample, all judges rated the silicone as ‘satisfactory/good’ for 16 subjects; 17 subjects received a ‘satisfactory/good’ rating from 2 judges; 10 subjects received ‘satisfactory/good from 1 judge; and 6 subjects received ‘satisfactory/good’ from 0 judges. There was a difference in the baseline skin measurements between initial skin reading and reading at the time of judges’ assessment.
ConclusionPreliminary results reveal positive agreement from judges with use of this colour system. The difference in baseline skin colour measurements may have contributed to non-agreement from judges; further exploration is required to better understand this phenomenon. Overall, Delta E values of silicone samples compared to skin were within reported acceptable ranges of colour systems for this population. Improving our understanding of clinician perception will enable us to more appropriately select technology solutions for clinical use.
Notes
8�
P03 A Reproducible Pigment Dispensing System Applicable in the Production of Facial Prostheses
van Oort, R. P.*, Blokland, L., Borsboom, P.C.F.
Oral Maxillofacial Surgery, Maxillofacial Prosthetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
PurposeTo achieve a good colour match towards facial prostheses, not only the colour but also the aspect of translucency of the skin has to be mimicked. To match both colour and translucency the total doses of pigments has to be limited. For that purpose a reproducible pigment dispenser is needed. We tested and applied an EFD (Engineered Fluid Dispension, Inc., Maastricht, NL) dispenser system, capable of dispensing very small drops of adhesive in a range of viscosities. The EFD system is capable to achieve doses down to 0.1 milligram
Methods & MaterialsAn EFD dispensing system type Performus II, 0-7 Bar, using pistons of �0 ml and a set of dedicated dispenser needles. The pistons were filled with 8 different Factor 2 (USA) colour pastes (pigments dispersed in silicone oil). To achieve acceptable doses per second for every pigment, the dispenser needles were adapted. We applied an air pressure in the range of � - � Bar. It is essential to avoid air bubbles in the piston
ResultsThe reproducibility was tested by weighing � successive doses, applying a total dispensing time of 10 seconds. A second series of new filled pistons / pigments in combination with a second dispenser showed the same result. Next, we produced a series of complete test samples adding a specific recipe of pigments to � gram of Silastic (Factor 2). Visual or measurable colour differences after repeating the same recipe 10 times was investigated. No visual differences appear. From color measurements: differences were within a range of CIElab; E < �, which is too small to observe.
ConclusionReproducible pigment dispensing for pigment pastes is possible. It makes it feasible to apply it in colour formulation systems in order to ease the production of facial prostheses. The pigment-pastes from Factor 2 can be improved with regard to the amount of added silicone oil; we experienced some degradation. When the dispenser system is not used for a period of > � weeks needles have to be re-renewed or replaced by EFD piston stops.
86
P04 New Material and New Method for Reshaping Lost Tissue in Situ
Gehl, G.
Craniofacial Prosthetics, Zentrum Felsenburg, Frauenfeld, Switzerland
P05 The Use of Newly-Developed Monitoring System to Evaluate the Stress of Dental Treatment
Minami, I.*, Nakamura, T., Wadachi, J., Sato, M., Ueno, T., Igarashi, Y.
Removable Prosthodontics, Department of Masticatory Function Rehabilitation, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
PurposeThe aims of this study were to describe and demonstrate the use of an electrodermal response and grasping force (ER-GF) monitoring system based on objective and subjective evaluation system for the psychological stresses during dental treatment.
Methods & Materials20 healthy subjects volunteered to participate in this study after obtaining informed consent. They were recruited from patients registered at Tokyo Medical and Dental University Dental Hospital from 2006 to 2007. The electrodermal response and grasping force were recorded during ordinary dental treatment. This project was approved by the Institutional Review Board for Human Subjects Protection at the Tokyo Medical Dental University.
ResultsRecordings of all 20 subjects were performed using this system without substantial difficulty in the clinical settings. The degree of pain and tension were revealed as a numerical value objectively in most of all subjects by combining with the data of each dental invasion.
ConclusionThis result suggests that ER-GF monitoring system has clinical validity for the evaluation of the psychological stresses, which reflects the degree of pain and tension and that it has high potentials for dental clinical use because of its ease and peculiarity.
PurposeAfter the loss of soft tissue in the surface of the body, generally, the defect is surgically reconstructed with a flap but this is not always possible. Another option for the rehabilitation is the reconstruction with prostheses as a substitute in the colour and shape of the lost contour of the body. However, we developed a new mineralic substance and a method for reshaping the contours of lost body parts in situ. We do not use any growth factors or proteins
Methods & MaterialsWe have developed a new mineralic substance and a method for reshaping the contours of lost body parts in situ. We do not use any growth factors or proteins. Our material is a pure mineralic substance. It is not a drug but it is a medical device. The mineralic substance is applied as a powder in the wound and then the wound is closed by bandage for three or four days. After these days the wound is cleaned again and after debridement and the application of a new portion of the wound healing substance the wound is bandaged again.
ResultsAfter three to six weeks, the cavity of the wound is filled with ingrown juvenile tissue and perfectly covered with skin. Thus we could cure diabetic feet and a necrotic finger. After four pilot cases in which we could cure necrotic tissue to nicely vascularized juvenile soft tissue we developed in a further step shapes and moulds of body parts and facial parts, which are modified facial, and breast prostheses of our standard prosthetics program. These standard shapes for body parts have a thin layer of our wound healing substance on their underside.
ConclusionThe advantage of the new material and method is that we can avoid scars and we see a new use for facial and breast templates for the remodelling of soft tissue in situ. Thus, we reshape lost parts of the body by remodelling the tissue with the help of a mineralic powder, which lets soft tissue grow into the pre-shaped templates, which covers the defect as a wound healing plate.
Notes
87
P06 The Effect of Nerve Reconstruction on Swallowing Function in Head and Neck Surgery
O’Connell, D. A.1, Rieger, J. 2, Mlynarek, M. A. 1, Harris, J. R. 1,2, Seikaly, H. 1,2
1Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada2iRSM, Edmonton, Alberta, Canada
PurposeTo examine the effect on swallowing function of reanastomosis of lingual and hypoglossal nerves divided and reconstructed during head and neck cancer surgery.
Methods & Materials6� patients underwent resection and free tissue reconstruction of oropharyngeal squamous cell carcinoma between April 1999 and July 2006. Post-operative lingual and hypoglossal nerve status was recorded. All patients were scheduled to undergo videofluoroscopic swallowing assessments pre- and 12 months post-operatively. The pharyngeal residue score, aspiration score, and bolus oral transit time was recorded on all patients completing the assessments.
ResultsPatients who underwent reanastomosis of their lingual and hypoglossal nerves had decreased pharyngeal residue scores and decreased bolus oral transit times compared to patients who had these cranial nerves sacrificed, at 12 months post-surgery.
ConclusionReconstruction of lingual and hypoglossal nerves divided or sacrificed during head and neck cancer surgery preserves the efficiency of the oral phase of swallowing. This improves overall post-operative swallowing function and likely enhances patient quality of life.
* Presented by Dr Peter Dziegielewsk on behalf of the authors
88
P08 The Osstell and Periotest: What are these Devices Really Measuring?
Swain, R.*, Faulkner, G., Raboud, D.
Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
P07 Functional Outcomes Measurements Following Treatment of Oral and Oropharyngeal Cancer: A Review of Literature
Seikaly, H.1,2,*, Mlynarek, A.1, Rieger, J.2, O’Connell, D. A.1, Chau, J.1, Al-Qahtani, K.1, Harris, J. R1,2. 1Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada2iRSM, Edmonton, Alberta, Canada
PurposeTo discuss various methods of assessing functional outcomes after various treatments for oral and oropharyngeal carcinoma.
Methods & MaterialsArticles were identified using MEDLINE database search engine. The “methods” sections of relevant articles were then reviewed.
ResultsWe identified 60 articles published in the last seven years (2000-2007) that reported on functional outcomes following treatment for oral, oropharyngeal cancer. 2� studies used quality of life questionnaires and 12 used clinical observations. Swallowing was assessed objectively in 18 studies with video fluoroscopic swallowing studies (VFSS) as the primary method of assessment.
Speech was specifically assessed in only 10 articles, with perceptual analysis used as the primary assessment modality.
ConclusionPreserving good speech and swallowing following treatment for oral and oropharyngeal cancer remains an extremely important aspect of cancer care. Nevertheless, there is a clear lack of uniform methods for assessing functional outcomes. In our opinion a combination of objective and subjective techniques, assessing both speech and swallowing, are necessary in order to gain sufficient information of post treatment function.
PurposeThe purpose of this study was to evaluate and compare measurements between the Osstell (both classic and Mentor system) and Periotest in a controlled laboratory setting utilizing different implant/abutment geometries.
Methods & MaterialsPeriotest and Osstell measurements were completed on a variety of different implants placed into modeling material with a similar modulus of elasticity as bone. Measurements from a Periotest hand-piece were converted to natural frequency by collecting and analyzing the impact signal and comparing results with a measured natural frequency during impact determined by a laser Doppler. For the Classic and Osstell Mentor systems the resonant frequency was determined solely with the use of the laser Doppler. By converting all measurements to resonant frequency a direct comparison between the different devices on the same scale could be completed.
ResultsWhile the Periotest and Osstell devices are essentially measuring the same property (natural/resonant frequency), the resonant frequency values between the devices when measuring the same implant/abutment system varies significantly. Additionally, the changes in the resonant frequency when comparing different implant/abutment systems placed into the same bone modeling material are significantly different for each device.
ConclusionBoth implant/abutment geometry and the measuring devices themselves (Periotest and Osstell systems) significantly affect resonant frequency measurements on implants. While resonant frequency is related to the underlying bone properties, it is not a direct measure of these properties. Until the nature of the relationship between resonant frequency and bone properties is understood measurements of implant “health” from these devices will be extremely difficult to interpret.
Notes
89
P09 Contrasting Aspects of Orbital Floor Fractures in the Setting of Zygomaticomaxillary Complex Injuries versus Isolated Orbital Injury
Marcus, J.R.*, Tahernia, A., Grimes, J., Follmar, K., Mukundan, S., Erdmann, D. E.
Departments of Surgery, Radiology, and Biomedical Engineering, Duke University Medical Center, Durham, North Carolina, USA
PurposeOrbital floor injuries may occur in isolation or in association with zygomaticomaxillary complex (ZMC) fractures. There are intuitive differences in mechanism, morphology and repair technique between orbital floor fractures in these two groups. Herein, management and post-operative outcomes of isolated and ZMC-associated orbital floor reconstruction are contrasted. Volumetric CT measurements of affected orbits are used as a guide in management
Methods & MaterialsThe medical records of all patients with craniomaxillofacial (CMF) injuries (200�-200�) were reviewed. Of �22 total patients, there were �� patients with isolated orbital floor fractures, 1� of whom underwent repair (28%); 6� patients with ZMC fractures, �6 of whom underwent reconstruction (�6%) and 10 of whom underwent orbital floor repair (1�%). Volume measurements of the affected orbits were obtained and compared to the contralateral orbit, which served as controls using Image Segment. From segmented data, polygon (triangle) models were fitted to the segmented structures using a marching cubes algorithm and input to Rhinoceros NURBS modeling software.
ResultsThe decision to proceed with orbital floor exploration was based on clinical and radiographic indications. The radiographic indications for exploration were: �0% area injury for isolated injuries; 10mm compression for ZMC-associated injuries. Pre-treatment, in the ZMC group, there was an average decrease in orbital volume of 18.�%. In the isolated orbital floor group, there was an average increase in orbital volume of 28.� %. There was no difference in the incidence of complications between groups.
ConclusionZMC-associated orbital floor injuries are compressive injuries associated with loss of volume, while isolated injuries result from expansile (hydrolic) force. Radiographic criteria are used to guide orbital floor exploration to avoid late enophthalmos. In ZMC injuries, compression is associated with volume loss. The literature suggests that a 20% change in orbital volume results in perceptible deformity. An estimated 10mm of compression (18.�% volume loss), may therefore be a reasonable operative criterion for exploration
90
P10 Can You Trust Your I-CAT?
Bryant, J. A.*, Drage, N. A., Richmond, S.
Orthodontics, Cardiff University Dental Hospital, Cardiff, Wales, UK
P11 Application of 3-D Photogrammetry for Planning Surgery in Hemifacial Microsomia
Jayaratne, Y. S. N.*, Lo, J., Cheung, L. K.
Discipline of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
PurposeHemifacial microsomia (HFM) is characterized by facial asymmetry resulting from the unilateral congenital deficiency of both hard and soft tissues. The complex three-dimensional (�-D) skeleton of the maxillofacial region coupled with the aesthetic and functional considerations poses significant challenges when planning reconstruction in such patients. We aim to illustrate the applications of �-D photogrammetry for surgical planning, monitoring treatment response and longitudinal assessment of the volumetric changes in HFM.
Methods & MaterialsA case of HFM presented with left facial deficiency and occlusal canting. Bimaxillary osteotomies followed by soft tissue expansion during the first stage and transplantation of a vascularized scapular flap in the second stage were planned. A �-D photogrammetry system (�dMDface) was employed during treatment planning. To calculate facial deficiency, a mirror image of the unaffected side was superimposed on the pre-operative image. Post-surgical volumetric changes were monitored by serial superimposition of �-D images.
ResultsBased on the �-D photogrammetry estimation, a tissue volume of 16 cm� was required to restore facial symmetry. A total of 21 cm� of tissue expansion was achieved within a period of � weeks. A scapular flap measuring 8 cm x � cm was transplanted to augment the facial deficiency. This resulted in good facial symmetry in this patient with HFM.
Conclusion�-D photogrammetry provides the surgeons a non-invasive objective tool for planning surgery in HFM. It facilitates the identification of the extent and degree of tissue deficiency, selection of the tissue expander of appropriate dimensions, monitoring of volumetric changes during tissue expansion and estimation of the tissue volume required from the donor site.
PurposeCone beam computed tomography (CBCT) images obtained with an I-CAT are qualitatively good and spatially accurate, but the accuracy of the CT number can be poor. Accurate CT numbers are required so an accurate assessment can be made of bone density. This may be important prior to implant placement and in the diagnosis of osteoporosis. We will show a simple test that can demonstrate the performance of CBCT units in measuring CT numbers.
Methods & MaterialsAn I-CAT CBCT unit was used in the study using the following scan parameters: 120 keV, � mA and 20s. This equated to a voxel size of 0.� mm�. Scans were performed on a series of water-filled phantoms.
Results Linear correlations were found for both the CT number of water and the noise against the mass in the 0.� mm thick slice being scanned. In the case of the change in the CT number with the mass of water in the slice, it would be possible, from the linear relationship to make a simple correction to bring the values to 0 HU.
ConclusionCorrecting the CT number is important for establishing thresholds for constructing surfaces, calculating volumes, judging bone densities and for the general comparison of data from different studies. A linear relation between the CT number and the mass has been shown that can be used to correct the absolute values.
91
P12 Precision of Surface Scans in Head and Neck Surgery
Krarup, S.1,�,�*, Darvann, T. A.1, Hermann, N. V.1,2, Larsen, P.1, Kreiborg, S.1,2, Vedtofte, P.�, Kofod, T.�, Hillerup, S.�,�
1�D Craniofacial Image Research Laboratory, (School of Dentistry, University of Copenhagen; Copenhagen University Hospital; Informatics and Mathematical Modelling, Technical University of Denmark), Copenhagen, Denmark 2Department of Pediatric Dentistry and Clinical Genetics, School of Dentistry, University of Copenhagen, Copenhagen, Denmark�Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Copenhagen, Copenhagen, Denmark�Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
PurposeQuantification of changes in soft tissue morphology after head and neck surgery may be carried out by use of a �D surface capturing device. The aim of the present work was to assess the precision of such a device and to determine the influence of head posture and facial expression on data acquisition of the head and submental / submandibular regions.
Methods & MaterialsFacial geometry of a volunteer was captured a total of �0 times, on the same day, in a �dMDface system (capture speed 1.6ms). The volunteer was instructed to keep a natural head posture/facial expression. Head posture/facial expression was changed between sessions but returned to a normal state during captures. Average nose, lower face and submental / submandibular surfaces were created after ICP-registration using the forehead, before deviations were calculated at each point across the surface.
ResultsMean deviation for the nose region, the lower face region and the submental/submandibular region was 0.10+/-0.0�mm (1SD), 0.17+/-0,08mm (1SD), and 0.��+/-0.18 (1SD) respectively. Mean SD for the nose region, the lower face region and the submental/submandibular region was 0.08 mm, 0.1� mm and 0.�9 mm respectively. Max SD for the nose region, the lower face region and the submental/submandibular region was 0.�� mm, 0.�2 mm and 0.68 mm respectively.
ConclusionIn general, the nose and lower face regions showed a higher degree of reproducibility with a natural head posture than the submental/submandibular region. All deviations were, however, within acceptable limits in a clinical context. The precision of the method was shown to be adequate for studying soft tissue changes in the head, including the submental/submandibular regions.
Notes
92
P13 Atlas Segmentation of the Human Skull for Computer Assisted Surgery
Metzger, M.*, Schulze, D., Dorner, A., Schmelzeisen, R.,
Department of Craniomaxillofacial Surgery, University Freiburg, Freiburg, Germany
PurposeSegmentation of bony structures is one of the main steps for computer assisted preoperative planning. Thin bony structures of the midface bring out some problems resulting in “pseudo-foramina”, which have to be closed in a time-consuming manual way.
Methods & MaterialsThe fully automatic atlas segmentation allows outlining of bony structures of the skull from a CT-dataset without any user interaction. In a master dataset all anatomical structures were outlined. This master dataset is based on a real anonymous patient from the University of Freiburg where an initial outlining was done.
In a two-step algorithm, the master dataset is fused with the real patient. A rigid fusion tries to overlay the two datasets as well as possible. This technique is also used in the "auto fusion" where different datasets from one patient can be matched. The fusion result is used for a second deformation, which performs an elastic adaptive fusion. The master-dataset is deformed in all three dimensions to get the best possible overlay. As a result, a transformation matrix is generated that allows the projection of every voxel from the master-dataset to the real patient. This transformation matrix is used with the outlined structures and so the structures are transferred to the real patient anatomy.
ConclusionBy using this automatic segmentation procedure time consuming manual segmentation procedures become obsolete and new possibilities of virtual reconstructions are offered.
PurposeOral cancer is the sixth most common malignancy worldwide. The presence or absence of cervical malignant adenopathy is the most important prognostic indicator for patients with squamous cell carcinoma (SCC) of the head and neck, along with tumor site and size. Criteria used in the interpretation of CT and MRI for staging lymph nodes include the size of the lymph nodes, the existence of central necrosis and the presence of indistinct nodal margins. The calculated sensitivity of CT and MRI for detecting lymph node metastases ranges from �6% to 9�%, respectively, whereas the reported specificity ranges from �0% to 98%. Neck dissection with histologic examination is the most reliable staging procedure, providing important prognostic information. 18F-FDG PET is a functional imaging technique that provides information about tissue metabolism and has been successfully applied in head and neck cancer. Currently available data demonstrate for 18F-FDG PET in the detection of cervical lymph node metastases in head and neck cancers ranged from 67% to 96% for sensitivity and from 82% to 100% for specificity.
ResultsPET scanning with the tracer fluorine-18 (F-18) fluorodeoxyglucose (FDG), called FDG-PET. A typical dose of FDG used in an oncological scan is 200-�00 MBq for an adult human, since phosphorylated sugars, due to their ionic charge, cannot exit from the cell. This results in intense radiolabeling of tissues with high glucose uptake, such as the brain, the liver, and most cancers. As a result, FDG-PET can be used for diagnosis, staging, and monitoring treatment of cancers
ConclusionThe present management of head and neck cancer mainly consists of resection of the primary tumor, which may be coupled with neck surgery or subsequent radiotherapy. It is evident from the literature that 18F-FDG PET is very sensitive for detecting primary tumors in the oral cavity. However, 18F-FDG PET does not provide detailed information necessary for surgical planning of primary tumor resection. CT or MRI, by virtue of their better anatomic resolution, remain the ideal for evaluation of primary tumor with reliable T-staging. Nevertheless, 18F-FDG PET appears to be helpful for the identification of primary oral cavity tumors not seen in morphologic imaging modalities, particularly those obscured by dental artifacts.
P14 8F-FDG PET and CT/MRI in Oral Cavity Squamous Cell Carcinoma
Mirzaey, M.*, Tari, M.
Department of Oral & Maxillofacial Radiology, Tehran University of Medical Science, Tehran, Iran
Notes
9�
P15 The Role of Cone Beam CT and 3D Facial Soft Tissue Scanning in the Assessment, Planning and Continued Evaluation of Patients Undergoing Orthognathic Surgery
Mustafa, S. F.*, Lloyd, T. E., Cronin, A. J., Richmond, S., Kau, C. H., Drage, N.
Oral & Maxillofacial Surgery, University Dental Hospital, Cardiff University, Cardiff, UK
PurposeThe use of Cone Beam CT adds a third dimension to conventional radiography allowing more accurate patient assessment and treatment planning. Although this greatly improves our ability to image & digitally manipulate hard tissues, it lacks the ability to map the exact position and relationship of the associated soft tissue structures. The reliability and reproducibility of �D soft tissue morphology measurements using facial scanning systems has previously been validated in the literature. The combined use of these two modalities in the assessment and planning of orthognathic cases is described in this poster.
Methods & MaterialsThe patients are clinically assessed on the combined orthognathic clinic. They then have a preoperative cone beam CT and a �D soft tissue scan. The two scans are then combined & superimposed. Patients subsequently undergo a facial soft tissue scan on day 1 post-operatively, at one week, one month, three months and six months.
ResultsCombining cone beam CT with facial soft tissue scans allows the assessment of existing pre-treatment hard–soft tissue relationship and helps predict the postoperative resultant soft tissue changes based on the digitally simulated hard tissue movements.
ConclusionThe accuracy of preoperative assessment and planning is of great importance in patients undergoing orthognathic surgery. The incorporation of a third dimension to conventional radiographic and photographic methods allows a better appreciation of the shape, quality and relationship of facial hard and soft tissues. This allows more accurate preoperative assessment and treatment planning leading to a more realistic outcome prediction compared with existing conventional methods.
9�
P16 Volumetric and Multi-dimensional Analysis of Oral Cavity and Oropharyngeal Defects: a Cadaveric Study
Seikaly, H.1,2*,, Mlynarek, A.1, Dziegielewski, P.1, O’Connell, D. A.1, Al-Qahtani, K1, Harris, J. R.1,2
1Division of Otolaryngology—Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
2iRSM, Edmonton, Alberta, Canada
PurposeFasciocutaneous free flaps, such as radial forearm and anterolateral thigh, are commonly used to reconstruct oral and oropharyngeal defects. Most reconstructive surgeons design these free flaps by estimating the size of the defect and by using basic geometric shapes (rectangles, squares, ellipses, etc.) but actual defects following tumor extirpation are much more complex. A more detailed and defect-specific reconstruction would likely result in better functional and cosmetic outcomes for the patients. This study is an attempt to gain knowledge of the two- and three-dimensional nature of oral cavity and oropharyngeal defects. A better understanding of the three dimensional structure of the defects following cancer extirpation will aid reconstructive surgeons in their ability to reconstruct them using various free tissue transfer and locoregional tissue transfer techniques. The objective of this study is: 1) to gain knowledge of the two- and three-dimensional nature of oral cavity and oropharyngeal defects following oncological resections. 2) To assess the dimensions and the shapes the fasciocutaneous free flaps and locoregional tissue flaps required for reconstruction of these defects.
Methods & MaterialsThis study involved creating defects in the oral cavity and oropharynx including partial and total glossectomies, floor of mouth excisions, soft palate excisions, lateral pharyngeal excisions and base of tongue excisions in two cadavers. Once these tissues were removed they were measured, and their volume, surface area, and contours (two-dimensional representations of their three-dimensional structures) was recorded.
ResultsThe forms and the dimensions of the resected specimens were all found to be irregular and different for the various anatomic sites.
ConclusionWe propose that the fasciocutaneous free flaps need to be customized and designed specifically for the different defects of the head and neck.
P17 Validity of Digital Panoramic Radiographs for Identifying Risk of Osteoporosis
Slaidina, A.*, Soboleva, U., Rogovska, I., Daukste, I., Zvaigzne, A., Lejnieks, A.
Department of Prosthodontics, Riga Stradins University, Riga, Latvia
PurposeTo determine relation between two different radiological indices of the mandibular cortical layer and the objective measurements of the osteoporosis. Evaluate precision of these radiological indices
Methods & Materials67 women (age �0 to 8�) were included in the study. All patients undergo digital OPG and bone mineral density measurements by dual energy X-ray absorptiometry.OPG were used to determine mental foramen index (MI) and cortical index (C). Measurements were made by � independent observers.
To test differences between proportions, Pearson test was used. Mean differences were evaluated by T-test. Observer’s agreement was assessed by calculation of weighted kappa statistic.
ResultsThere was a statistically significant difference between the groups according MI (p= 0.0001) and C (p< 0.0001). Group of osteoporosis represented reduced cortical bone height (norm- �.68 (SD= 0.8�); osteopenia - �.�� (SD= 0.8�); osteoporosis- 2.�� (SD= 0.91)) and higher percentage of patients with severe destruction of cortical bone (norm-6.67%, osteopenia-20%; osteoporosis-7�.��%). Reproducibility of MI measurements was low. Kappa for C was 7�, 1�% to 79.1% between observers.
ConclusionSpecific changes in cortical bone of the lower jaw can be seen in osteoporotic women. Cortical index can be used to determine the risk of the osteoporosis.
Notes
9�
P18 3D Surface Variation of the Human Face: A Pilot Study
Winder, R. J.1*, Graham, C.1, Darvann, T.2, Wulf, J.�, Ramsay-Baggs, P.�
1Health and Rehabilitation Sciences Research Institute University of Ulster, Newtownabbey, County Antrim, UK2Copenhagen University Hospital, Copenhagen, Denmark�Christian Albrechts University of Kiel, Kiel, Germany�Ulster Hospital, Belfast, County Antrim, UK
Purpose�-D surface imaging is providing reliable data for maxillofacial surgery and subjects may be assessed on a temporal basis to monitor facial development. To maximize the sensitivity of this technique, it is important to minimize any variables, except the one under observation. The purpose of this pilot study was to determine the repeatability of a neutral facial expression and also determine if it was possible to detect any diurnal variations.
Methods & Materials8 subjects had 1� surface images recorded using the Di�D photogrammetry system. Subjects were asked to produce a repeatable neutral expression. Image data was recorded as follows;
1) Repeatability of neutral expression: subjects were imaged 10 times, �0 seconds apart.
2) Diurnal variation: subjects were imaged on � occasions at two hourly intervals.
�D surfaces were spatially registered and the difference calculated between each surface. Color coded surface difference maps were generated.
ResultsVariation in neutral facial expression ranged from undetectable to a maximum of �.0 mm. Three areas of the face showed the greatest variation between sittings; around the eyes and eyebrows, the nose and the edges of the mouth. Only minor variations (< 2.0 mm) were recorded on the forehead, cheeks and chin. There was significant variation in difference maps between subjects.
ConclusionResults indicate that normal healthy volunteers had varying degrees of success in reproducing a neutral expression. The sensitivity of �D surface imaging to monitor facial development is limited by the ability of subjects to reproduce facial expression repeatability did not allow detection of any diurnal variation.
96
P19 Preprosthetic Consultation by Visualizing Facial Prosthesis Using 3D Modeling System
Yoshioka F.*, Ozawa S., Miyamae S., Fukuzawa R., Tanaka Y.
The First Department of Prosthodontics, Aichi-Gakuin University School of Dentistry, Nagoya, Japan
PurposeFacial prostheses is a treatment option to transform the congenital or acquired facial defect. The patient should be given guidance and information about the treatment plan and consent to it. Visualizing the final image of facial prosthesis is often difficult especially for patients who have never worn one before. The purposes of this study are to establish a simulating system for facial prostheses and to present a final image to patients through the computer prior to treatment.
Methods & MaterialsThe patient was a 66-year old male, with his right orbit resected due to cancer ablation and referred for prosthetic treatment. He did not have much knowledge of facial prostheses. A digital facial image was obtained by using a non-contact �D digitizer (Vivid910, Konica-Minolta). A virtual facial prosthesis was designed through the computer using CAD software (Mimics, Materialise) based on the mirror image technique. At the same time, the patient’s photograph was attached to the digital image.
ResultsIt took 0.7s to obtain the digital image using �D digitizer and took approximately �0 minutes to design the prosthesis using Mimics. When the virtual image of the facial prosthesis was shown to the patient, we discussed with the patient about final image and finalized it with some minor modifications. After that, the patient could get motivated for the treatment. The final prosthesis was fabricated by a rapid prototyping technique using the obtained digital data.
ConclusionIn this study, we described how to visualize the final image of a facial prosthesis using the non-contact �D digitizer. A digital image of the patient was easily obtained prior to the treatment without taking CT or any other complicated impression, which improves the patient’s cooperation with the treatment and adaptation after delivery of final prosthesis. This simulation system would be also effective for reconstructive surgical planning or craniofacial implant placement.
P20 Computer-Assisted Treatment of Oral and Maxillofacial Tumors
Barth, E. L.*, Essig, H., Ruecker, M., Tavassol, F., Eckardt, A., Gellrich, N. C.
Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
PurposeSurgical treatment of patients with oral and oropharyngeal cancer needs detailed preoperative planning using CT or MRI to show extension of the tumor, define intended safety resection margins and point out vital structures. Hard tissue reconstruction following tumor resection needs reliable information also to choose correct type and volume of grafts and predict outcomes.
Methods & MaterialsRecent advances in both computer hardware and software technology achieve �D analysis of anatomical position and extension of the neoplasm and virtual planning of surgical procedures. Based on CT or MRI data sets modern navigation systems can be used for preoperative planning, intraoperative navigation and postoperative controlling of resection and reconstruction. Furthermore, computer-based virtual �D simulation methods for surgical procedures that are based on imaging data assist the necessary visual understanding of pathological situations and give the ability to perform 'virtual surgery' preoperatively.
ResultsWe present our experience with computer-assisted treatment in oral and oropharyngeal cancer: Navigation systems offer better anatomical orientation in biopsies of orbital or skull base tumors. Furthermore, preoperatively outlined safety margins can be exactly controlled during tumor resection. Computer-assisted planning and surgery can also be very helpful in primary reconstruction after tumor resection. By mirroring and superimposing the unaffected over the affected side, an ideal virtual template for navigation-controlled reconstruction can be achieved. Furthermore, image-fusion of CT-scans before and after radio-chemotherapy enables a better assessment of changes in tumor volume.
ConclusionComputer-assisted surgery in tumor surgery improves preoperative planning, intraoperative navigation makes radical tumor surgery more reliable by going for the safety margins and saving vital structures, furthermore computer assisted surgery helps leading reconstruction to preplanned results.
Notes
97
P21 Implant Reconstruction of the Jaws with Computer-Guided Implant Navigation
Serafin, T.
Prostho-Implant Services, Dental Art of Stamford LLC, New York, USA
PurposeRehabilitate a partial or fully edentulous patient with implants and a computer �-D software system to place implants and a definitive prosthesis the same day of the surgery
Methods & Materials
The patients comes to the office, a CT scan is taken, evaluated, a surgical stent is fabricated according to the number, position of the implants and type of the prosthesis. So the same day of the surgery patient comes in with no teeth and leaves the office with teeth in function.
Computerized implant dentistry requires a three-stage procedure; first; the patient has a CT scan with a marked prostheses of the area to reconstruct. CT slices have to be with a 0.�-0.� mm reconstruction interval to work properly with the software. The second step is to scan the denture alone in the same orientation as it was during the first scan. With this information, the software adjusts the density of the first scan to make the alveolar bone visible and the shape of the prostheses. Both files are saved and imported into the software (Ex, Nobel Biocare). The resulting image provides a clinical view of the bone in relation to the prototype prostheses. The ideal implant placement is determined, and the software creates a surgical template. The laboratory creates a master cast, articulation, surgical index, bite registration and provisional prosthesis.
At surgery, the surgical template is positioned using a surgical index and secured by means of guided anchor pins. The placement of the implants is carried out flapless, after implant insertion; the provisional or permanent prosthesis is placed.
ResultsThe reconstruction of the jaws with implants and navigation system has been proven to be a highly successful treatment with secure surgery procedure when exact measurements are needed in relation to nerves, nasal fossas, maxillary sinus are in close proximity to the implant site. The navigation system accurately plans and organizes the safe procedures.
ConclusionComputer-guided implant treatment is a new trend in implantology that allows the clinician to render excellent treatment with less time, patient comfort and excellent results
98
P22 Correcting the Depressed Sub-Nasal in Cleft Lip Patient Using Computer-Assisted Navigation System
Toyohiko S.*, Shinobu I., Hiromasa K., Taneaki N.
Department of Oral and Maxillofacial Surgery, University of Keio, Tokyo, Japan
P23 A New, Simple, Non-invasive Surgical Guide for Implant Placement in Oral Cancer Patients
Bodard, A. G.*, Paris, M., Gourmet, R., Salino, S., Fortin, T.
Oral Surgery, University of Lyon Centre Léon Bérard, Lyon, France
PurposeThe treatments of oral cancer patients render many patients unable to wear conventional prostheses and these patients are thus candidates for oral rehabilitation with osseointegrated implants. Anatomical and histological therapy-induced changes decrease their success rate. The use of an image-guided system for oral implant placement based on a custom template is now used for healthy patients but not yet generalized for oral cancer patients. It might reduce the risk of implant placement in irradiated bone.
Methods & MaterialsFirst, we develop a positioning system for the surgical template for edentulous mandible, non-invasive, repeatable, stable on the oral mucosa, in adequacy with the asepsis of the operating block and comfortable for the patient. This system is constituted of an X-cube and an extra-oral support, which is a facial thermoplastic mask, coupled with the CadImplant® system. The link between the mask and the template is the cube.
ResultsA direct evaluation of the reproducibility of the repositioning system is performed on � anatomic pieces. The translation error is 0.1� +/- 0.12 mm and the rotation error is 1.29+/-1.17 degrees. A clinical study with a pre and post-operative CT-scan for the evaluation of accuracy is currently done. Preliminary results seem to confirm the simple use of the system and an acceptable accuracy.
ConclusionThe expected outcomes are to reduce the invasiveness of implant placement in oral cancer patients. This technique should promote the use of a flapless surgery, thus making oral implant placement less risky for this population. It should also increase the amount of oral cancer patients treated with oral implants.
PurposeIt is one of the most challenging procedures in oral and maxillofacial surgery to correct facial asymmetry, especially in adult cleft lip and palate patients. The aim of this study is to show the surgery to correct facial asymmetry using a computer-assisted navigation system, and evaluate it.
Methods & MaterialsA �2-year-old female patient, who had not been treated for unilateral alveolar cleft, underwent surgery to correct facial asymmetry. Surgical procedure involved particulate iliac bone grafted into the alveolar cleft, after that block iliac bone was grafted on the piriform area with the help of the computer-assisted navigation system.
ResultsThe surgical procedure was performed without postoperative complication. Clinical outcome was satisfactory in this case. It was easy to correct facial asymmetry using the computer-assisted navigation system.
ConclusionThe computer-assisted navigation system is very useful in corrective facial asymmetry surgery.
Notes
99
P24 Free Tissue Transfer Flap Reconstruction of Parotidectomy Defects: A Paired Outcomes Analysis Using Three Dimensional Laser Surface Scans
Cote, D.1*, Rieger, J.2, Mlynarek, M. A.1, Harris, J. R.1,2, Seikaly, H.1,2
1Division of Otolaryngology—Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada2iRSM, Edmonton, Alberta, Canada
PurposeTo utilize objective three-dimensional surface laser scanning and subjective questionnaire data to evaluate post-parotidectomy reconstruction with de-epithelialized free tissue transfer flaps.
Methods & MaterialsA series of patients at the University of Alberta Hospital who required parotidectomy underwent simultaneous reconstruction of the resulting contour deformity employing radial forearm and anterolateral thigh de-epithelialized free tissue transfer flaps.
These patients were matched to a series of patients who underwent parotidectomy without contour reconstruction. Both series of patients underwent volumetric analysis using three-dimensional surface laser scanner at the Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit to objectively evaluate volumetric asymmetry. Patients also completed a comprehensive survey to assess post-operative function, complications, and perceptions of cosmetic outcome.
ResultsPreliminary analysis of the volumetric data suggests a significant objective benefit in symmetry among patients who underwent free flap reconstruction. Additionally, reconstructed patients tended to have better functional and subjective cosmetic outcomes.
ConclusionParotidectomy patients who underwent free tissue transfer flap reconstruction tended to have better contour and functional outcomes. Objective volumetric analysis using laser surface reconstruction has a strong correlation with patients' own subjective perceptions of postoperative cosmesis.
100
P25 Transferring Digital Planning Imaging into the Operating Theatre
Evans, P. L.*1, Bocca, A.1, Grimstead, I.1, Hodder, S.1, Key, S.1, Avis, N.2
Maxillofacial Unit, Morriston Hospital, Swansea, UKSchool of Computer Science, University of Cardiff, Cardiff, UK
P26 Combined Computer Guided, Flapless Surgery and Bone-Split Procedures in the Narrow Maxilla: A Case Report
Katsoulis, J.*, Mericske-Stern, R.
Department of Prosthodontics, University of Bern, Bern, Switzerland
PurposeTo perform implant-prosthodontic treatment for an elderly patient with an edentulous maxilla, insufficient facial support and an increased nasio-labial angle. The aim was to apply computer-assisted virtual implant planning and template-guided flapless surgical procedure. The general health status revealed no contraindications for implant therapy. The final treatment goal was a fixed prosthesis supported by 6 implants.
Methods & MaterialsThe denture of the patient was checked intraorally and directly used for virtual �D implant planning based on CT’s (NobelGuide™). The radiographic assessment revealed a maxillary ridge of reduced height (10-12 mm) and extremely narrow width (�-6 mm). The optimum implant location was identified with regard to the jawbone and prosthetic tooth configuration. Due to reduced width of the jaw, a template-guided flapless surgery had to be combined with conventional surgical techniques. A stereolithographic template was produced by means of the electronic planning data.
ResultsPilot drilling was carried out template-guided by a flapless procedure, in order to obtain the planned implant position. Then a half-thickness flap was raised and the implants were placed in determined positions, using spreading technique with piezosurgery and bone graft material. A submerged healing phase of six months was maintained. All implants healed uneventfully and after reentry surgery, they were found to be located in proper position. The prosthodontic treatment with a fixed CAD-CAM implant bridge followed the state of the art and fulfilled the patient's demands.
ConclusionThis case report shows some limitations in the application of a flapless, computer-guided procedure. However, by means of CT-based virtual planning, the best prospective implant position in the maxilla is determined and additional surgical measures (GBR, sinus floor elevation) are easily identified. This results in optimized better predictability of implant placement and clinical outcome. Thus, a combined template-guided flapless procedure with a conventional surgical technique should more often be suggested.
PurposeThe Maxillofacial Unit at Morriston has adopted advanced digital technologies for the planning and stent design for Maxillofacial Surgery cases. Despite software such as Mimics, Simplant (Materialise, Belgium NV) and Freeform (SensAble US) enabling the operator to work digitally within 2D and �D environments, the transfer to the operating theatre environment is considerably more basic and the surgeon must rely on A� colour print outs of the plan attached to the wall. This takes away the advantages of working in �D, as the surgeon is limited to the single views that have been previously chosen. The presentation describes the various cost effective and practical methods trialed to enable the surgeon to best visualize and manipulate the �D data during surgery.
Methods & MaterialsThe trials involve the use of laptop computers, LCD projectors, wireless and remote technologies and experimenting with various methods of remote manipulation including �D mice and joysticks all within a sterile environment. Solutions are flexible to allow different setups to suit different operators and cope with the ever changing physical and lighting environment of the operating theatre.
ConclusionThe authors present their ideal solutions along with costing and predictions for future technologies that will aid the surgeon with visualization and orientation during the surgical procedure
Notes
101
P27 A Comparison Study: ‘Proposed Digital Position’ of Auricular Implant Retained Prostheses Using Computer Aided Design Versus the ‘Final Position’ of Fitted Prostheses.
Regunathan, A., Karimi-Boushehri, F.*, Grosvenor, A., King, B.
Caritas Health Group/Capital Health/University of AlbertaMedical Modeling Research Laboratory, iRSM, Edmonton, Alberta, Canada
PurposeNumerous papers have been published that document the combination CAD technologies with traditional maxillofacial prosthetic laboratory and clinical techniques in creating facial prostheses. Existing literature illustrates that using this approach reduces time and inconvenience to the patient. A scenario was proposed utilizing a fully automated approach, whereby the prosthesis was created entirely using CAD and rapid prototyping/manufacture technologies, thus requiring minimal clinical contact to ‘fit’ the final prosthesis. We compare the proposed ‘digital position’ of auricular prostheses, with the ‘final position’ following clinical adjustment and processing of the wax prototype of the ‘digital positioned’ ear. We will establish if significant clinical changes occurred during verification, which would render a fully automated approach ineffective.
Methods & MaterialsThree-dimensional (�-D) scans were obtained of patients requiring a single side auricular prosthesis with the gold bar and substructure in situ. These scans were imported into a haptic-based CAD software (FreeForm, SensAble Technologies Inc., 1� Constitution Way Woburn, MA, USA). The non-treatment side was copied, mirrored and positioned by the clinician to create an acceptable symmetrical appearance. This data was saved as a baseline to compare post treatment scans. A Boolean operation was completed to create a fitting surface and the resultant data was transmitted to a Multijet Modeling (MJM) rapid prototype device (ThermoJet Solid Object Builder, �D Systems, Valencia, CA, USA) to create a wax prototype. Following clinical verification/adjustment of the wax prototype, moulds were created of the wax prostheses. Silicone was cast into the moulds and was polymerized using manufacturers’ recommendations. The final prostheses were all fitted using conventional clinical maxillofacial methods.
�-D scans of each patient were taken with the completed prosthesis in situ. These newly acquired data sets were then aligned over the previously saved ‘digitally positioned’ scan data for each patient in an attempt to compare the proposed 'digital' and 'final' auricular positions. (Magics® 11.1, Materialise, Ann Arbor, MI, USA).
ResultsResults of these findings will be presented.
102
P28 Maxillofacial Surgery Simulation from 3D CT Images
Marchetti, C.*, Bianchi, A., Bassani, L.
Oral and Maxillofacial Surgery Unit, University of Bologna, Bologna, Italy
PurposeThe modelling of the visco-elastic behaviour of soft tissue is central to accurately predicting surgical results. Our model began with segmentation of the CT volume in � different types of tissues: bones, soft tissues and embedding materials. Each region was modelled with a different equation to obtain a “simulation algorithm” to predict soft tissues behaviour.
The project aim is to analyze Simplant CMF® software (Materialise, Belgium) for planning the aesthetic impact of accepted osteotomies used to correct dentoskeletal malocclusions.
Materials & MethodsMulti-slice images were obtained preoperatively using a CT unit (16 slices LightSpeed; G E Healthcare, WI,US) in helical mode. The Frankfort Plane of the patient was vertical to the horizontal plane of the CT.
Simplant CMF®s' semiautomatic tools were used to process 2D CT to obtain �-D volumes necessary for simulation. The hard and soft tissues were segmented with suitable thresholding levels to create a hard and soft tissue �-D virtual model.
Osteotomy lines can be traced onto the �-D CT and any anatomical region can be moved and relocated. The bone segment movements are quantified in terms of translational and rotational parameters (millimeters and degrees). The surgeon can check the new occlusion and skeletal balance, and ultimately, any bone interference or asymmetry in the new bone position. After the surgical planning, a hypothesis for the new bone geometry is put forward.
Simplant CMF® computes the soft tissue deformation caused by the new bone geometry using a validated physically based simulation kernel. The patient’s new facial appearance can be visualized. The reliability and repeatability of the simulation will be tested using a suitable validation procedure developed by Materialise engineers in accordance with surgeons.
Results10 patients had been previously studied with a �D CT scan before and 6 months after the surgical correction. Before surgery hard and soft tissues orthognathic surgery simulation �D CT images had been performed and now is possible to observe the post-operative surgical outcome.
Conclusion�DCT surgery simulation is feasible which could allow the surgeon to simulate the hard and soft tissues outcome of orthognathic procedures. 10 new patients had been studied using a �D Cone Beam (CBCT) machine in order to decrease the dangerous exposure to radiation. The simulations and the real surgery had already been performed and we are waiting to reach 6 months postoperatively to validate the algorithm.
P29 Correction of Postankylotic Deformity through Distraction Osteogenesis
Mehrotra, D.*, Pradhan, R., Sugar, A. W., Evans, P.,
Oral & Maxillofacial Surgery, CSMMU (King George's Medical University) Lucknow, Uttar Pradesh, India
PurposeTemporomandibular ankylosis is a frequently seen problem in Indian children causing restricted mouth opening and gross facial deformity. Inter-positional arthroplasty provides excellent postoperative mouth opening but correction of facial deformity needs special attention. Distraction Osteogenesis has been used successfully for lengthening of human mandible in cases of hemifacial microsomia. Computerized fabrication of guiding splint can help to accurately position the distractors intra-operatively. The aim of this study was to assess the accuracy of such splint, its feasibility, ease of surgery it offered and compare the results with cases where no such splint was used.
Methods & MaterialsChildren in the age range of �-1� years with unilateral temporomandibular ankylosis and facial asymmetry visiting the department of Oral & Maxillofacial Surgery, CSMMU were included in this study. These patients were randomly divided into two groups. In Group 1, the CT scan images were sent to Maxillofacial Unit, Morriston Hospital for computerized fabrication of guiding splint and the distractors were placed with the help of these splints. In Group 2 no such splint were used intraoperatively for placement of distractors.
ResultsResults were compared in both the groups in terms of correction of deformity, operating time, wound healing and complications.
ConclusionDistraction Osteogenesis when achieved with use of computerized guiding splint provided excellent postoperative results with correction of postankylotic facial deformities
Notes
10�
P31 3D Simulation of Soft Tissue in Preoperative Planning for Computer Assisted Surgery
Metzger, M.*, Gissler, M., Schulze, D., Schwarz, U., Schmelzeisen, R., Teschner, M.
Department of Craniomaxillofacial Surgery, University Freiburg, Freiburg, Germany
PurposeOne of the most important steps in computer-aided surgery (CAS) should be seen in the process of virtual preoperative planning. Up to now, planning in CMF surgery is mainly based on hard tissue, disregarding soft tissue behaviors. The proposed research project aimed at the development and implementation of algorithms that enable the preoperative planning and simulation regarding soft tissue in the context of mid face reconstruction and orthognathic surgery. Algorithms were developed that transform complex tomographic data sets into tetrahedral meshes of reduced geometric complexity. Hard- and soft-tissue models were created which particularly consider the dynamic interaction of tissue with surgical instruments, implants and/or repositions of bony fragments. In this context, we investigated efficient collision handling approaches that consider the sliding contact between tissue and surgical tools and among anatomical structures. By integrating this technology into the preoperative planning process, updating of the common possibilities of preoperative planning can be increased.
10�
P31 Applying Virtual Orthognathic Surgery: Lesson Learned And Challenges That Remain Oral Presentation
Morris, D.E.1*, Zhao, L.2, Patel, P.K.2
1The Craniofacial Center, University of Illinois Medical Center, Chicago, Illinois, USA 2Shriners Hospitals for Children at Chicago, Plastic and Craniofacial Surgery, Chicago, Illinois, USA,
P32 Indigenous Technologies in Redefining Distraction for Mandibular Reconstruction in India
Neelakandan, R. S.*
Oral & Maxillofacial Surgery Unit, Meenakshi Ammal Dental College & Hospital, Meenakshi University, Chennai (Tamil Nadu) 600 09� India
PurposeTransport Distraction for Mandibular reconstruction though still in its infancy, is becoming increasingly popular. However, the prohibitive costs involved and the lack of technical expertise make its application limited in developing countries. This presentation highlights the experience the author has had in the reconstruction of various Mandibular continuity defects with different indigenously designed distraction devices.
ResultsTransport Distraction osteogenesis was performed on patients. Each type of continuity defect was distracted using a different design of distraction device. The various problems and hurdles that we encountered were analyzed and solutions were arrived at. Based on the various findings a protocol for the various devices used was formulated.
ConclusionThe distraction devices that we designed using the materials and technology available to us proved to be very effective for Mandibular reconstruction. The protocol we arrived at for the use of the different devices will certainly act as a guide to understanding the demands of each individual situation involving a Mandibular continuity defect.
PurposeThe ability to use computer-based, virtual planning for orthognathic surgery allows the surgeon to simulate different surgical approaches for a given case, to predict postoperative aesthetic outcome and dental occlusion to minimize intraoperative errors in osteotomy design and in positioning of the osteotomized segment(s). As such, software-based orthognathic simulation has been attempted to varying degrees.
Methods & MaterialsFor each of 22 patients undergoing orthognathic surgery, a CT scan of the facial bones was obtained and DICOM data imported into SIMPLANT Pro/CMF software (Materialise, Belgium). Following segmentation, virtual osteotomy cuts are made and osteotomized segments positioned so as to achieve desired goals in postoperative occlusion and in facial skeletal harmony. Intraoperative splints were made based on the planned movements. In parallel, conventional model surgery was performed.
ResultsHere we report our techniques used in performing virtual surgery and transferring these plans to the operating room. We demonstrate our approach in cases of facial asymmetry and both single and double jaw procedures.
ConclusionVirtual surgery offers the possibilities of more accurate planning of orthognathic procedures, and a simpler way of considering multiple surgical approaches to achieve a result. However, the practical translation of pre-surgical planning to the operating theater on a routine basis remains to be solved. Our paper presents challenges that we have encountered how we have solved some of these and those that remain.
Notes
10�
P33 An Integrated System for Three-Dimensional Data Utilization in Maxillectomy Model Applications: Three-Dimensional Scanning, Solid Modeling and Finite Element Analysis
Miyamoto, S., Ujigawa, K.*, Kizu, Y., Ozawa, Y., Tonogi, M., Yamane, G-Y.
Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, Chiba, Japan
PurposeMaxillectomy for maxillary cancer causes postoperative problems such as communication among the oral cavity, nasal cavity and maxillary sinus and defects of the maxillary alveolar crest and teeth and markedly impairs masticatory function. Few biomechanical studies have examined craniofacial bone and maxillary prostheses. The present study attempted to analyze the influence of loading through generation of three-dimensional finite element studies of the craniofacial region after the maxillectomy structures derived from DICOM imaging date.
Methods & MaterialsA three-dimensional finite element solid model of the skull was constructed based on DICOM imaging data after the right partial maxillectomy due to cancer of a 6�-year-old Japanese; maxillary edentulous man was arbitrarily chosen. Image-processing software; Mimics® was used to generate three-dimensional outer shapes of the Craniofacial and alveolar bone. The output data were transferred to three-dimensional computer-aided design software for finite element solid model conversion.
ResultsBased on maxillectomy DICOM imaging date, the system allowed visual confirmation and analysis of stress distribution, as well as convenient and simple construction of a digital biomechanical model of the model that provided details of anatomical structures in the regions of interest, such as the maxillary sinus and craniofacial bone. Subsequently, a finite element application (COSMOS/Works®) was used to generate a finite element mesh. This was loaded by simulating the bite force generated through masseter muscle action.
ConclusionIt was possible not only to confirm visually and to analys stresses, but also to construct finite element solid model simply and accurately to recreate the anatomical intricacies of the craniofacial region based on DICOM data. This system could be allowed visual confirmation and analysis of stress distribution as well as convenient and simple construction of solid models that provided detail of the anatomical structures of the region of interest.
106
P35 Three-Dimensional Surface Reconstruction in the Management of Impacted Maxillary Canines using Minimum Invasion Surgery
Veyre-Goulet, S.*, Salino, S., Coudert, J. L.
Department of Oral Surgery, University of Lyon, Lyon, France
PurposeThe aim of the present study was to refine a computer-assisted surgical method enabling: - Precise location of the anatomical site and its relationship with the maxillary impacted canine - Transposition of the exact surgical approach from the virtual computer image to the actual surgical location - An approach to the impacted canine in the palatine position by the labial access to cement the orthodontic bracket to the vestibular surface of the impacted tooth.
Methods & MaterialsThis study is based on 290 patients with �72 maxillary impacted canines. For each of the patients a CT-scan was performed enabling the �D surface rendering to be processed. The localization of the impacted canine was visualized precisely, a surgical corridor was showen and the distances transposed to reality to determine the labial or palatine surgical access.
ResultsOf the �72 maxillary impacted canines, 176 were situated in the vestibular or intermediate position and 196 were situated in the palatal position. Of the 196 impacted canines in the palatine position, 1�� were approached by the labial access and �2 were approached using a "palatine disk".
ConclusionThree-dimensional surface reconstruction with simulation of the surgical operation and transposition of virtual measurements to actual reality allows minimum invasion surgery to be undertaken and provides the orthodontist with the means to more rapidly position the tooth into the maxillary arch.
PurposeTo present a simple technique fusing traditional and contemporary �D technologies to deliver accurate planning and delivery of cleft distraction osteotomy surgery.
Methods & MaterialsA �D planning and stent manufacture technique is presented. The process uses readily available techniques and technologies to produce surgical cutting guides and stents for placement of maxillary distractors. The stents, guides and carriers facilitate easier and very accurate placement of distractors to achieve good vector control.
ResultsSeven cases have been treated in our unit using this technique. The results have been pleasing to patients and surgeons. An average of 16mm of forward movement was achieved in this patient group with a follow up period of between 6 and 1� months. The technique is established as part of the protocol for management of this kind of case.
ConclusionThe technique offers a cost effective solution to the challenge of achieving accuracy in placement of maxillary distractors in cleft patients.
P34 Surgical Guides for Cleft Distraction Osteotomy: A Simple Technique to Assist Surgery
Sharp, I., Jeynes, P., Dimond, J.*
West Midlands Cleft Lip & Palate Team, University Hospital Birmingham, Birmingham, UK
Notes
107
P36 Three-Dimensional Finite Elemental Analysis of Craniofacial Bone after Hemimaxillectomy and Planning Designs of Maxillary Prostheses with Zygomatic Implants
Ozawa, Y.*, Miyamoto, S., Ujigawa, K., Kizu, Y., Tonogi, M., Yamane, G-Y.
Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, Chiba, Japan
PurposeDental implants have been used to establish retention and support for a maxillary obturator after maxillectomy. However stress, such as increasing occlusal force, is strong. In addition, there are not dynamic examinations of stress for the implants, which are support source. With a three-dimensional finite element method, we performed examination of biodynamics for the craniofacial bone after hemimaxillectomy and the maxillary prostheses with zygomatic implants.
Methods & MaterialsMaxillary prosthesis model with different numbers of implants were prepared for the right maxillary defect. One or two implants were placed in the affected-side zygoma, from one to three implants were placed in the left alveolar bone. Maxillary prostheses with these designs were compared and analyzed. These models were coincident relations and were read into a finite elemental program (COSMOS/Works®) for mesh generation.
ResultsTwo implants placed in the affected-side zygomatic bone is better than one implant, where stress can be dispersed to the implant-abutments and craniofacial bone. Three implants or two implants which did not use the cantilever to be placed in the unaffected-side alveolar bone, stress concentrates around implants were not potentially damaging osseointegration.
ConclusionBy placing zygomatic implants, stress in the unaffected-side alveolar bone can be dispersed to the affected-side zygoma Maxillofacial bones, prognosis is better for maxillary prostheses with zygomatic implants. Based on CT-DICOM data, the system allowed visual confirmation and analysis of stress distribution as well as convenient and simple construction of solid models that provided detail of the anatomical structures of the region of interest. The system can plan the designs of maxillary prostheses.
108
P37 Surgical-Prosthetic Rehabilitation of a Large Mid-Face Defect
Brom, J.
Epithetics, Brom Epithetik, Heidelberg, Germany
PurposeThe most important condition for good patient-rehabilitation is a well functioning and acceptable retention of the prosthesis — a bone retained prosthesis on implants and magnets. Cases with low offering bone and/or chemotherapy of the bone may be best implanted by osseointegrated miniplates.
Methods & MaterialsThe silicone prosthesis is attached by medicon-miniplates on Magnacap-magnets. The big white eyebrows are made by hairs from the buffalo and mountain goat.
ResultsThe patient received the best possible treatment, due to careful planning of the surgeon and the anaplastologist.
ConclusionThis case shows that difficult situations can be treated fast and well and for this, the patient will have an excellent rehabilitation. The right implant system in each individual situation (whether implants or plates) and the teamwork in planning will obtain the best success.
P38 Using Interactive Flash Multimedia for Medical Education of Osseointegration Procedures in Facial Prosthetic Treatment
Klein, J.*, Seelaus, R.
Biomedical Visualization, Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
PurposeThe aim of this project is to introduce interactive elements into educational material for medical professionals. The intent of this multimedia program is to educate members of the treatment team in procedures for osseointegrated implant retained facial prostheses including pre-surgical planning, instrumentation and implant components. The goal of this project is to provide users several learning pathway options to suit their ideal learning style and preferences.
Methods & MaterialsAdobe Flash was used to create a collective resource of information with interactive access and navigation. Existing educational material, including websites, print media and DVD video were adapted to this new media. Simple vector graphics were used to illustrate or animate steps. Photographs, video and audio were included to give the user the ability to interact with the material by viewing movies, exploring tutorials, answering quizzes and engaging with a more stimulating multimedia experience.
ResultsThe program will enable users to navigate though the material in any chosen nonlinear pathway, providing improved control over selecting areas of importance and exploring required levels of detail. Clinicians involved at different levels of patient care can explore all areas of this topic. Multiple pathways of interaction will likely appeal to a wider range of learning styles and have potential to reach larger audiences within the medical community.
ConclusionThis Flash-based multimedia program provides medical professionals a resource for improving their understanding of osseointegrated implant procedures. The potential to expand the education of the clinician may contribute to enhanced interaction with patients who are considering this course of treatment.
Notes
109
P39 Development of an Impact Test for Oral Implants with Fixed Prostheses Raboud, D.1*, Mo, A.1, Swain, R.1,2, Faulkner, G.1, Wolfaardt, J.2
1Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada 2iRSM, Edmonton, Alberta, Canada
PurposeThe stability of the bone-implant interface is critical for the success of percutaneous implants both in terms of long-term survival as well as in deciding when it is appropriate to begin loading the implants. The ability to monitor these interface properties is therefore an ongoing clinical concern. Mechanical methods have been developed to perform these evaluations, but these suffer from issues of reliability and accuracy. One such device, the Periotest, has recently been studied and methods have been suggested to aid in the interpretation of the measurement signal to provide direct quantitative information about the bone-implant interface properties.
This work was performed primarily with BAHA implants and needs to be extended to include oral implants as well as deal with fixed prosthesis. The purpose of this study was to develop an understanding of the Periotest impact test when used with oral implants with fixed prosthesis
Methods & MaterialsIn vitro measurements were also completed on Branemark and Nobel Biocare ReplaceSelect implants placed into modeling material with similar mechanical properties to bone. These tests were conducted with both standard abutments as well as with fixed prosthesis. In parallel, an analytical model of the impact event was developed to aid in understanding the output signal. Finally, In vivo Periotest measurements were also taken on patients with intraoral ReplaceSelect implants for comparison.
ResultsThe developed analytical model was able to simulate the impact event reasonably well. The procedure can be used to quantify the bone-implant interface properties. The in vivo measurements in some cases showed significantly different signal characteristics from the in-vitro situation. This may be due to incomplete or non-uniform support along the implant and highlights the importance of a correct interpretation of the measurement signal.
ConclusionA mechanical test, based on the Periotest hand piece that was previously developed for BAHA implants has been shown to be applicable to oral implant situation, with both abutments and fixed prostheses. The test is able to quantify mechanical properties of the bone-implant interface.
110
P40 Immediate Loading Implant Therapy Using the Computer Guided System
Yasuhiro, K.
Yokohama Oral Implant Center - Kizu Dental Clinic, Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, Yokohama, Japan
PurposeIn a conventional implant treatment, there are some problems that do not permit the wearing of a temporary denture after surgery, there is healing period of �-6 months between implant placement and loading. The use of CT scans and surgical planning software to produce a CAD/CAM surgical template with a restoration fabricated prior to implant placement for immediate loading can make implant placement more predictable, safer and easier for patients.
Methods & MaterialsThis report is that a computer-guided surgical technique for the single, partial and fully edentulous patient, with a restoration fabricated prior to implant placement, for immediate loading using NobelGuide (Nobel Biocare) concept in Japanese patients. We analyzed a cumulative success rate of 1� patients (7� Branemark implants) with this therapy for 6-2� months after loading.
Results� implants were lost after loading. Cumulative success rate was 96% for 6-2� months after loading. These failed implants were in the same patient. Parafunctional oral motor behavior (bruxing and clenching) during sleep was in this patient.
ConclusionThe computer guided surgical technique, minimally invasive surgery is performed without a flap and the prosthesis is delivered, achieving immediate functional loading to the implants. The surgical time required is typically shorter than conventional implant surgery. Postoperative symptoms such as pain, swelling, and inflammation are dramatically reduced. It indicates that this technique is a very reliable treatment option for single, partial and fully edentulous patients without having parafunctional oral motor behavior.
P41 Direct Fabrication of Custom-Fitting Stainless Steel Surgical Guides
Bibb, R.*, Bocca, A., Eggbeer, D., Evans, P., Sugar, A. W.
Centre for Applied Reconstructive Technologies in Surgery (CARTIS), a collaboration between the National Centre for Product Design & Development Research, University of Wales Institute Cardiff, Cardiff, UK and the Maxillofacial Unit of Morriston Hospital, Swansea, UK
PurposeOver the past few years, the Centre for Applied Reconstructive Technologies in Surgery (CARTIS) has been investigating the application of advanced �D surgical planning using FreeForm �D CAD software and transferring these plans into surgery through the direct manufacture of custom-fitting stainless steel surgical guides. This paper presents the results of a number of maxillofacial cases that have utilized these methods.
Methods & MaterialsSeveral cases have been undertaken including mandibular and Le Fort 1 osteotomies for distraction osteogensis and extra-oral osseointegrated implant placement. Cases were planned using SensAble FreeForm �D CAD using �D CT data. Various types of surgical guides were designed in FreeForm to transfer the surgical plans effectively into surgery. The guides were manufactured directly from the CAD data in �16L Stainless Steel using an MCP Selective Laser Melting machine.
ResultsTen cases have been undertaken, including three osteotomies and seven extra-oral implant cases. The results in each case were successful in transferring the surgical plan to the operation. However, many technical difficulties have been encountered and the paper will present these and how they are being addressed through ongoing research.
ConclusionsSelective Laser Melting has been used to produce surgical guides that have successfully transferred surgical plans from the computer screen into surgery. The procedures and designs used have attempted to address the technical difficulties encountered and successful design principles and future work will be presented.
Notes
111
PurposeThe objective is to provide a detailed presentation of the use of CAD/CAM guidance in severely resorbed posterior maxilla as a new option to place an implant on a very limited amount of bone to avoid sinus graft
Methods & MaterialsBased on CT- axial images, implant positions are planned on imaging software. A surgical template is fabricated and drilled with a numerically controlled machine. To avoid sinus graft implants can be planned in the anterior or posterior wall and in the septa of the sinus and in the palatal curvature. Recipient site preparation is done transgingivally with drill or with dedicated bone spreader to increase the amount of bone when necessary.
Results1� resorbed posterior maxillae were treated. In all cases, implants were placed as planned. 17 implants were planned tilted with an angle ranging from 20 to ��°. 7 implants were placed in the palatal curvature, 11 implants were closed to the anterior wall. Only 1 implant was placed closed to the posterior wall and 2 were placed in septa. During the four-year observation period no complications were recorded.
ConclusionThe use of image-guided system associated with bone spreading for oral implant placement in the atrophic posterior maxilla should be an alternative therapy to sinus graft. This minimally invasive procedure should be requested by the patient because it decreases pain and treatment duration by eliminating the graft-healing period and improves surgical results.
P42 Placement of Posterior Maxillary Implants Using CAD/CAM Guidance to Avoid Sinus Grafting
Bodard, A. G.*, Paris, M., Bouchet, H., Fortin, T.
Oral Surgery, University Claude Bernard, Lyon, France
112
P43 Pectus Excavatum: Construction of a Silicone Implant Utilizing MRI/CT Data Acquisition and Three-Dimensional (3D) Digital Technology – A Technique Report.
Grosvenor, A., King, B.*, Edwards, D., Wilkes, G., Olsen, J.
Caritas Health Group/Capital Health/University of Alberta, Medical Modeling Research Laboratory, iRSM, Edmonton, Alberta, Canada
PurposeTraditional methods of creating a silicone implant to correct Pectus Excavatum defects often require moulages of the chest wall to be taken. The impression process is inconvenient to the patient and provides technical challenges when recreating the underlying bony and muscle contour. This is particularly the case in female patients when the defect site extends below the breast tissue. The technique described here defines how a silicone implant was created utilizing Magnetic Resonance Imaging/Computed Tomography (MRI/CT) data, Computer Assisted Design (CAD) and Rapid Prototype (RP) technology to treat Pectus Excavatum.
Methods & MaterialsMRI/CT data of the chest was imported into CAD software (Mimics® 9.11, Materialise, Ann Arbor, MI, USA). The digital data was edited by removing the dermal layer, which established an accurate underlying muscle base for the implant. The data was further manipulated in a secondary CAD program that utilizes a haptic device (FreeForm, SensAble Technologies Inc., 1� Constitution Way Woburn, MA, USA) to create the shape and contour of the implant and achieve a symmetrical appearance. The resultant �D data set was transmitted to a Multijet Modeling (MJM) rapid prototype device (ThermoJet Solid Object Builder, �D Systems, Valencia, CA, USA). After the prototype was built, the support structures were removed. The wax polymer prototype implant was converted into a medical grade silicone elastomer implant (Mentor, 201 Mentor Drive, Santa Barbara, CA, USA) through a commercial lost wax technique. The implant was then sterilized using a low temperature ‘Sterad’ process.
ResultsThe silicone elastomer implant was surgically implanted subcutaneously restoring symmetry and provided an acceptable aesthetic appearance. Subjective evaluation is still considered the standard for this surgical procedure, as there are no accurate outcome assessment measures currently available.
ConclusionThe use of digital technology to design and construct the implant provided an opportunity to evaluate tissue dimensions and chest wall contours. Commercial techniques at best only allow for estimations of dimensions in this region. The digitally driven process was found efficient, allowed evaluation of predicted treatment outcomes and resulted in the patient being satisfied with the treatment outcome.
P44 Stereolithographic Models in Treatment Planning Reconstruction after Maxillectomy Using Bone Graft and Dental Implants
Casey, D. M.*, Sullivan, M.
Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute, Buffalo, New York, USA
PurposeStereolithographic models may be utilized following a maxillectomy in order to articulate to the reconstructive surgeon the exact dimension and location of bone required to facilitate implant-retained prosthetics. In order to restore the edentulous maxilla with implant retained fixed crown and bridge predictably the surgical placement of the implant fixtures must be prosthetically driven. This is of the utmost importance in the treatment planning of the reconstructed maxilla secondary to oncologic resection.
Methods & MaterialsA patient with a partial maxillectomy secondary to treatment for cancer of the hard palate requested surgical reconstruction followed by fixed implant retained prosthetics. Treatment history included chemotherapy before and after maxillectomy with no adjuvant radiation. A CT was obtained to fabricate a stereolithographic model, which included a separate mirror image segment of the unaffected side. Modifications of the mirror image were made in order to illustrate ideal sites for implant fixtures to the surgeon.
ResultsA stereolithography model with a removable segment of the maxillary defect mirrored from the normal side was fabricated. It was then modified by removing the clinical crowns in order to illustrate the ideal quantity as well as location of bone graft required. Finally, the segment was marked and drilled to articulate to the surgical team the ideal sites for implant placement.
ConclusionIn order to provide ideal implant retained fixed maxillofacial prosthetic rehabilitation following maxillectomy, the shape and placement of bone graft should be determined by the treating prosthodontist. A stereolithographic model fabricated with a removable segment of the proposed bone graft provides the surgical team a precise template to utilize.
Notes
11�
P45 RP Anatomical Modeling for Head and Neck Reconstruction: Survey Results Summary for Over 250 Patient Cases
Christensen, A.*, Flannery, N., Drury, K.
Medical Modeling Inc., Golden, Colorado, USA
PurposeRapid prototype (RP) generated anatomical models of bony anatomy continue to play an important role in planning and executing complex reconstructive surgeries. To date most of the clinical articles published are either anecdotal case studies or cover limited range studies.
Methods & MaterialsAn anatomical modeling survey was created to track a number of key points regarding usage of physical anatomical models: Pre-Operative Use of the Model, Intra-Operative Use of the Model, Increase or Decrease of Time for Surgical Procedure and Change in Overall Outcome of Surgical Procedure. The survey was included with every RP anatomical model shipped by Medical Modeling for the period of 2000 through 2007. While only a small percentage of surgeons returned this voluntary survey, the results of 2�0+ cases represent a substantial amount of information about the models’ usage. 72% of the cases with completed surveys were reported based on using the ClearView® Anatomical Model, a product that is produced using the two-color stereolithography (SLA) technique. The surveys involved surgical cases in the following specialties: Oral and Maxillofacial Surgery, Otolaryngology, Neurological Surgery, Maxillofacial Prosthodontics and Plastic & Reconstructive Surgery (Craniofacial Surgery). The data from the two-page survey was tabulated and analyzed.
ResultsTo date more than 2�0 surveys have been voluntarily completed and returned to Medical Modeling Inc. Some of the highlights of the tabulated survey data include, 1) The perceived quality of the model compared to other medical imaging modalities was considered to be either “better” or “much better” by over �0% of the respondents. 2) 7�% of the respondents performed some form of surgical simulation on the model, �) the average respondent noted a decrease in surgical time of almost �0 minutes, �) over 90% of respondents found the models to be “useful” or “essential” to an improved surgical outcome.
ConclusionResults of this large group of survey data show that models are often used for physical simulation of the surgery on the model. The data also reveals a very significant reduction in surgical time of almost �0 minutes per procedure. Surgical timesavings combined with perceived value to improve surgical outcomes provide evidence that RP-generated physical anatomical models offer surgeons a valuable tool for planning and rehearsing complex reconstructive procedures.
11�
P46 The Use of Stereolithographic Models and Conventional Craniofacial Laboratory Technology in Simulation and Transfer of Maxillary Distraction with the Trans-Sinusoidal Maxillary Distractor: A Technical Note
Ghazali, N.1*, Haers, P.2, Nacher-Garcia, C.1, Thompson I.2.
1Maxillofacial Unit, King’s College Hospital, 2South Thames Cleft Unit, Guy’s Hospital, Department of Biomaterials, Guy’s, King’s & St Thomas’ (GKT) School of Dentistry, London, UK
PurposeThe management of severe maxillary hypoplasia can be achieved by maxillary distraction but its successful outcome is dependent on accurate vector planning and transfer during surgery. The intraoral trans-sinusoidal multidirectional maxillary distractor (TS-MD, KLS Martin, Germany) device is recommended in cases of severe maxillary hypoplasia for movements of up to �0mm. The manufacturers recommend the use of computer software planning coupled with rapid prototyping technology for ‘perfect vector indication’. These systems are often expensive and not widely accessible. The purpose was to develop an alternative method by utilizing stereolithographic (SLG) models with conventional craniofacial laboratory technology for the pre-surgical distraction planning, simulation and vector transfer.
Methods & MaterialsA stereolithographic model was constructed using CT data to allow for surgical planning, plate pre-bending and fabrication of an acrylic customized distractor-locating device. Simulation of the planned maxillary distraction was performed in the laboratory. The osteotomy cuts were completed on the SLG model and the TS-MD devices activated to ensure that correct translation of the maxillary segment according to the desired distractor vector was achieved. The pre-planned distraction procedure was surgically simulated in a clinical case with a severe maxillary hypoplasia.
ResultsThe SLG model allowed visualisation and physical manipulation of the dentoskeletal deformity facilitating complex surgical planning and simulation, particularly when the vector of movement required is multidirectional. The accuracy of SLG model enabled precise pre-locating and pre-bending of the device with implications on vector determination, especially with the TS-MD, as the upper plate incorporates the distractor screw. The accuracy and precision of our protocol is illustrated by excellent plate adaptation achieved in optimal areas for anchorage, shorter operating times and good clinical outcome
ConclusionThe SLG model combined with conventional craniofacial laboratory technique is a viable and cost-effective alternative method to computer software technology in the planning, simulation and vector transfer of maxillary distraction using the TS-MD device.
P47 Manufacture of Facial Burns Conformer Splints using 3D Technologies
Jeynes, P.*, Sharp, I., Lopes, V.
Department of Maxillofacial Technology, University Hospital Birmingham, Birmingham, UK
PurposeTo demonstrate the use of �D Digital capture in the manufacture of splints for managing facial burns
Methods & MaterialsBurns to the face are debilitating and mutilating injuries. The management of the scarring associated with these injuries often requires pressure splints. Traditionally this has necessitated the use of full-face impressions and sometimes, general anesthesia to achieve a model on which to manufacture the splint. Our paper demonstrates the novel application of �D photographic capture to facilitate this process.
ResultsSix patients have been treated in this way. In all cases, the process was very acceptable to the patient and was not associated with discomfort or risk to the airway. The accuracy of fit of the mask was excellent and the ease of the manufacture process facilitates ready replacement over time as the treatment progresses.
ConclusionThis technique offers a simple and cost effective method of manufacture of burns conformers. Indeed this technology could easily be adapted to other areas where an accurate surface mould is required e.g. radiotherapy masks. It is now established as a routine part of our protocol of management for children and adults with facial burns.
Notes
11�
P48 Bespoke Neo-Condyle and Mandibular Reconstruction Plate using 3D Technologies
Jeynes, P.,* Parmar, S., Martin, T., Sharp, I.
Department of Maxillofacial Technology, University Hospital Birmingham, Birmingham, UK
PurposeTo present the surgical/technology interface in management of mandibular reconstruction using a custom made implant in conjunction with free tissue transfer
Methods & MaterialsWe present a case of a fully dentate 2�-year-old woman with ameloblastoma requiring left hemimandibular resection including the condyle. Planning for reconstruction was carried out using stereolithographic modelling and traditional maxillofacial technology techniques to produce a custom made reconstruction plate and neo-condyle. This was implanted along with a free fibula transfer to restore mandibular continuity, form and function.
ResultsThe manufacture of a custom-made reconstruction was facilitated by the use of �D technologies. Delivery of this reconstruction has restored near normal function and form to this patient. Occlusion has been restored and range of movement of the mandible is near normal. Functionally the result is excellent 1-year post operatively with no sign of recurrent disease.
ConclusionThis technique has facilitated high quality reconstruction of a young adult patient, which would have been challenging by any other means. The fusion of traditional and contemporary �D techniques has made this possible.
116
PurposeThe use of advanced digital technology in head and neck reconstruction improves each passing year. Advancements in implant surgery and prosthodontics using CT derived surgical templates has been instrumental in improving functional recovery for edentulous patients and reducing overall treatment time with evidenced based approaches.
We have experienced the benefits of CT derived surgical templates for implant rehabilitation of maxillary and mandibular defects reconstructed with microvascular bone free flaps in a multidisciplinary setting. This intra oral experience includes the importance of planning and patient management, immediate loading of implants, implants in irradiated tissues, prosthetic design relating to fibula and iliac crest free flap reconstructions and adjunctive pre-prosthetic surgical procedures.
Extra-oral applications for surgical reconstruction with CT derived surgical templates and navigation is equally promising. The reconstruction of the facial skeleton and overlying soft tissues are reaching new heights for precision and outcome. This is evident in orthognathic surgery applications and other maxillofacial reconstruction procedures. While the use of these techniques and applications are instrumental for head and neck reconstruction and rehabilitation, in our experience also discusses the potential problems that can arise when embracing new technology.
P50 Application of CT Derived Surgical Templates in Head and Neck Reconstruction
Okay, D.*, Buchbinder, D., Urken, M., Persky, M.
Beth Israel Medical Center, Albert Einstein College of Medicine
P49 The History of Rapid Prototyping
Lambrecht, J. T.
Department of Oral Surgery, Oral Radiology and Oral Medicine, University of Basel, Basel, Switzerland
PurposeConstruction of milling machines models (MMM) Construction of laser technology models (LTM)
Methods & MaterialsConstruction of milling machines models (MMM) starts with CT patient imaging followed by software processing of the data. The automated production of bone models on a five-axis computerized numerical control (CNC) milling machine required the reduction of the CT dataset to �D geometrical description of the surface of the object. To achieve this , the contours of the structures have to be derived from the image dataset. 1. Interactive data presentation. 2. Contour detection and summation. �. “Hypothetical �D data construction. �. Interactive visualization. Milling the �-D model after verification of the previous steps, the interpolated contour dataset is submitted to a program that generates a control data file for a multi-axis milling machine (Medical Diagnostic Computing, Germany), with three linear and 2 rotational axes. The milling process is performed in two steps: first, a rough milling and finally a fine milling. Construction of laser technology models (LTM) Laser technology is a new way to produce �-D models. These replicas are produced not by grinding a solid block, as with MMM, but by selectively irradiating a photo-curable resin with an ultraviolet laser beam to harden it. Two terms are used synonymously in the current literature “rapid prototyping” and “stereolithography”. LTM are based on acrylic resins. Depending on how the CT data are processed, skeletal and soft tissue models can be produced. The generation of the basic 2D data and the surface-generation algorithm are similar to the MMM system. The volume consists of a stack of planar cross-sectional slices so that all points within the volume with the same properties lie on an iso-surface. Fabrication of LTM 1. A container for the UV-sensitive material in the form of liquid polymer and photo-initiators. 2. A platform, which carries the object to be built and is lowered into the liquid polymer in 0.2, 0.�, 0.� or 0.� mm steps, depending on the thickness of the layer. �. A helium-cadmium laser-based light system for photopolymerization to harden each layer of the object.
ConclusionApplications of fabricated models, prediction and planning of precise surgical movements of the skeleton is greatly aided by the creation of an exact model. Accurate, prosthetic devices can be produced in the laboratory, thus minimizing operating time, and in addition, the surgeon has a precise knowledge of the anatomy. At present, we are able to plan and simulate procedures in orthognathic, craniofacial and functional skeletal surgery, tumor and pre-prosthetic surgery and implants. Computer-aided surgery (CAS) leads to better results in secondary reconstructions of the midface and mandible, asymmetrical craniofacial anomalies and large bone grafts in particular and is therefore regarded as an essential prerequisite.
Notes
117
P51 Stereolithographic Biomodelling in Mandibular Reconstruction
Seikaly, H.1,2,* Zhu, J.1, Wolfaardt, J.2, Cote, D.1, Mlynarek, M. A.1, O’Connell, D. A.1, Harris, J. R.1,2,
1Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada2iRSM, Edmonton, Alberta, Canada
PurposeTo evaluate the utility of stereolithographic biomodels in mandibular reconstruction in the laboratory setting.
Methods & MaterialsUsing medical rapid prototyping, thirty sets of anatomic models were created based on CT images of a patient affected by a tumor involving the mandible and undergoing a resection of the anterior mandibular segment from angle to angle. Ten of the models were of the complete craniofacial skeleton. Another 20 copies were incomplete, lacking a segment of the mandible from angle to angle. Ten experienced reconstructive surgeons and ten novice surgical trainees received the incomplete models and ten surgeons randomly received the complete model of the skeleton as a guide. Each participant was asked to bend a titanium reconstruction plate to simulate the native mandible. The end product was evaluated on the basis of its accuracy, with a focus on the angle of the arch and degree of protrusion.
ResultsThe data showed that plates bent with the aid of a complete bio-model were more accurate than their counterpart. The difference was more pronounced with the surgical trainees.
ConclusionRapid prototype aids the reconstructive surgeon in creating a more accurate neo-mandible. It also has potential utility in surgical education.
118
P52 Cone-Beam CT Imaging for Anatomical Modeling using RP Technologies: Challenges and Applications
Christensen, A.*1, Flannery, N.1, Bonner, M.1, George, C.2, Eckstein, N.1, Hoffman, D.�, Glick, P.�
1Medical Modeling Inc., Golden, Colorado, USA, 2University of Colorado, Boulder, Colorado, USA, �Private Practice Oral and Maxillofacial Surgeon, Staten Island, NY USA, �Private Practice Periodontist, Littleton, Colorado, USA
P53 Establishing New Standardized Method for Reconstructing 3-D Human Vocal Tract Model by Using CT Images
Inohara, K.1*, Sumita, Y. I.1, Ohbayashi, N.2, Kurabayashi, T.2, Ino, S.�, Ifukube, T.�, Taniguchi, H.1
1Maxillofacial Prosthetics, Tokyo Medical and Dental University, 2Oral and Maxillofacial Radiology, Tokyo Medical and Dental University, �Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
PurposeThe purpose of this study is to establish a new standardized method for reconstructing three-dimensional (�-D) human vocal tract models for measuring the transmission characteristics of head and neck cancer patients. This was done by using the X-ray computed tomographic (CT) images that were already taken for post-operative diagnosis, because they show teeth more clearly than MRI, require no added exposure to radiation.
Methods & MaterialsCT images were obtained after the surgery from a Siemens Somatom Plus-S single beam CT scanner. The optimum threshold between soft tissue and air was determined for each individual by assessing images of buccal fat pad. �-D images were then reconstructed by using Mimics software (Materialise n. v., Belgium), and a �D solid model was built by the rapid prototyping system, E-DARTS (Autostrade Co., Ltd., Japan).
ResultsThe shape of the vocal tract was successfully reconstructed, and �-D standardized solid models divided bilaterally in two were built by using a stereolithography method to harden each stratum of liquid-resin with the light beam of a diode laser. Because the model has vents which are identical to those of vocal cords, mouth, and nose, it will enable their transmission characteristics to be measured by setting a speaker and a microphone.
ConclusionBy using CT images that were already taken for postoperative diagnosis secondary, �D standardized human vocal tract models were successfully reconstructed. We are standing at the starting point of establishing the method for standardizing reconstruction of the vocal tract.
PurposeCone-beam computed tomography (CBCT) has developed into a preferred means of volumetric data acquisition in dental specialty offices and freestanding facilities due to patient accessibility, capital cost and lower radiation dose compared to traditional CT. Utilizing CBCT data as input, the authors have experience in output of three-dimensional anatomical models using rapid prototyping (RP) techniques. Clinicians report models aid in understanding of underlying, non-visible anatomy and creation of custom implants and guides. Using CBCT data as input for RP-generated physical models presents some unique challenges from a technical standpoint, which has not been reported to date.
Methods & MaterialsMedical Modeling has experience working with several hundred scans obtained by CBCT. The majority of these scans come from Imaging Sciences International’s iCAT volumetric imaging system, which is the most prevalent system in the US market. Previous reports comparing CT to CBCT have indicated that CBCT has limitations with signal to noise ratio, making segmentation of surfaces needed for RP anatomical modeling more difficult. The authors’ recent experience working with clinical CBCT data has reflected similar findings. Surgeons and other dental specialists seem interested in CBCT for dental implant planning procedures although a trend is being seen to expand usage into orthodontics and cranio-maxillofacial specialties.
ResultsTechnically, the procedure for creation of an accurate RP-generated anatomical model is more time consuming. This is largely due to two factors. 1) The images may now be acquired at 0.1mm to 0.�mm voxels giving 10 times more data than previous scans taken with 1.0mm CT scans, and 2) image processing technicians spend more time with “manual” image editing tools where automatic tools fail. With careful attention and appropriate image processing time, the authors have been able to produce RP-generated anatomical models that both aesthetic (i.e.: smooth surfaces, indication of anatomical structures such as the i.a. canal and tooth roots) and are highly accurate. Surgeons report that using the physical models generated from CBCT allows for more accurate case planning and for creation of drilling guides, osteotomy templates and custom implants.
ConclusionAccurate RP-generated anatomical models can be produced using CBCT data as input. While image-processing time generally increases, it is possible to create both accurate and nice-looking physical models from CBCT. Devices for volumetric dental imaging will continue to improve over time and it is expected that data quality and image processing will also improve.
Notes
119
P54 Fabrication of Realistic Nasal Airway Replicas for Aerosol Deposition Experiments
Storey-Bishoff, J.*, Noga, M., Thompson, R., Golshahi, L., Finlay, W. H.
Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
PurposeOur purpose was to create realistic nasal airway replicas for in-vitro measurement of aerosol deposition. Multiple subjects of different ages and sizes were needed to try to establish predictive models which explain the large variation in deposition from person to person.
Methods & MaterialsA mixture of CT and MRI data were used as source images. Partitioning of the airways in these images was performed by thresholding for CT images and by manual region growing for MRI images. A consistent level of smoothing was performed for each airway by using the smoothing algorithm with large numbers of iterations to establish a final metric and smoothing to a certain percentage of that metric. Models were built in several pieces using acrylic plastic on rapid prototyping hardware. Deposition of inhaled aerosol droplets was measured in assembled models under realistic breathing conditions.
ResultsFour nasal models of adults were built and aerosol deposition measured. A reasonable agreement with in-vivo data was found which validates the modeling process. CT scans of a completed model were taken and compared with original CT airway scans to validate the modeling process further. Ten infant airway models were constructed and aerosol deposition measured. Deposition was found to vary greatly between individuals (up to 7�% with the same impaction parameter). Measurements of airways dimensions were taken from CAD files and correlated with individual deposition.
ConclusionPhysically realistic nasal geometries for in-vitro experimentation can be constructed from MRI or CT scans using rapid prototyping techniques. These models can be very useful in performing aerosol deposition experiments that would be impossible or impractical with human subjects. Based on results from these experiments a model was constructed to predict aerosol deposition in infant nasal airways based on the Reynolds and Stokes numbers. Average deviation from prediction curve in the present data is �%. The authors would like to acknowledge COMPRU for the use of their facility and their help in constructing these models and to the National Science and Engineering Research Council of Canada for financial support.
120
P55 Reconstruction of an Orbital Blowout Fracture Using an Aerospace Six Axis Laser Sinter
Williams, J.V.*, Page, K.B., Hodkisson, M.T., Revington, P.J.
Oral & Maxillofacial Surgery, Frenchay Hospital, Bristol, UK
P56 Tissue Engineering of composite grafts: First Steps Towards a Directly Fabricated Co-Culture Graft for Oral Reconstruction
Glaum, R.1*, Carvalho, C.2, Scherfler, S.�, Mülhaupt, R.2, Gutwald, R.1, Schmelzeisen, R.1
1Department of Oral and Maxillofacial Surgery, Albert Ludwigs University, Freiburg, Germany 2Freiburg Materials Research Center, FMF, Freiburg, Germany�Department of Oral and Maxillofacial Surgery, Ruprecht Karls University, Heidelberg, Germany
PurposeThe restoration of more than one tissue is very often required in oral reconstruction. Three-dimensional grafts should therefore contain different cell types. The aim of our investigation is to construct a scaffold fabricated using rapid prototyping techniques with integrated cells. These three-dimensional objects would be used in tissue engineering to repair bone defects, while building a mucosal lining on the surface of the scaffold.
Materials & MethodsThe BioplotterTM is used to fabricate three-dimensional scaffolds. The authors prepared objects using different materials and seeded them with different cells on the surface. Furthermore, the possibility of integrating cells into the plotting material previous to the fabrication process was investigated. Cell proliferation was observed using PI staining and EZ�U tests.The co-cultivation of osteoblast-like cells and oral keratinocytes was investigated on different commercially available membranes. Proliferation and morphology of the cells were analysed by EZ�U test, light and scanning electron microscopy.
ResultsThe integration of cells into the rapid prototyping process using the BioplotterTM is possible. After 10 days there were still a large number of vital cells in the scaffolds. A stable co-culture of oral keratinocytes and osteoblast-like cells was also achieved. Both cell types could be detected by light and electron microscopy on the corresponding sides of the carriers. Proliferation analysis resulted in about 1�-�0% cell viability on the carriers in comparison to the cultivation in culture dishes depending on the membrane used.
ConclusionsWhile current development is very promising, further research into co-cultures and cell integration into the bioplotting process is required. Viable three-dimensional objects with different cells types for in vivo testing will be available in the near future.
PurposeA 29-year-old male was struck on the left side of his face whilst snowboarding. He demonstrated the classical clinical signs and symptoms of a left orbital blowout fracture. Radiographically, a CT scan demonstrated a significant blowout of the inferior rectus muscle with slight descent of the entire globe into the maxillary sinus.
Methods & MaterialsA stereolithographic model was constructed using the data from the CT scan. It was envisaged that a custom made prosthesis could be made using this to restore the orbital floor. There were difficulties and limitations with this model, related to the compounding effects of a thin bony orbital floor and the tolerance of the laser sinter.
ResultsThe patient was an aerospace engineer with access to a six-axis laser sinter. The same CT data was used to construct a new model from sintered nylon, which was vastly superior in quality than the first model. The new model was used to construct a custom-made 0.2� mm thickness titanium prosthesis to surgically reconstruct the floor of the orbit with a successful outcome.
ConclusionThe use of a six-axis laser sinter to construct an accurate model of an orbital blowout fracture has not been previously described in the literature. The high definition reproduction of the defect allows a custom-made prosthesis to be readily constructed for surgery.
Notes
121
P57 New Trend in the Management of Ameloblastoma
Khidr, M. B.1*, El Kashishy, K.2, Al Mallah, M. H.�
1Oral and Maxillofacial Surgery Department, �Oral Pathology Department, Al Minia University, Al-Minia City, Egypt2General Pathology Department, Zagazig University, Zagazig City, Egypt
PurposeUp until now the surgical management of ameloblastomas depends on the extension of the lesion radiographically and the histological findings. Meanwhile, there is controversy regarding the surgical techniques of different types of ameloblastoma. The aim of this study was to assess the degree of aggressiveness of the lesion cells to clarify the potential biologic behavior of those lesions using p��.
Methods & Materials17 cases (10 males and 7 females with age ranged between 1� and 67 year) has been operated in this study. Cases included primary, recurrent and of malignant ameloblastoma. Immunohistochemical analysis was used to classify ameloblastomas into aggressive and non aggressive lesions. Surgical technique was done according the immunohistochemical result.
ResultsThe postoperative follow-up was accepted and no recurrence was observed in all cases.
ConclusionThe study concluded that the histological and radiographical assessment is not enough for the final management of such cases and p�� is a unique approach to detect the biological behavior of the cells upon which surgery should be addressed.
122
P58 A New Index for Rating Gummy Smile: The Gummy Smile Index
Marzook, H.*
Oral Surgery Department, Mansoura University, Mansoura, Dakahlia, Egypt
PurposeA number of procedures have been utilized in an attempt to restore reasonable smile in patients suffering from a gummy smile. There is no evaluation index for this condition included in evaluation studies. The aim of this study was to develop and validate an index for rating excessive gingival display during smiling (gummy smile). This work aimed also to apply this index for the evaluation of the outcome of using a modified camouflage surgery for lowering the gingivolabial sulcus as a treatment of gummy smile.
Methods & MaterialsFourteen patients (12 females, 2males) diagnosed as suffering from the distressing condition of gummy smile, ranging in age from 1� to �8 years, were included in this work. A photograph was taken for every patient preoperatively and postoperatively and processed on a computer program. The area displayed during maximum smile was calculated as an index for gummy smile for the patients and compared with that of 1� randomly chosen persons not complaining from that condition. All patients were treated under local anesthesia. A horizontal intraoral mucoperiosteal incision was followed by subperiosteal release of the soft tissues from the anterior maxilla, and alveolus. Stretching and trimming of the flap to be sutured at a lower level was done. Assessments of the gingival and periodontal conditions was done pre and post-operatively up to 6 months follow up and statistical evaluation was also done to evaluate the outcome using this gummy smile index. The cases were followed up for any complication that might occur.
ResultsThere was a significant difference between normal individuals and patients suffering from gummy smile using our smile index. The camouflage technique effectively decreased the height of the gingivolabial sulcus and thus decreased the measured area of gingival display. It tethers partially the upper lip and prevents the excessive upward excursion during smiling with valuable improvement in appearance in all selected cases. Our statistical evaluation revealed that there was a significant improvement in the different studied cases. However, gingival recontouring was recommended in some cases.
ConclusionBecause of its simplicity and its predictable validity for evaluation of the surgical outcome, this gummy smile index seems to be of interest. The modified technique of camouflage surgery as a treatment of gummy smile provides controlled shortening of the labial mucosa, with decreased possibility of complications.
12�
Notes
Abstract Index by Author
12�
Abstract Author Page
L26 Ayoub 7�
P20 Barth 96
P�1 Bibb 110
P2�, P�2 Bodard 98, 111
K12 Boulanger ��
L0� Brix 60
P�7 Brom 108
P10 Bryant 90
K02 Buchbinder �6
P�� Casey 112
L08, P��, P�2, L1�
Cervidanes 62, 11� 118, 66
P2� Cote 99
L0� DeCubber �9
K01 Devauchelle �6
L02 Eeg-Olofsson �8
L0� Eggbeer 60
L20 Essig 71
P2� Evans 100
K06 Ewers �9
P0� Gehl 86
K07 Gellrich �0
P�6 Ghazali 11�
P�6 Glaum 120
L07 Goldhahn 62
K08 Golding �0
L2� Granstrom 7�
P�� Grosvenor 112
L16 Grybauskas 68
K09 Hammer �1
P�� Inohara 118
P11 Jayaratne 90
P�7, P�8 Jeynes 11�, 11�
P26 Katsoulis 100
P�7 Khidr 121
P�8 Klein 108
L�� Korfage 80
P12 Krarup 91
K0� Kuriakose �8
P�9 Lambrecht 116
L1� 67
P28, L01 Marchetti 102, �8
P09, L2� Marcus 89, 7�
P�8 Marzook 122
P29 Mehrotra 102
K10, P12, P�0, L�0
Metzger �2, 92, 10�, 78
P0� Minami 86
P1� Mirzaey 92
P�� Miyamoto 10�
P�1 Morris 10�
P1�, L22 Mustafa 9�, 72
P01 Nacher-Garcia 8�
P�2 Neelakandan 10�
P06 O'Connell 87
P�0, K02 Okay 116, �6
P�6 Ozawa 107
12�
L1� Patel 68
L12 Poukens 66
P�9 Raboud 109
L�� Ramin 80
P27 Regunathan 101
L28 Rieger 76
L11 Rouse 6�
K1� Sader ��
L�� Sauerbier 81
L29 Schicho 77
K0�, L21 Schön �8, 72
L17 Schramm 69
P02, L2�, L�2,
Seelaus 8�, 7� 79
L10, P07, P16, P�1
Seikaly 6�, 88 9�, 117
L09 Sensen 6�
P21 Serafin 97
P�� Sharp 106
P17 Sladinia 9�
K0� Snyderman �7
P�� Storey-Bishoff 118
P08 Swain 88
L�1 Taha 78
P22 Toyohiko 98
P0� van Oort 8�
L27 Verdonk 76
L19 Verma 70
P�� Veyre-Goulet 106
P�� Williams 120
P18 Winder 9�
P�0 Yasuhiro 110
P19 Yoshioka 96
K11 Zeilhofer �2
L06 Zenha 61
L18 Zhang 70
Abstract Author Page Abstract Author Page
3dMDContact: Kelly S DuncanVicarage House58-60 Kensington Church Street London W8 4DB, UK T: 44 (0) 207 368 1630 Email: [email protected]: www.3dmd.com
ABM University NHS TrustContact: Susan Bailey, Communications ManagerManagement Centre,Morriston Hospital,Swansea, SA6 6NLT: (01792) 517844F: (01792) 517010Email: [email protected]: www.abm.university-trust.wales.nhs.uk
AO Research Fund Contact: Anita Anthon Stettbachstrasse 68600 Dübendorf Switzerland T: 41 (0)44 200 24 10 F: 41 (0)44 200 24 11Email: [email protected] Website: www.aofoundation.org
BrainLAB AGContact: Alexander DornerRegus House 1010 Cambourne Business Park Cambridge, CB3 6DP UKT: 44 12 23 59 78 17F: 44 12 23 59 81 16Email: [email protected]: www.brainlab.com
Capital HealthContact: Michele HalesWalter C. Mackenzie Health Sciences Centre8440 – 112 StreetEdmonton, Alberta T6G 2B7 T: (780) 407-1000F: (780) 407-7161Email: [email protected]: www.capitalhealth.ca
Caritas Health GroupPatrick Dumelie, President5y35, 11111 Jasper AvenueEdmonton, Alberta, Canada T5K 0L4T: (780) 735-9000F: (780) 482-8061Email: [email protected]: www.caritas.ab.ca
Cochlear Europe Ltd.Contact: Sian Jones9 Weybridge Business ParkAddlestone RoadAddlestone, Surrey, KT15 2UF UKT: 44 (0) 1932 871 500F: 44 (0) 1932 871 526Email: [email protected]: www.cochlear.co.uk
Codman - Johnson & Johnson Medical LtdContact: Nicky StephensCoronation RoadAscot, BerkshireSL5 9EY EnglandT: 44 1344 87 1000F: 44 1344 87 1120Email: [email protected]: www.codman.com
Dimensional ImagingContact: Ken Wood1 Ainslie RoadGlasgow, Scotland G52 4RU UKT: 44 (0) 141 585 6481F: 44 (0) 141 585 6301Email: [email protected]: www.di3d.com
Dolphin Imagining and Management SolutionsContact: Paul M Thomas, Country Manager26 Village Farm, BonvilstonCardiff, Wales CF5 6TYT: 44 (0) 7793.817.933F: 44 (0)1446.781.153 Email: [email protected]: www.dolphinimaging.com
Exhibitor Contact Information
126
Imaging Sciences InternationalContact: Nicole Serago1910 North Penn Road Hatfield, PA 19440 USAT: (215) 997-5666; (800) 205-3570F: (215) 997-5665 Email: [email protected] Website: www.i-CAT.com
Majenta SolutionsContact: Stuart NotonMajenta HouseCoptfold RoadBrentwood, Essex, CM14 4BST: 01277 263244F: 01277 263245Email: [email protected] Website: www.majentasolutions.com
Materialise NVContact: Catherine Cober, Communication Specialist MedicalTechnologielaan 153001 Leuven, BelgiumT: 32 16 39 66 11F: 32 16 39 66 00Email: [email protected]: www.materialise.com
Medical ModelingContact: Andy Christensen17301 W. Colfax Avenue, Suite 300 Golden, CO 80401 USAT: 303-273-5344F: 303-273-6463Email: [email protected]: www.medicalmodeling.com
Nobel Biocare ABBox 5190SE-402 26 Göteborg SwedenT: 46 31 81 88 00F: 46 31 16 31 52Email: [email protected]: www.nobelbiocare.com
Philips HealthcareContact: Mrs. Andrea Sheargold, Marketing Communications ManagerThe ObservatoryCastlefield RoadReigate, Surrey RH2 0FYT: 01737 230 400F: 01737 230 401Email: [email protected]: www.philips.com/healthcare
Stryker UKContact: Vanessa GoodallHambridge RoadNewbury, West Berkshire RG14 5EG UKT: 44-1635-262-400F: 44-1635-580-300 Website: www.stryker.co.uk
Synthes LimitedContact: Richard Bourne20 Tewin RoadWelwyn Garden City Hertfordshire AL7 1LG T: 44 1707 33 22 12 F: 44 1707 33 85 04 Email: [email protected]: www.synthes.com
Welsh Assembly GovernmentContact: Dr. Sharon Thomas, Healthcare & Life Science SpecialistTechnology & Innovation Plas Glyndwr Kingsway Cardiff CF10 3AH T: 029 20 828712 F: 029 20 368229 Email: [email protected]: www.wales.gov.uk/bioscience
127
128
129
Workshops
* All workshops are elective and require a fee. Evening workshops are concurrent and colleagues are encourage to select one of the options.
1�0
Monday 30th June 12:30 - 1:30Virtual Reality meets Medicine: CAVEman demonstration
Prof. Dr. Christoph W. Sensen and Dr. Jung Soh, University of Calgary
Biography: Prof. Dr. Sensen is a tenured full Professor at the University of Calgary, Faculty of Medicine, Department of Biochemistry and Molecular Biology. Dr. Sensen’s main research topic is Bioinformatics and Medical Informatics. He is currently funded by Genome Canada and Genome Alberta for a study with the title: “Four-dimensional modeling of genetic diseases and developmental patterns”.
Instructional Level: lecture and demonstration.
Course Objective Outline:
• Introduction to the concept of surface modeling • Demonstration of the CAVEman model • Integration with volumetric information • Integration with gene expression patterns • Integration with metabolomic information • Discussion of further needs
1�1
Monday 30th June 3:30 - 6:303D Cranio-maxillofacial Surgery Simulation with SurgiCase CMF (Materialise)
Marian Duron, Department Manager - CMF
Biography: Marian Duron holds an MSc Degree in Kinesiology and Rehabilitation Sciences, a Specialization Degree in Biomedical and Clinical Engineering and a Masters Degree in Bio-Informatics, from the Catholic University of Leuven, Belgium. As department manager of CMF, she has been leading Materialise’s developments in the virtual maxillofacial surgery simulation field since 200�
Instructional Level: Hands-on
Course Objective Outline:
• Introduction to Materialise • Introduction to SurgiCase CMF • Demonstration of different clinical applications • Hands-on by doctors
*Workshop Requirements: Personal laptop with a CD drive to transfer software program. Software program to be loaded prior to workshop at the Materialise exhibit booth.
Virtual preoperative planning and intraoperative realization becomes more and more a standard in the treatment of patients. This hands-on workshop will focus on the use of the preoperative planning software iPlan CMF and the intraoperative navigation software VectorVision/ Kolibri in the field of head and neck reconstructive surgery as well as their indications for use. Participants of this workshop will be trained by experienced well-known clinical leaders who will also give an insight in their daily routine while using planning and navigation.
Workshop Instructor: Alexander Dorner
Instructional Level: Hands-on
Course Objective Outline:
• Clinical Indications • Introduction of Hardware and Software • Hands-On preoperative planning iPlan CMF • Hands-On intraoperative Application VectorVision/ Kolibri
Preoperative Planning and Intraoperative Navigation for Head & Neck Reconstructive Surgery
BrainLAB AG
1�2
Biography: James Mason has 18 years experience in the CAD/CAM arena. The latest being the FreeForm modeling System from SensAble Technologies, specialising in modeling complex surfaces, �D scan data and sculpted form, working in all industries from footwear to medical/dental
Delegates will receive hands on experience of using the FreeForm Modellingtm system and be lead by an experienced instructor through a comprehensive introduction to the technology and key concepts.
Our workshop will guide through the creation of a cranial implant by performing specific tasks from importing �D data from a CT or MRI scan source, right through to producing a final model. Transform this �D data into ‘virtual clay’ and learn about the application of haptically (touch) enabled tools to develop a cranial implant over source data in the virtual clay material.
You will be able to explore your design and make fit/measurement/ and manufacturability checks before preparing the implant model for export to Rapid Prototyping and other downstream applications such as CNC milling.
It will quickly become apparent why FreeForm Modellingtm is the leading organic modeling tool and you will have a chance to see for yourself how this system is applied to many different medical or dental modeling tasks.
Instructional Level: Instructor led, hands on workshop experience
Course Objective Outline:
• Delegates to be introduced to FreeForm Modelling Plus system • Hands on instruction to import medical scan data • Creation of max-fac implant • Preparing data for rapid-prototyping or machining
Digital Maxillofacial Reconstruction: SensAble Freeform
Majenta Solutions
1��
Research Fund
AO Research Fund celebrates 25 years of funding research throughout the world
YEARS50THE FIRST
AO_8x10_080416.indd 1 29.4.2008 17:02:31 Uhr
1�7
Cymorth arloesedd a thechnoleg i chiMae’n tîm yma i helpu i wneud busnesau Cymreig yn fwy arloesol drwy dechnoleg a thrwy helpi datblygu cynnyrch, gwasanaethau, prosesau a thechnolegau a arweinir gan y farchnad.
Paham dod atom ni am help?Cyngor diduedd, rhad ac am ddim oddi wrth bobl ag arbenigedd diwydiannolMynediad i wybodaeth, syniadau ac arfer da i ddatblygu’ch busnesNawdd i amddiffyn, datblygu a manteisio i’r eithaf ar eich syniadauCymorth arbed amser i helpu i’ch arwain i’r dechnoleg, y cyfarpar a’r cyfl eusterau diweddarafRhwydwaith o ganolfannau arloesedd ddyluniwyd at anghenion busnesau’n seiliedig ar dechnoleg
Ffôn 03000 6 03000 www.cymorth-busnes-cymru.gov.uk
Innovation and technology support for youOur team is here to help make Welsh businesses more innovative through technology, and help develop new market led products, services, processes and technologies.
Why come to us for help?Free impartial advice from people with industrial expertiseAccess to knowledge, ideas and good practice to develop your businessFunding to protect, develop and exploit your ideasTime saving help to guide you to the latest technology, equipment and facilitiesA network of innovation centres designed for the needs of technology based businesses
Telephone 03000 6 03000 www.business-support-wales.gov.uk
WAG ADT2008 Advert.indd 1 12/5/08 08:57:31
1�8
NobelGuide™
increase your profitability by placing implants more efficiently
Increase your share of the fast-growing dental implant market. Find out more about our available NobelGuide™ courses at www.nobelbiocare.com©
Nob
elBi
ocar
e 20
08
NobelGuide™
Using NobelGuide™, you plan and predict every aspect of flapless implant treatments using either CT-scanning or stone-based modeling. A surgical template is then generated, which guides predictableflapless surgeries with increased safety.
With NobelGuide™:
• Patients receive functioning beautiful teeth in as little as just one surgical session
• The exact position and depth of implants is known before surgery
• You place implants with pin-point accuracy using the surgical template
program & abstracts
Saturday - TuesdayJune 28 – July 1, 2008
3rd International Coference ofADVANCED DIGITAL TECHNOLOGYIN HEAD AND NECK RECONSTRUCTION
Cardiff, Wales, UK
www.res-inc.com/AT_2008.htm
