Digital Technologies in Craniomaxillofacial Surgery PDF
Preview Digital Technologies in Craniomaxillofacial Surgery
Alex M. Greenberg Editor Digital Technologies in Craniomaxillofacial Surgery Digital Technologies in Craniomaxillofacial Surgery Alex M. Greenberg Editor Digital Technologies in Craniomaxillofacial Surgery Editor Alex M. Greenberg Columbia University New York, NY, USA ISBN 978-1-4939-1531-6 ISBN 978-1-4939-1532-3 (eBook) https://doi.org/10.1007/978-1-4939-1532-3 Library of Congress Control Number: 2017913738 © Springer Science+Business Media, LLC, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Preface It is with great pleasure that I present this first comprehensive book on the subject of digital technologies in Craniomaxillofacial Surgery. With the development of CT scanning and advanced imaging, 3D visualization of the facial bones and soft tissues has evolved to now include the virtual planning of surgical procedures and intraoperative navigation. These tech- nologies can allow surgeons to preplan procedures to ensure precise surgical results. Rather than using the surgeon’s 3D perception to imagine bone cuts, fitting of osteotomy segments, and grafts, these tools allow preoperative enactment and template design. 3D stereolitho- graphic and rapid printed models can be used for osteotomy design, anatomically accurate implant fabrication, and communication with the surgical team. In this new textbook, we are able to review many of the latest advances in 3D modeling, software for virtual surgical plan- ning (VSP), navigation, surgical cutting and drill templates, surgical occlusal splints, cranio- plasty, radiation therapy, and custom facial and cranial implants. These innovative technologies allow for improved cost savings, time savings, improved outcomes, and the development of new surgical techniques. I am indebted to my many colleagues from the many disciplines of Oral and Maxillofacial Surgery, Plastic and Reconstructive Surgery, Otolaryngology/Head and Neck Surgery, Neurosurgery, and Oral and Maxillofacial Radiology, as well as the 3D printing industry who have contributed to this work. New York, NY, USA Alex M. Greenberg v Contents 1 Introduction to Digital Technologies in Craniomaxillofacial Surgery ................. 1 Alex M. Greenberg 2 The Digital Thread for Personalized Craniomaxillofacial Surgery ................... 23 Andrew M. Christensen, Katherine Weimer, Christopher Beaudreau, Michael Rensberger, and Benjamin Johnson 3 Cone Beam CT ........................................................................................................ 47 Samuel J. Zeichner 4 Craniomaxillofacial Reconstruction Based on 3D Modeling .............................. 55 Gerald T. Grant 5 Clinical Cone Beam CT and CT-Guided Dental Implant Surgery .................... 67 Alex M. Greenberg and Leslie H. Sultan 6 Virtual Surgical Planning for Orthognathic Surgery .......................................... 117 Vincent Carrao, Mohammad Tofigh, and Alex M. Greenberg 7 Computer Planning for Craniofacial Surgery ...................................................... 157 Oleh M. Antonyshyn, Glenn Edwards, and James G. Mainprize 8 Craniomaxillofacial Implants Based on 3D Modeling ......................................... 167 Marc C. Metzger and Rainer Schmelzeisen 9 Facial Implant Cosmetic Augmentation Using Digital Technologies .................. 175 Alex M. Greenberg and Barry Eppley 10 Navigation of Sinus and Skull Base Surgery ........................................................ 283 Sarah M. Kidwai, Arjun K. Parasher, Joshua B. Bederson, and Satish Govindaraj 11 Cranioplasty: Development and Clinical Use in Neurosurgery .......................... 297 Kyle J. Riley, Anthony B. Costa, Joshua B. Bederson, and Raj Shrivastava 12 Digital Planning in Pediatric Craniofacial Surgery ............................................. 305 Samer Elia Haber, Anup Patel, and Derek M. Steinbacher 13 Craniomaxillofacial Free Flap Reconstruction Using Virtual Surgical Planning ....................................................................................... 331 James Leighton Mayo and Hugo St. Hilaire 14 Navigation and Computer-Assisted Craniomaxillofacial Surgery ..................... 351 Nils-Claudius Gellrich and Majeed Rana 15 Digital Planning of Craniomaxillofacial Radiation Therapy .............................. 375 Gido Bittermann, Marc C. Metzger, and Rainer Schmelzeisen Index ................................................................................................................................. 381 vii Contributors Oleh M. Antonyshyn, MD, FRCSC Division of Plastic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada Christopher Beaudreau, BS 3D Systems, Littleton, CO, USA Joshua B. Bederson, MD Department of Neurosurgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA Gido Bittermann, DMD, MD, Dr Department of Craniomaxillofacial Surgery, University of Freiburg, Freiburg, Germany Vincent Carrao, DDS, MD Division of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA Andrew M. Christensen, BS Division of Medical Physics, University of Ottawa, Ottawa, ON, Canada Anthony B. Costa, PhD Department of Neurosurgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA Glenn Edwards, BES, BArch Calavera Surgical Design, Toronto, ON, Canada Nils-Claudius Gellrich, MD, DDS, Prof Dr Department of Oral & Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany Satish Govindaraj, MD Department of Otolaryngology, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA Gerald T. Grant, DMD, MS, FACP Oral Health and Rehabilitation, University of Louisville School of Dentistry, Louisville, KY, USA Alex M. Greenberg, DDS Division of Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, New York, NY, USA The New York Presbyterian Hospital, New York, NY, USA The Mount Sinai Hospital, New York, NY, USA Samer Elia Haber, MD Plastic and Maxillofacial Surgery Department, Hôtel Dieu de France Hospital, Beirut, Lebanon Hugo St. Hilaire, DDS, MD, FACS Division of Plastic & Reconstructive Surgery, Department of Surgery, Louisiana State University, New Orleans, LA, USA Benjamin Johnson, BS 3D Systems, Littleton, CO, USA Sarah M. Kidwai, MD Department of Otolaryngology, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA James G. Mainprize, PhD Department of Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada ix x Contributors James Leighton Mayo, MD Aesthetic and Reconstructive Surgery Institute, Orlando Health- University of Florida Cancer Center of Orlando, Orlando, FL, USA Marc C. Metzger, DMD, MD, PhD, Prof Dr Department of Maxillofacial and Oral Surgery, University of Freiburg, Freiburg, Germany Arjun K. Parasher, MD Department of Otolaryngology, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA Anup Patel, MD, MBA Yale Plastic Surgery, New Haven, CT, USA Majeed Rana, MD, DDS, PD Dr Department of Oral & Craniomaxillofacial Surgery, Hannover Medical School, Hanover, Germany Michael Rensberger, MS 3D Systems, Littleton, CO, USA Kyle J. Riley, BA Icahn School of Medicine at Mount Sinai, New York, NY, USA Rainer Schmelzeisen, MD, DDS, PhD, FRCS, Prof Dr Department of Maxillofacial and Oral Surgery, University of Freiburg, Freiburg, Germany Raj Shrivastava, MD Department of Neurosurgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA Derek M. Steinbacher, DMD, MD, FACS Craniomaxillofacial Surgery, Yale University School of Medicine, New Haven, CT, USA Leslie H. Sultan, DDS Department of Surgery, Broward Health Medical Center, Fort Lauderdale, FL, USA Mohammad Tofigh, DDS, MD Private Practive, Oral and Maxillofacial Surgery, New York, NY, USA Katherine Weimer, BS, MS 3D Systems, Littleton, CO, USA Samuel J. Zeichner, DMD, MA, MS(Hyg) Division of Oral and Maxillofacial Radiology, Columbia University College of Dental Medicine, New York, NY, USA University of Basel Faculty of Medicine, Department of Clinical Morphology, Biomedical Engineering/Hightech Research Center, Allschwil, Switzerland Introduction to Digital Technologies 1 in Craniomaxillofacial Surgery Alex M. Greenberg The purpose of this textbook is to review digital technologies cephalometric x-rays, the production of mounted dental in craniomaxillofacial surgery that have become important casts, the cutting of plaster models, and hand fabrication of new tools for surgeons. As a result of improvements in digi- occlusal splints are now replaced with highly accurate and tal imaging technology and the software programs that are timesaving virtual surgical planning and rapid printed cut- able to utilize their data, a wide variety of applications have ting guides and occlusal templates (Fig. 1.6) [6]. Distraction been developed [1, 2]. These applications include the use of osteogenesis can also be planned and performed utilizing virtual surgical planning (VSP) for the design and intraop- VSP with cutting and drill guides for the creation of osteoto- erative implementation of surgical procedures involving mies and the placement of hardware. Stereolithographic orthognathic surgery, resection and immediate reconstruc- models can be sterilized and used in surgery for various tion of tumors, distraction osteogenesis, cranioplasty, cos- applications. Stereolithographic models can also be utilized metic facial implants, dental implant placement, and facial to practice osteotomy cuts and design bone cutting proce- fractures. Stereolithographic and rapid printing allows the dures (Figs. 1.7–1.15). Stereolithographic models can also fabrication of highly accurate 3D models and surgical tem- be utilized for the custom fabrication of patient-specific plates to support these various craniomaxillofacial surgical implants for facial cosmetic surgery utilizing solid silicone procedures (Fig. 1.1). Primary to all of these applications or PTFE (Figs. 1.16–1.24) [7]. The precision placement of have been advances in CT scanning specifically cone beam dental implants utilizing software planning with surgical CT (CBCT), which has become widely available as an out- drill guides fabricated by rapid printing allows flapless place- patient office scanning procedure [3]. CBCT has a signifi- ment with control of implant trajectory and depth (Figs. 1.25– cantly lower radiation exposure [3] and provides high levels 1.32) [3, 8]. Immediate temporization through laboratory or of 3D imaging at a reduced cost. For the first time, 3D imag- CADCAM milling in coordination with dental implant soft- ing has become available in an office setting with CBCT ware planning can allow for teeth in a day procedures. software applications that provide surgeons with powerful Cranioplasty procedures with mesh and methylmethacrylate diagnostic and treatment tools (Figs. 1.1, 1.2, 1.3, and 1.4). are now replaced by 3D modeling using VSP to create Data from CBCT can be uploaded to various vendors for use patient-specific cranial and craniofacial implants [9]. Cranial with virtual surgical planning (VSP). implants made with PEEK can be CNC milled, or titanium Stereolithographic model fabrication, rapid manufactur- mesh fabricated by titanium implants can be fabricated using ing, and rapid printing allow the implementation of VSP or selective laser melting (SLM), electron beam melting other planning methods by the production of accurate ana- (EBM), and direct metal sintering (DMLS) [2]. tomic models, cutting and drilling guides (Fig. 1.5) [4], pre- Navigation has proven to be a valuable new tool for the fabrication of bone plates, occlusal splints [5], and other management of complex head and neck tumor surgery, cra- surgical hardware. Orthognathic surgical procedures that niofacial surgery, endoscopic sinus surgery, and ortho- required 6–8 h of planning utilizing hand drawn tracings of graphic surgery to ensure the correct resection of margins, repositioning of segments, and immediate reconstruction A.M. Greenberg (*) with complex bone grafts in 3D real-time space [10–15]. Division of Oral and Maxillofacial Surgery, Columbia University Complex surgery for facial transplantation, war injury- College of Dental Medicine, 18 East 48th Street Suite 1702, related facial reconstruction, cancer ablation, and immedi- New York, NY 10017, USA ate reconstruction can benefit from intraoperative e-mail: [email protected] © Springer Science+Business Media, LLC, part of Springer Nature 2018 1 A.M. Greenberg (ed.), Digital Technologies in Craniomaxillofacial Surgery, https://doi.org/10.1007/978-1-4939-1532-3_1 2 A.M. Greenberg Fig. 1.1 Stereolithographic model of skull with meningocele anterior cranial base and hypertelorism with nasal deformity and skeletal Class III malocclusion Figs. (a) and (b). (a) Frontal view. (b) Superior view. (c) 3D printed maxilla and mandible Fig. 1.2 CBCT axial view of mandible cutting guide utilization. Head and neck tumor surgery can Digital technologies are just at the beginning of providing be preoperatively precisely digitally planned for both the surgeons with important tools to allow more accurate, pre- resection and immediate reconstruction with microvascular cise surgical procedures with the advantage of improved osteomyocutaneous grafts with dental implant planning as patient outcomes. The savings of time allows surgeons to a single procedure with rapid printed or milled bone cutting care for more patients in an efficient manner compared to guides, drill guides, and occlusal splints (Figs. 1.33–1.43) traditional analog methods. Sharing of information through [16]. New frontiers in facial transplantation also benefit the Internet whether data transfer, sharing of images, and from preoperative digital planning and the use of cutting participation of doctors as teams improves communication guides (Figs. 1.44–1.50) [17]. Digital planning for radia- and reduces misdiagnosis and errors that were acceptable in tion therapy for head and neck tumors with improved accu- the past. Innovations can multiply more rapidly in the digital racy for preoperative, intraoperative, and postoperative environment, and entire fields of surgery can be upended beam orientation and more precise field of exposure is a overnight by breakthrough techniques that can be practiced new area of interest. virtually before implementation in the operating room.
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