- Email: [email protected]
The surgical reconstruction of post-traumatic defects and deformities of the orbit with frameless navigation
21st ICOMS 2013 - Abstracts: Oral Papers T22.OR001
1307
T22.OR003 Surgical navigation on tablet PC—feasibility study with a newly developed navigation system
T22. Navigation Navigation-guided mandibular distraction osteogenesis: a preliminary study M. Cai 1,∗ , G. Shen 1 , Y. Lin 2 , X. Wang 1 1 2
Oral & Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, China College of Mechanical and Power Engineering, Shanghai Jiaotong University, China
Purpose: This preliminary animal study aim to evaluate the accuracy of navigation assisted distraction osteogenesis (DO) in goat’s mandible by TBNavis-CMFS navigation system. Materials and methods: A total of 6 adult goats were included in this study. After 5 maxillary marking screws implantation and intermaxillary fixation with prefabricated occlusal splint, CT scan with 0.625 mm thickness was performed. The CT data was then transferred to the workstation of TBNavis-CMFS navigation system (Multifunctional Surgical Navigation System, Shanghai, China) to reconstruct a 3D imagine. Simulating distraction osteogenesis was planned in unilateral mandibular body for 10 mm lengthening and three dimensional measurement was carried out for each animal. An imagine-guided navigation surgery was performed for unilateral mandibular distraction osteogenesis based on the pre-operative design. Post-surgical measurement was compared statistically at the time of 3 m post-operatively. Results: The accuracy of intra-operative registration was within 1 mm and mandible was lengthened 10.02 mm in average (9.89–10.12 mm). No significant differences were recognized of pre and post-surgical 3D measurements comparison (P > 0.05). Conclusions: Pre-surgical planning could be transferred to unilateral mandibular distraction osteogenesis surgery with high accuracy by using of TBNavis-CMFS navigation system.
P. Jürgens 1,2,∗ , A. Schneider 3 , C. Zeilhofer 1,2 , P. Cattin 3
Baumberger 3 , M.
Griessen 3 , J.
Beinemann 2 , H.F.
1 Dept. of Oral & Maxillofacial Surgery, University Hospital Basel, Faculty of Medicine, University of Basel, Switzerland 2 Hightech-Research Center of CMF Surgery, University of Basel, Switzerland 3 Medical Image Analysis Center, MIAC, University of Basel, Switzerland
The application of navigational support is commonly accepted in CMF surgery for several indications. Still the use is limited to those medical centers that can effort the costs for a navigation system. Usually the navigation systems provide information (e.g. an anatomical structure of interest) in 2D cross-section in three different directions. A pointer-tool is used to define the actual position of the instruments inside the working volume. In this paper we propose a cost effective real-time augmented reality approach using an off-the-shelf tablet PC in combination with novel 2D/3D point correspondence mapping techniques. The two proposed point pattern matching algorithms are tailored towards moderate projective distortions and computational low-power devices. The Android guidance application provides a 3D display of all relevant structures. The system was tested, evaluated and validated in the laboratory environment on a concrete medical indication (removal of an intraosseous tumour with security margins) by surgeons with experience in navigation as well as absolutely unexperienced students of dentistry. It could be shown, that the tablet navigation is simple and intuitive. As it allows to perform interventions with the same accuracy like with ‘classical’ navigation, it could become a cost-effective alternative to the existing systems. http://dx.doi.org/10.1016/j.ijom.2013.07.461 T22.OR004
http://dx.doi.org/10.1016/j.ijom.2013.07.459 T22.OR002 Computer-assisted planning and intraoperative navigation in post-traumatic orbital reconstruction
The surgical reconstruction of post-traumatic defects and deformities of the orbit with frameless navigation V. Mikhaylyukov 1,∗ , D. Davydov 2 , O. Levchenko 1 1
Moscow State Medical-Dental University, Russia N.V. Sklifosovsky Research Institute of Emergency Medicine, Russia
A. Dean 1,∗ , S. Heredero 1 , F. Alamillos 1 , J. Solivera 2 , A. Candau 1
2
1
Introduction: One of the urgent tasks of the modern neurosurgery is to increase the quality of the surgical care for patients with posttraumatic defects and deformations of the orbit. The area of damaged bone structure orbital requires the primary reconstruction of the defects by using the autografts, implants and metal. The size and location of the implant plays a great role in restoration of the right anatomy of the bone structures in the zygomaticoorbital complex. Procedure of the frameless navigation is one of the ultimate solutions for this problem. Materials and methods: 20 reconstructive operations with orbital posttraumatic defects had been performed in our clinic. In the preoperative period CT-scan had been performed. The CT-scan data were loaded into the database of the neuro-navigation equipment. The layer construction of the virtual model of the missing fragments in bone structures of the orbit were performed on the axial sections. The check of the installed implant shape has been made intraoperative by using the pointer of the navigation equipment so that each point on the surface of the implant makes a similar point coincided with the ‘virtual model’, displayed on the display. Results: All patients have recovered the correct anatomy of the zygomaticoorbital complex. Conclusion: There is no need to produce a stereolithographic model to create a virtual model of the eye socket. The virtual bone defects simulation of the orbit takes about 20 min. The method of the frameless navigation makes possible to reproduce most accurately the shape, the size and the position of the bone fragments and implants after elimination of the deformation and orbital defects. This allows to achieve high functional and aesthetic results. Key word: frameless navigation
2
Oral And Maxillofacial Service, University Hospital Reina Sofía, Córdoba, Spain Neurosurgery Service, University Hospital Reina Sofía, Córdoba, Spain
Aim: Post-traumatic enophthalmos or distopia may be a sequella of orbital fractures after inaccurate restoration of orbital anatomy. The preoperative computer-assisted planning with virtual correction has been combined with intraoperative navigation in an attempt to more accurately reconstruct the bony orbital walls. The purpose of this presentation is to show our experience with computer planning, and intraoperative navigation in patients with orbital wall fractures. Material and methods: Eight patients with orbital trauma were included in this study. The imaging and planning platform used in this study was iPlan (Brainlab). Virtual correction was made using the uninjured side by creating a mirror image that was superimposed on the traumatized side and using the image of a contoured titanium orbital mesh (in floor of the orbit and medial wall) or a virtual guide for the reconstruction of the roof. Intraoperative navigation was used to assess the accuracy of walls restoration and the computer planning models were used intraoperatively as a virtual template to navigate the preplanned bony contours. All patients were reconstructed with a previously contoured titanium orbital mesh, either commercially available or molded in a skull. Results: Enophthalmos decreased to less than 2 mm in all the patients. Anatomic restoration of orbital contours was obtained in all the patients according to the comparison of preoperative and postoperative CT scans. Accuracy was proved by comparing postoperative CT and the computed virtually planned reconstruction. Conclusions: Preoperative computer modelling and intraoperative navigation is a useful guide and provides an accurate reconstruction of orbital fractures. Key words: navigation; computer planning; orbital trauma http://dx.doi.org/10.1016/j.ijom.2013.07.460
http://dx.doi.org/10.1016/j.ijom.2013.07.462
1307
T22.OR003 Surgical navigation on tablet PC—feasibility study with a newly developed navigation system
T22. Navigation Navigation-guided mandibular distraction osteogenesis: a preliminary study M. Cai 1,∗ , G. Shen 1 , Y. Lin 2 , X. Wang 1 1 2
Oral & Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, China College of Mechanical and Power Engineering, Shanghai Jiaotong University, China
Purpose: This preliminary animal study aim to evaluate the accuracy of navigation assisted distraction osteogenesis (DO) in goat’s mandible by TBNavis-CMFS navigation system. Materials and methods: A total of 6 adult goats were included in this study. After 5 maxillary marking screws implantation and intermaxillary fixation with prefabricated occlusal splint, CT scan with 0.625 mm thickness was performed. The CT data was then transferred to the workstation of TBNavis-CMFS navigation system (Multifunctional Surgical Navigation System, Shanghai, China) to reconstruct a 3D imagine. Simulating distraction osteogenesis was planned in unilateral mandibular body for 10 mm lengthening and three dimensional measurement was carried out for each animal. An imagine-guided navigation surgery was performed for unilateral mandibular distraction osteogenesis based on the pre-operative design. Post-surgical measurement was compared statistically at the time of 3 m post-operatively. Results: The accuracy of intra-operative registration was within 1 mm and mandible was lengthened 10.02 mm in average (9.89–10.12 mm). No significant differences were recognized of pre and post-surgical 3D measurements comparison (P > 0.05). Conclusions: Pre-surgical planning could be transferred to unilateral mandibular distraction osteogenesis surgery with high accuracy by using of TBNavis-CMFS navigation system.
P. Jürgens 1,2,∗ , A. Schneider 3 , C. Zeilhofer 1,2 , P. Cattin 3
Baumberger 3 , M.
Griessen 3 , J.
Beinemann 2 , H.F.
1 Dept. of Oral & Maxillofacial Surgery, University Hospital Basel, Faculty of Medicine, University of Basel, Switzerland 2 Hightech-Research Center of CMF Surgery, University of Basel, Switzerland 3 Medical Image Analysis Center, MIAC, University of Basel, Switzerland
The application of navigational support is commonly accepted in CMF surgery for several indications. Still the use is limited to those medical centers that can effort the costs for a navigation system. Usually the navigation systems provide information (e.g. an anatomical structure of interest) in 2D cross-section in three different directions. A pointer-tool is used to define the actual position of the instruments inside the working volume. In this paper we propose a cost effective real-time augmented reality approach using an off-the-shelf tablet PC in combination with novel 2D/3D point correspondence mapping techniques. The two proposed point pattern matching algorithms are tailored towards moderate projective distortions and computational low-power devices. The Android guidance application provides a 3D display of all relevant structures. The system was tested, evaluated and validated in the laboratory environment on a concrete medical indication (removal of an intraosseous tumour with security margins) by surgeons with experience in navigation as well as absolutely unexperienced students of dentistry. It could be shown, that the tablet navigation is simple and intuitive. As it allows to perform interventions with the same accuracy like with ‘classical’ navigation, it could become a cost-effective alternative to the existing systems. http://dx.doi.org/10.1016/j.ijom.2013.07.461 T22.OR004
http://dx.doi.org/10.1016/j.ijom.2013.07.459 T22.OR002 Computer-assisted planning and intraoperative navigation in post-traumatic orbital reconstruction
The surgical reconstruction of post-traumatic defects and deformities of the orbit with frameless navigation V. Mikhaylyukov 1,∗ , D. Davydov 2 , O. Levchenko 1 1
Moscow State Medical-Dental University, Russia N.V. Sklifosovsky Research Institute of Emergency Medicine, Russia
A. Dean 1,∗ , S. Heredero 1 , F. Alamillos 1 , J. Solivera 2 , A. Candau 1
2
1
Introduction: One of the urgent tasks of the modern neurosurgery is to increase the quality of the surgical care for patients with posttraumatic defects and deformations of the orbit. The area of damaged bone structure orbital requires the primary reconstruction of the defects by using the autografts, implants and metal. The size and location of the implant plays a great role in restoration of the right anatomy of the bone structures in the zygomaticoorbital complex. Procedure of the frameless navigation is one of the ultimate solutions for this problem. Materials and methods: 20 reconstructive operations with orbital posttraumatic defects had been performed in our clinic. In the preoperative period CT-scan had been performed. The CT-scan data were loaded into the database of the neuro-navigation equipment. The layer construction of the virtual model of the missing fragments in bone structures of the orbit were performed on the axial sections. The check of the installed implant shape has been made intraoperative by using the pointer of the navigation equipment so that each point on the surface of the implant makes a similar point coincided with the ‘virtual model’, displayed on the display. Results: All patients have recovered the correct anatomy of the zygomaticoorbital complex. Conclusion: There is no need to produce a stereolithographic model to create a virtual model of the eye socket. The virtual bone defects simulation of the orbit takes about 20 min. The method of the frameless navigation makes possible to reproduce most accurately the shape, the size and the position of the bone fragments and implants after elimination of the deformation and orbital defects. This allows to achieve high functional and aesthetic results. Key word: frameless navigation
2
Oral And Maxillofacial Service, University Hospital Reina Sofía, Córdoba, Spain Neurosurgery Service, University Hospital Reina Sofía, Córdoba, Spain
Aim: Post-traumatic enophthalmos or distopia may be a sequella of orbital fractures after inaccurate restoration of orbital anatomy. The preoperative computer-assisted planning with virtual correction has been combined with intraoperative navigation in an attempt to more accurately reconstruct the bony orbital walls. The purpose of this presentation is to show our experience with computer planning, and intraoperative navigation in patients with orbital wall fractures. Material and methods: Eight patients with orbital trauma were included in this study. The imaging and planning platform used in this study was iPlan (Brainlab). Virtual correction was made using the uninjured side by creating a mirror image that was superimposed on the traumatized side and using the image of a contoured titanium orbital mesh (in floor of the orbit and medial wall) or a virtual guide for the reconstruction of the roof. Intraoperative navigation was used to assess the accuracy of walls restoration and the computer planning models were used intraoperatively as a virtual template to navigate the preplanned bony contours. All patients were reconstructed with a previously contoured titanium orbital mesh, either commercially available or molded in a skull. Results: Enophthalmos decreased to less than 2 mm in all the patients. Anatomic restoration of orbital contours was obtained in all the patients according to the comparison of preoperative and postoperative CT scans. Accuracy was proved by comparing postoperative CT and the computed virtually planned reconstruction. Conclusions: Preoperative computer modelling and intraoperative navigation is a useful guide and provides an accurate reconstruction of orbital fractures. Key words: navigation; computer planning; orbital trauma http://dx.doi.org/10.1016/j.ijom.2013.07.460
http://dx.doi.org/10.1016/j.ijom.2013.07.462