Algorithms at the intersection of computer graphics and medicine have recently gained renewed attention. A particular interest are methods for virtual surgery planning (VSP), where treatment parameters must be carefully chosen to achieve a desired treatment outcome. FEM simulators can verify the treatment parameters by comparing a predicted outcome to the desired one. However, estimating the optimal parameters amounts to solving a challenging inverse problem. In current clinical practice it is solved manually by surgeons, who rely on their experience and intuition to iteratively refine the parameters, verifying them with simulated predictions. We prototype a differentiable FEM simulator and explore how it can enhance and simplify treatment planning, which is ultimately necessary to integrate simulation-based VSP tools into a clinical workflow. Specifically, we define a parametric treatment model based on surgeon input, and with analytically derived simulation gradients we optimise it against an objective defined on the visible facial 3D surface. By using sensitivity analysis, we can easily explore the solution-space with first-order approximations, which allow the surgeon to interactively visualise the effect of parameter variations on a given treatment plan. The objective function allows landmarks to be freely chosen, accommodating the multiple methodologies in clinical planning. We show that even with a very sparse set of guiding landmarks, our simulator robustly converges to a feasible post-treatment shape.

Purpose Presurgical orthopedic plates are widely used for the treatment of cleft lip and palate, which is the most common craniofacial birth defect. For the traditional plate fabrication, an impression is taken under airway-endangering conditions, which recent digital alternatives overcome via intraoral scanners. However, these alternatives demand proficiency in 3D modeling software in addition to the generally required clinical knowledge of plate design. Methods We address these limitations with a data-driven and fully automated digital pipeline, endowed with a graphical user interface. The pipeline adopts a deep learning model to landmark raw intraoral scans of arbitrary mesh topology and orientation, which guides the nonrigid surface registration subsequently employed to segment the scans. The plates that are individually fit to these segmented scans are 3D-printable and offer optional customization. Results With the distance to the alveolar ridges closely centered around the targeted 0.1 mm, our pipeline computes tightly fitting plates in less than 3 min. The plates were approved in 12 out of 12 cases by two cleft care professionals in a printed-model-based evaluation. Moreover, since the pipeline was implemented in clinical routine in two hospitals, 19 patients have been undergoing treatment utilizing our automated designs. Conclusion The results demonstrate that our automated pipeline meets the high precision requirements of the medical setting employed in cleft lip and palate care while substantially reducing the design time and required clinical expertise, which could facilitate access to this presurgical treatment, especially in low-income countries.

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