Development and first clinical application of automated virtual reconstruction of unilateral midface defects

Wagner, Maximilian; Lichtenstein, Jürgen; Winkelmann, Marcel; Shin, Hoen‐oh; Gellrich, Nils‐Claudius; Essig, Harald

doi:10.1016/j.jcms.2015.06.033

Cited by 27 publications

(16 citation statements)

References 31 publications

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“…Nevertheless, to improve patient care, the clinical routine includes the option of virtual planning before the operation, using the established methods of mirroring or registration. However, the mirroring and registration techniques can only be applied to unilateral fractures [19][20][21]. In the case of a bilateral midface fracture, there is still no clinically proven concept of how to virtually restore the midface compartment.…”

Section: Discussionmentioning

confidence: 99%

The statistical shape model as a quality assurance measure in the treatment of complex midface fractures: a case control study

et al. 2021

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Background Complex bilateral midface fractures necessitate a surgically challenging procedure to preserve or restore the occlusion and the sensitive eye area. In this case control study, we aim to show the potential of a statistical shape model (SSM) for measuring the quality of the midface reconstruction, compared to the estimated preoperative situation. Methods An individualized SSM was postoperatively registered on 19 reconstructed complex bilateral midface fractures. Using this SSM, the distances from the simulated preoperative situation to the postoperative positions of the fracture segments were calculated. The fracture lines for Le Fort II, Le Fort III, and NOE fractures were chosen as reference points for the distance measurements. Results The SSM could be registered on all 19 complex bilateral midface fractures. All analyzed fractures showed a dorsal impaction (negative values) of the midface. Le Fort II fractures showed deviation values of –0.98 ± 4.6 mm, Le Fort III fractures showed values of –3.68 ± 3.6 mm, NOE type 2 fractures showed values of –0.25 ± 4.6 mm, and NOE type 1 fractures showed values of –0.25 ± 4.6 mm. Conclusions The SSM can be used to measure the quality of the achieved reduction of complex bilateral midface fractures based on the estimated preoperative situation. Trial registration DRKS00009719.

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Section: Discussionmentioning

confidence: 99%

The statistical shape model as a quality assurance measure in the treatment of complex midface fractures: a case control study

et al. 2021

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“…Maxillofacial fractures occur in a significant proportion of trauma patients because of the prominent and exposed position of the head and have been increasing over the past decades (Chrcanovic et al, 2012 ). Close proximity of various critical structures is a challenge in terms of functional, as well as esthetic outcomes, in craniomaxillofacial surgery (Wagner et al, 2015 ). Due to its exposed position and its limited bone thickness, orbital structures are involved in up to 40% of the maxillofacial trauma cases (Hoffmann et al, 1998 ), resulting in blowout fractures of zygomatic fractures involving the area of the orbital floor or the medial orbital wall, which may lead to diplopia and enophthalmos (Manolidis et al, 2002 ).…”

Section: Introductionmentioning

confidence: 99%

Virtual reconstruction of orbital floor defects using a statistical shape model

et al. 2021

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Purpose The current standard in reconstructing defects of the orbital floor, by using the concept of mirroring, is time‐consuming and ignores the natural asymmetry of the skull. By using a statistical shape model (SSM), the reconstruction can be automatized and improved in accuracy. The present study aims to show the possibilities of the virtual reconstruction of artificial defects of the orbital floor using an SSM and its potentials for clinical implementation. Methods Based on 131 unaffected CT scans of the midface, an SSM was created which contained the shape variability of the orbital floor. Nineteen midface CT scans, that were not included in the SSM, were manually segmented to establish ground truth (control group). Then artificial defects of larger and smaller sizes were created and reconstructed using SSM (Group I) and the gold standard of mirroring (Group II). Eventually, a comparison to the surface of the manual segmentation (control group) was performed. Results The proposed method of reconstruction using an SSM leads to more precise reconstruction results, compared with the conventional method of mirroring. Whereas mirroring led to the reconstruction errors of 0.7 mm for small defects and 0.73 mm for large defects, reconstruction using SSM led to deviations of 0.26 mm (small defect) and, respectively, 0.34 mm (large defect). Conclusions The presented approach is an effective and accurate method for reconstructing the orbital floor. In connection with modern computer‐aided design and manufacturing, individual patient‐specific implants could be produced according to SSM‐based reconstructions and could replace current methods using manual bending techniques. By acknowledging the natural asymmetry of the human skull, the SSM‐based approach achieves higher accuracy in reconstructing injured orbits.

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“…However, the mirroring and registration techniques can only be applied to unilateral fractures. (19)(20)(21) In the case of a bilateral midface fracture, there is still no clinically proven concept of how to virtually restore the midface compartment.…”

Section: Discussionmentioning

confidence: 99%

The Statistical shape model as a quality assurance measure in the treatment of complex midface fractures: A Case control study

Fuessinger

Steffen

Gass

et al. 2020

Preprint

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BackgroundComplex bilateral midface fractures necessitate a surgically challenging procedure to preserve or restore the occlusion and the sensitive eye area. In this case control study, we aim to show the potential of a statistical shape model (SSM) for measuring the quality of the midface reconstruction, compared to the estimated preoperative situation.MethodsAn individualized SSM was postoperatively registered on 19 reconstructed complex bilateral midface fractures. Using this SSM, the distances from the simulated preoperative situation to the postoperative positions of the fracture segments were calculated. The fracture lines for Le Fort II, Le Fort III, and NOE fractures were chosen as reference points for the distance measurements.ResultsThe SSM could be registered on all 19 complex bilateral midface fractures. All analyzed fractures show a dorsal impaction (negative values) of the midface. Le Fort II fractures show deviation values of − 0.98 ± 4.6 mm, Le Fort III fractures show values of − 3.68 ± 3.6 mm, NOE type 2 fractures show values of − 0.25 ± 4.6 mm, and NOE type 1 fractures show values of − 0.25 ± 4.6 mm.ConclusionThe SSM can be used to measure the quality of the achieved reduction of complex bilateral midface fractures based on the estimated preoperative situation.Trial registrationDRKS00009719

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Development and first clinical application of automated virtual reconstruction of unilateral midface defects

Cited by 27 publications

References 31 publications

The statistical shape model as a quality assurance measure in the treatment of complex midface fractures: a case control study

The statistical shape model as a quality assurance measure in the treatment of complex midface fractures: a case control study

Virtual reconstruction of orbital floor defects using a statistical shape model

The Statistical shape model as a quality assurance measure in the treatment of complex midface fractures: A Case control study

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