Development and refinement of computer-assisted planning and execution system for use in face–jaw–teeth transplantation to improve skeletal and dento-occlusal outcomes

Hashemi, Sepehr; Armand, Mehran; Gordon, Chad R.

doi:10.1097/mot.0000000000000350

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…A Computer-Assisted Planning and Execution workstation has been described by Gordon et al 44 and piloted in swine and human cadaveric simulations of Le Fort-type face transplants with satisfactory accuracy. 45,46 The experimental system seeks to dynamically integrate CSP, CAD/CAM, and surgical navigation. It enables intraoperative revision of CSP based on real-time cephalometric and occlusion analyses and positional tracking of cutting guides, combined with the use of custom prebent fixation plates and palatal splints.…”

Section: Discussionmentioning

confidence: 99%

Computerized Approach to Facial Transplantation: Evolution and Application in 3 Consecutive Face Transplants

Ramly

Kantar

Diaz-Siso

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background:Face transplant (FT) candidates present with unique anatomic and functional defects unsuitable for autologous reconstruction, making the accurate design and transplantation of patient-specific allografts particularly challenging. In this case series, we present our computerized surgical planning (CSP) protocol for FT.Methods:CSP, computer-aided design and manufacturing, intraoperative navigation, and intraoperative computerized tomography have been successfully incorporated into a comprehensive protocol. Three consecutive FTs were performed. CSP and postoperative results were compared using computerized tomography–derived cephalometric measurements, and the literature was reviewed.Results:Two full and 1 partial FT were successfully performed using the CSP protocol. CSP facilitated the execution of FT with minor angular and translational cephalometric variations on immediate postoperative imaging. Our evolving experience was accompanied by a decreased reliance on cadaveric simulation, from 10 mock transplants and a research procurement before the senior author’s first clinical FT (2012) to 6 mock transplants and no research procurement before the third FT (2018). Operative time was significantly reduced from 36 to 25 hours, as was the need for major orthognathic surgical revision. This reflects the learning curve and variable case complexity, but it is also representative of improved planning and execution, complemented by the systematic incorporation of CSP into FT.Conclusions:A CSP protocol allows for refinement of operative flow, technique, and outcomes in partial and full FT. Standards for functional and esthetic outcomes are bound to evolve with the field’s growth, and computerized planning and execution offer a reproducible approach to FT through objective quality assurance.

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Section: Discussionmentioning

confidence: 99%

Computerized Approach to Facial Transplantation: Evolution and Application in 3 Consecutive Face Transplants

Ramly

Kantar

Diaz-Siso

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…20 Preoperative casts can be very time consuming, however, and may be hindered by the unexpected presence of dental caries, soft tissue bulk, and difficulty with intraoperative osteotomies. 21,22 Virtual Surgical Planning Preoperative CT imaging of donor and recipient bony structures can allow for virtual manipulation, occlusal and other bony comparisons, and planning of osteotomies to maximize the skeletal match. Jacobs et al described a protocol for VSP to aid in appropriate bony match between a donor and recipient.…”

Section: Orthognathic Planningmentioning

confidence: 99%

Section: Orthognathic Planningmentioning

confidence: 99%

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Maxillofacial Bony Considerations in Facial Transplantation

et al. 2021

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Alloplastic facial transplantation has become a new rung on the proverbial reconstructive ladder for severe facial wounds in the past couple of decades. Since the first transfer including bony components in 2006, numerous facial allotransplantations across many countries have been successfully performed, many incorporating multiple bony elements of the face. There are many unique considerations to facial transplantation of bone, however, beyond the considerations of simple soft tissue transfer. Herein, we review the current literature and considerations specific to bony facial transplantation focusing on the pertinent surgical anatomy, preoperative planning needs, intraoperative harvest and inset considerations, and postoperative protocols.

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“…[40][41][42][43] Almost all studies noted improvements in operative time, resolution of malocclusion, and postoperative satisfaction with appearance. [44][45][46][47][48][49][50] Intraoperative time was markedly improved in cases where surgical residents were involved, with the most difference and surgical difficulty noted at the zygomatic arch. [40][41][42] Markiewicz and Bell noted an average deviation of approximately 1 mm in midface and mandible projections, with highest deviations at the LeFort and chin triangles at 2 and 5 mm, respectively.…”

Section: Three-dimensional Printing and Patient-specific Modelingmentioning

confidence: 99%

Implications of Applying New Technology in Cosmetic and Reconstructive Facial Plastic Surgery

et al. 2020

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The field of facial plastic and reconstructive surgery is privy to a myriad of technological advancements. As innovation in areas such as imaging, computer applications, and biomaterials progresses at breakneck speed, the potential for clinical application is endless. This review of recent progress in the implementation of new technologies in facial plastic surgery highlights some of the most innovative and impactful developments in the past few years of literature. Patient-specific surgical modeling has become the gold standard for oncologic and posttraumatic reconstructive surgery, with demonstrated improvements in operative times, restoration of anatomical structure, and patient satisfaction. Similarly, reductions in revision rates with improvements in learner technical proficiency have been noted with the use of patient-specific models in free flap reconstruction. In the cosmetic realm, simulation-based rhinoplasty implants have drastically reduced operative times while concurrently raising patient postoperative ratings of cosmetic appearance. Intraoperative imaging has also seen recent expansion in its adoption driven largely by reports of eradication of postoperative imaging and secondary—often complicated—revision reconstructions. A burgeoning area likely to deliver many advances in years to come is the integration of bioprinting into reconstructive surgery. Although yet to clearly make the translational leap, the implications of easily generatable induced pluripotent stem cells in replacing autologous, cadaveric, or synthetic tissues in surgical reconstruction are remarkable.

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Development and refinement of computer-assisted planning and execution system for use in face–jaw–teeth transplantation to improve skeletal and dento-occlusal outcomes

Cited by 7 publications

References 28 publications

Computerized Approach to Facial Transplantation: Evolution and Application in 3 Consecutive Face Transplants

Computerized Approach to Facial Transplantation: Evolution and Application in 3 Consecutive Face Transplants

Maxillofacial Bony Considerations in Facial Transplantation

Implications of Applying New Technology in Cosmetic and Reconstructive Facial Plastic Surgery

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