Midface Fracture Simulation and Repair: A Computer-Based Algorithm

Abstract

We introduce a novel computer-based method to digitally fixate midfacial fractures to facilitate more efficient intraoperative fixation. This article aims to describe a novel computer-based algorithm that can be utilized to model midface fracture reduction and fixation and to evaluate the algorithm's ability to produce images similar to true postoperative images. This is a retrospective review combined with cross-sectional survey from January 1, 2010, to December 31, 2015. This study was performed at a single tertiary care, level-I trauma center. Ten patients presenting with acute midfacial traumatic fractures were evaluated. Thirty-five physicians were surveyed regarding the accuracy of the images obtained using the algorithm. A computer algorithm utilizing AquariusNet (TeraRecon, Inc., Foster City, CA) and Adobe Photoshop (Adobe Systems Inc., San Jose, CA) was developed to model midface fracture repair. Preoperative three-dimensional computed tomographic (CT) images were processed using the algorithm. Fractures were virtually reduced and fixated to generate a virtual postoperative image. A survey comparing the virtual postoperative and the actual postoperative images was produced. A Likert-type scale rating system of 0 to 10 (0 being completely different and 10 being identical) was utilized. Survey participants evaluated the similarity of fracture reduction and fixation plate appearance. The algorithm's capacity for future clinical utility was also assessed. Survey response results from 35 physicians were collected and analyzed to determine the accuracy of the algorithm. Ten patients were evaluated. Fracture types included zygomaticomaxillary complex, LeFort, and naso-orbito-ethmoidal complex. Thirty-four images were assessed by a group of 35 physicians from the fields of otolaryngology, oral and maxillofacial surgery, and radiology. Mean response for fracture reduction similarity was 7.8 ± 2.5 and fixation plate similarity was 8.3 ± 1.9. All respondents reported interest in the tool for clinical use. This computer-based algorithm is able to produce virtual images that resemble actual postoperative images. It has the ability to model midface fracture repair and hardware placement.

The application of virtual reality and augmented reality in Oral & Maxillofacial Surgery

“…In a series of case reports the virtual surgical planning and hardware fabrication for open reduction and internal fixation of atrophic edentulous mandibular fractures were demonstrated [18][19][20].…”

Improving Aesthetic Outcome in Managing Acute and Chronic Upper and Midface Deformities Using Computer Assisted Planning

“…Knowledge in these fields has improved technicalities in surgical procedures of facial region and have imparted their effect on all aspects of treatment [1]. The complexity in surgical execution has even extended to the educational aspects of the practitioner dealing with deformities in this region [2].…”

“…Despite this advantageous advancement in computer application and its inclusion into hospital protocols widely, some criticism was still in order. These techniques had room for surgical error and hence this was the demerits that had to be addressed [2].…”