Correction of a severe facial asymmetry with computerized planning and with the use of a rapid prototyped surgical template: a case report/technique article

Head & Face Medicine

Jozsef Piffko⁴  Endre Varga³  Balazs Bago²  Zoltan Rasko⁴  Andras Kocsis¹  Endre Varga⁴  Laszlo Seres⁴ 

[1] Orthodontic Clinic, Marostoi u. 29/A, 6726 Szeged, Hungary;Smart Dental Solutions Ltd, Pulcz u. 46/B, 6724 Szeged, Hungary;Department of Traumatology, University of Szeged, Semmelweis u. 6, 6725 Szeged, Hungary;Department of Oral and Maxillofacial Surgery, University of Szeged, Kalvaria sgt. 57, 6725 Szeged, Hungary

关键词: Three-dimensional rapid prototyping;    Digital intermediate wafer;    Computer-aided surgery;    Facial asymmetry;    Virtual model surgery;   

Others  :  1145577
DOI  :  10.1186/1746-160X-10-27

 received in 2014-05-05, accepted in 2014-06-06,  发布年份 2014

【 摘 要 】

Management of significant facial asymmetry presents a challenge due to the geometric complexity of the bony and other facial structures. Manual model surgery is an essential part of treatment planning but it can be complicated, time-consuming and may contain potential errors. Computer-aided surgery has revolutionized the correction of maxillofacial deformities. The aim of this study was to report a case of facial asymmetry when computerised simulation surgery was performed instead of manual model surgery and a virtually planned wafer splint was fabricated. A 26-year-old male was presented with a severe right-sided hemimandibular elongation. Following presurgical orthodontics high-resolution computer tomography scan was performed. The stack images were reformatted into a three-dimensional structure. Virtual Le Fort-I osteotomy was performed and the symmetry of the maxilla was corrected with the help of a three-dimensional planning software. A virtual intermediate surgical wafer was designed and produced with three-dimensional rapid prototyping technology. The mandible was rotated into the correct position following virtual bilateral sagittal split osteotomy to visualize the movements of the osteotomised mandibular segments. The two-jaw procedure was performed according to the virtual plan. The facial symmetry was improved significantly and stable occlusion was achieved. This complex case shows the advantages of computer-aided surgical planning and three-dimensional rapid prototyping for the correction of facial asymmetries.

【 授权许可】

   
2014 Seres et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

Figure 8.

Figure 9.

Figure 10.

Figure 11.

Figure 12.

Figure 13.

Figure 14.

Figure 15.

Figure 16.

Figure 17.

【 参考文献 】

• [1]Cheong YW, Lo LJ: Facial asymmetry: etiology, evaluation, and management. Chang Gung Med J 2011, 34:341-351.
• [2]Cevidanes LH, Tucker S, Styner M, Kim H, Chapuis J, Reyes M, Proffit W, Turvey T, Jaskolka M: Three-dimensional surgical simulation. Am J Orthod Dentofacial Orthop 2010, 138:361-371.
• [3]Ellis E III: Accuracy of model surgery: evaluation of an old technique and introduction of a new one. J Oral Maxillofac Surg 1990, 48:1161-1167.
• [4]Choi JY, Song KG, Baek SH: Virtual model surgery and wafer fabrication for orthognathic surgery. Int J Oral Maxillofac Surg 2009, 38:1306-1310.
• [5]Edler R, Wertheim D, Greenhill D: Outcome measurement in the correction of mandibular asymmetry. Am J Orthod Dentofacial Orthop 2004, 125:435-443.
• [6]Hwang HS, Hwang CH, Lee KH, Kang BC: Maxillofacial 3-dimensional image analysis for the diagnosis of facial asymmetry. Am J Orthod Dentofacial Orthop 2006, 130:779-785.
• [7]Gateno J, Xia JJ, Teichgraeber JF: A new three-dimensional cephalometric analysis for orthognathic surgery. J Oral Maxillofac Surg 2011, 69:606-622.
• [8]Baek SH, Kang SJ, Bell WH, Chu S, Kim HK: Fabricating a surgical wafer splint by three-dimensional virtual model surgery. In Distraction Osteogenesis of the Facial Skeleton. Edited by Bell WH, Guerrero CA. Hamilton, Ontario: BC Decker; 2006:115-130.
• [9]Swennen GR, Mollemans W, Schutyser F: Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging. J Oral Maxillofac Surg 2009, 67:2080-2092.
• [10]Hsu SS, Gateno J, Bell RB, Hirsch DL, Markiewicz MR, Teichgraeber JF, Zhou X, Xia JJ: Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: a prospective multicenter study. J Oral Maxillofac Surg 2013, 71:128-142.
• [11]Metzger MC, Hohlweg-Majert B, Schwarz U, Teschner M, Hammer B, Schmelzeisen R: Manufacturing splints for orthognathic surgery using three-dimensional printer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008, 105:e1-e7.
• [12]Levine JP, Patel A, Saadeh PB, Hirsch DL: Computer-aided design and manufacturing in craniomaxillofacial surgery: the new state of the art. J Craniofac Surg 2012, 23:288-293.
• [13]Lorensen WE, Cline HE: Marching cubes: A high resolution 3D surface construction algorithm. Comp Graph 1987, 21:163-169.
• [14]Erdőhelyi B, Varga E, Kuba A: Surgical planning tool with biomechanical simulation. Proceedings of the International Conference on Computer Assisted Radiology and Surgery (CARS). Int J Comput Assist Radiol Surg 2007, 2:S262-S263.
• [15]Parbatani R, Williams AC, Ireland AJ, Sandy J: The process of orthognathic care in an NHS region. Ann R Coll Surg Engl 2010, 92:34-39.
• [16]Varga E Jr, Hammer B, Hardy BM, Kamer L: The accuracy of three-dimensional model generation. What makes it accurate to be used for surgical planning? Int J Oral Maxillofac Surg 2013, 42:1159-1166.