ABSTRACT
@#BACKGROUND: Loss of skin elasticity due to redundancy of the upper eyelid (dermatochalasis) and falling of the upper eyelid border to a lower position (blepharoptosis) are often the earliest signs of facial aging. Upper eyelid blepharoplasty is an effective procedure to establish a good eyelid position, and is the most common facial cosmetic procedure [1]. When performing upper eyelid blepharoplasty, eyelid symmetry is essential for a satisfactory surgical outcome. Even if not possible, every surgeon tries to achieve complete symmetry when performing aesthetic eyelid surgery [2]. Several previous studies by surgeons with > 10 years of experience reported how preoperative incision markings should be made to achieve satisfactory surgical outcomes and excellent surgical results for upper eyelid blepharoplasty [3-7]. However, none of these studies investigated naturally occurring asymmetry when applying a preoperative design for upper blepharoplasty incision markings. During the preoperative design step, we noticed certain asymmetric tendencies. We therefore characterised these differences to ensure a more effective preoperative design for upper blepharoplasty incision markings for both eyelids. METHODS: This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. We measured medial canthal excision angle (MCA), maximal lid excision height (MLH), maximal lid excision width (MLW), peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software. RESULTS: The mean MCA for the right side (30.68 ± 10.16°) was significantly different to that for the left side (35.39 ± 13.82°; p < 0.001). The mean MLH for the right side (1.17 ± 0.24 cm) was significantly different to that for the left side (1.24 ± 0.25 cm; p = 0.002). The mean MLW for the right side (0.72 ± 0.19 cm) was significantly different to that for the left side (0.77 ± 0.21 cm; p = 0.011). The mean peak point angle for the right side (15.67 ± 5.09°) was significantly different to that for the left side (18.11 ± 5.49°; p = 0.001). The mean peak point distance for the right side (2.41 ± 0.31°) was significantly different to that for the left side (2.22 ± 0.28 cm; p = 0.001). CONCLUSION: In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximised by including the asymmetries in the preoperative design.
ABSTRACT
@#BACKGROUND: Loss of skin elasticity due to redundancy of the upper eyelid (dermatochalasis) and falling of the upper eyelid border to a lower position (blepharoptosis) are often the earliest signs of facial aging. Upper eyelid blepharoplasty is an effective procedure to establish a good eyelid position, and is the most common facial cosmetic procedure [1]. When performing upper eyelid blepharoplasty, eyelid symmetry is essential for a satisfactory surgical outcome. Even if not possible, every surgeon tries to achieve complete symmetry when performing aesthetic eyelid surgery [2]. Several previous studies by surgeons with > 10 years of experience reported how preoperative incision markings should be made to achieve satisfactory surgical outcomes and excellent surgical results for upper eyelid blepharoplasty [3-7]. However, none of these studies investigated naturally occurring asymmetry when applying a preoperative design for upper blepharoplasty incision markings. During the preoperative design step, we noticed certain asymmetric tendencies. We therefore characterised these differences to ensure a more effective preoperative design for upper blepharoplasty incision markings for both eyelids. METHODS: This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. We measured medial canthal excision angle (MCA), maximal lid excision height (MLH), maximal lid excision width (MLW), peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software. RESULTS: The mean MCA for the right side (30.68 ± 10.16°) was significantly different to that for the left side (35.39 ± 13.82°; p < 0.001). The mean MLH for the right side (1.17 ± 0.24 cm) was significantly different to that for the left side (1.24 ± 0.25 cm; p = 0.002). The mean MLW for the right side (0.72 ± 0.19 cm) was significantly different to that for the left side (0.77 ± 0.21 cm; p = 0.011). The mean peak point angle for the right side (15.67 ± 5.09°) was significantly different to that for the left side (18.11 ± 5.49°; p = 0.001). The mean peak point distance for the right side (2.41 ± 0.31°) was significantly different to that for the left side (2.22 ± 0.28 cm; p = 0.001). CONCLUSION: In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximised by including the asymmetries in the preoperative design.
ABSTRACT
Objective To investigate the application of 3D-printing and digital technology in the preoperative design of internal fixation for intra-articular calcaneal fractures.Methods Thin-layer CT images of bilateral calcanei were collected from 12 patients who had been treated for calcaneal fracture of Sanders type Ⅲ from November 2015 to October 2016.They were 7 men and 5 women,aged from 23 to 53 years (average,38.7 years).The images were uploaded into Mimics software for 3D reconstruction,virtual reduction and digital surgical design.Real-size calcaneal models and navigation modules were produced using 3D printing technology for plate preshaping and surgical simulation.The operations were carried out according to preoperative design.The postoperative calcaneal morphological parameters were evaluated.Comparisons were made between postoperative results and preoperative digital design.Results The operating time for the 12 patients ranged from 60 to 90 minutes,averaging 77.9 minutes.Their follow-ups ranged from 4 to 8 months,averaging 6.2 months.No complications affecting their soft tissues happened.The postoperative B(o)hler angle (32.6° ± 3.6°) and Gissane angle (123.9° ± 9.5°) were significantly improved compared with the preoperative values (12.4° ± 2.1° and 143.9° ± 7.8°) (P ＜ 0.001).The shape of postoperative calcaneus was similar to that of the preoperative reduction model.The internal fixation locations and nail directions were in agreement with the preoperative design.Their average Maryland score was 87.8 and excellent to good rate 91.7％.Conclusion This technique can transform a digital design for intra-articular calcanealfracture into real operation tools to help realize a precise surgical design for such fractures.
ABSTRACT
Objective To investigate the application of 3D-printing and digital technology in the preoperative design of internal fixation for intra-articular calcaneal fractures.Methods Thin-layer CT images of bilateral calcanei were collected from 12 patients who had been treated for calcaneal fracture of Sanders type Ⅲ from November 2015 to October 2016.They were 7 men and 5 women,aged from 23 to 53 years (average,38.7 years).The images were uploaded into Mimics software for 3D reconstruction,virtual reduction and digital surgical design.Real-size calcaneal models and navigation modules were produced using 3D printing technology for plate preshaping and surgical simulation.The operations were carried out according to preoperative design.The postoperative calcaneal morphological parameters were evaluated.Comparisons were made between postoperative results and preoperative digital design.Results The operating time for the 12 patients ranged from 60 to 90 minutes,averaging 77.9 minutes.Their follow-ups ranged from 4 to 8 months,averaging 6.2 months.No complications affecting their soft tissues happened.The postoperative B(o)hler angle (32.6° ± 3.6°) and Gissane angle (123.9° ± 9.5°) were significantly improved compared with the preoperative values (12.4° ± 2.1° and 143.9° ± 7.8°) (P ＜ 0.001).The shape of postoperative calcaneus was similar to that of the preoperative reduction model.The internal fixation locations and nail directions were in agreement with the preoperative design.Their average Maryland score was 87.8 and excellent to good rate 91.7％.Conclusion This technique can transform a digital design for intra-articular calcanealfracture into real operation tools to help realize a precise surgical design for such fractures.
ABSTRACT
Objective:To perform the preoperative design and operative simulation for periprosthetic femoral fractures (PFF)in one patient with complex tumor knee replacement under assistance of three-dimensional (3D) printing technology,and to explore a more accurate and feasible way to restore the normal anatomy and function of this kind of patients.Methods:The female patient aged 32 years old diagnosed with PFF after an complex tumor knee replacement was selected.The CT images of the patient’s bilateral legs were collected and reconstructed.The bilateral femurs were virtually sliced and the important parameters at each location of both sides were recorded respectively.Novel femoral stem and nail paths were specially designed on the basis of original prosthesis according to these parameters. Then vitual assemble was made with the residual femur. The prosthetic femoral stem components and navigator were customized based on the 3D simulation results when no more errors were found.The residual femoral resin model,customized components and navigator were printed with an SLA 3D printer.The bone cement was taken out and newly designed femoral stem was implanted successfully according to the steps designed preoperatively.The preconcerted allograft bone plates were applied for patch of the bone defect.The pathological results,X-ray and functional scores were included in the observation indexes. Results: With the help of successfully preoperative computer matching,successfully printed bone model-prosthesis assemble and re-customized navigator,the operation was successfully performed.The postoperative alignment shown in the X-ray image was good.The patient was able to normally walk and squat one month after operation with a crutch.MSTS93 score was improved from 0 before operation to 14 only one month after operation.Conclusion:As for PFF of complex tumor knee joint,preoperative design and simulation with 3D printing technology may provide a more accurately and effectively operative outcome than traditional methods.