Planejamento virtual em cirurgia ortognática: relato de caso / Virtual planning for orthognathic surgery: case report / Planificación virtual en cirugía ortognática: reporte de caso

Introdução: A correção das deformidades dentofaciais depende do bom diagnóstico, da precisão do planejamento e da correta execução da técnica cirúrgica. Buscando maior precisão, o planejamento virtual para cirurgia ortognática tem sido uma ferramenta amplamente aplicada pela cirurgia bucomaxilofacial. Este trabalho demonstra, por meio de caso clínico, os benefícios adquiridos pelo planejamento virtual, no que diz respeito a quantificação do movimento, avaliação da predição dos tecidos moles e osteotomias, assim como discorre sobre os cuidados e passos necessários para um correto planejamento. Relato do caso: Paciente de perfil classe II, submetida ao protocolo de planejamento virtual com aquisição de imagens tomográficas, escaneamento intraoral e utilização de software digital para avaliação diagnóstica, planejamento e impressão dos guias cirúrgicos. A mesma foi acompanhada durante 3 meses de pós operatório, apresentando boa precisão e previsibilidade nos movimentos cirúrgicos realizados. Discussão: Ao se realizar uma avaliação clínica acurada, somada a aquisição de imagens tridimensionais, a partir das tomografias de face, escaneamentos intraorais e o manejo da tecnologia CAD/CAM, é possível se alcançar maior precisão no planejamento e predictibilidade cirúrgica, bem como realizar um melhor diagnóstico das deformidades transversas. Contudo, deve-se levar em consideração a necessidade de conhecimento teórico-prático para a correta execução dos passos para o planejamento virtual. Considerações finais: Dado o exposto, foi possível observar precisão no resultado obtido e compatibilidade entre os movimentos planejados e executados. Assim como, demonstrou se aspectos relativos a cada um dos passos para o protocolo virtual, expondo-se suas particularidades e diferenças em relação ao planejamento convencional... (AU)

Introducción: La corrección de las deformidades dentofaciales depende de un buen diagnóstico, de la precisión de la planificación y la correcta ejecución de la técnica quirúrgica . Buscando mayor precisión, la planificación virtual para cirugía ortognática ha sido una herramienta aplicada ampliamente por la cirugia bucomaxilofacial. Este trabajo demuestra, por medio de un caso clínico, los beneficios obtenidos por la planificación virtual, en lo que respecta a la cuantificación del movimiento, evaluación de la predicción de los tejidos blandos y de las osteotomia, así enfatizando los cuidados y pasos necesarios para una correcta planificación. Relato de caso: Paciente con perfil clase II, utilizando protocolo de planificación virtual con adquisición de imágenes tomográficas, escaneamento intra-oral y uso de software digital para evaluación diagnóstica, planificación e impresión 3D de los guías quirúrgicos. La paciente tuvo seguimiento pos operatorio por tres meses, corroborando la precisión y previsibilidad de los movimientos quirúrgicos planificados y ejecutados. Discusión: Al realizarse una evaluación clínica acurada, sumando una adquisición de imágenes tridimensionales, a partir de la tomografía facial, escaneamento intra-oral y el manejo de tecnologia CAD/CAM, es posible alcanzar mayor precisión en la planificación y previsibilidad quirúrgica, así como un diagnóstico más acurado de las alteraciones transversas. Con todo, se debe considerar la necesidad de conocimiento teórico práctico para la correcta elaboración de un proyecto de planificación quirúrgica virtual. Consideraciones finales: Por lo expuesto, se observó precisión en el resultado obtenido considerando los movimientos planificados y ejecutados. Así como se describió aspectos relativos a cada uno de los pasos del protocolo virtual utilizado, exponiendo sus particularidades y diferencias en relación a la planificación quirúrgica convencional... (AU)

Introduction: The correction of dentofacial deformities depends directly on a good diagnosis, the precision of the surgical planning and the correct execution of the technique. Seeking greater precision, virtual planning for orthognathic surgery has been a tool widely applied in oral and maxillofacial surgery. This work demonstrates, through a case report, the benefits acquired by virtual planning, regarding the quantification of movement, evaluation of the prediction of soft tissues and osteotomies, as well as discusses the accuracy and steps necessary for a correct planning. Case report: Class II facial profile patient, submitted to the virtual planning protocol with acquisition of tomographic images, intraoral scanning and use of digital software for diagnostic evaluation, planning and printing of surgical guides. She was followed up for 3 months after the operation, showing good precision and predictability in the surgical movements performed. Discussion: When performing an accurate clinical evaluation, added up to the acquisition of three-dimensional images, from face tomography, intra-oral scans and the management of CAD/CAM technology, it is possible to achieve greater precision in surgical planning and predictability, as well as accomplish a better diagnosis of transverse deformities. However, one must take into account the need for theoretical practical knowledge for the correct execution of the steps for virtual planning. Final considerations: Given the above, it was possible to observe precision in the result obtained and compatibility between the planned and executed movements. As well, aspects related to each of the steps for the virtual protocol were demonstrated, exposing their particularities and differences in relation to conventional planning... (AU)

Development and research of high technology in precise laparoscopic gastric cancer surgery / 中华消化外科杂志

After more than 20 years of development,laparoscopic gastric cancer surgery has made considerable progress.Laparoscopic surgery for early gastric cancer has been recommended by the guidelines for routine clinical application.The preliminary results of clinical research on laparoscopic surgery for advanced gastric cancer are encouraging.However,as far as surgical technology is concerned,it has matured and reached a high plateau stage.The benefit of patients brought by the improvement of surgical technology has become a bottleneck,and it is difficult to be improved any more.In order to realize the leapfrog development of laparoscopic gastric cancer surgery,it is urgent to introduce the high-tech cutting-edge technology,make rational use of "black science and technology" and strengthen cross-domain collaboration,which are the key to break through the bottleneck of laparoscopic gastric cancer surgery technology development,as well as the new trend of minimally invasive surgery development in the future.

The development and recent status of the craniomaxillofacial surgery in China during past three decades / 中国修复重建外科杂志

The authors made a profound review on the development and the recent status of craniomaxillofacial surgery in China during past three decades. The emphases were placed on the following aspects: the modifications of the reconstructive procedure and minimal invasive mode, the researches on molecular genetic characteristics of the congenital craniofacial malformations, the clinical applications of three-dimensional digital computer-aided techniques (including three-dimensional printing and prefabricated template for precious osteotomies), the craniomaxillofacial defects reconstructing by using the distraction osteogenesis and osseous integrated titanium implant and prothesis, etc. Finally, the authors outlooked prospectively the future trends of the craniomaxillofacial surgery.

Application of computer navigation assisted mandibular angle osteotomy / 中华医学美学美容杂志

Objective To investigate the contouring plastic effect of the digital navigation techniques assisted mandibular angle osteotomy,thereby providing surgical reference and evaluation basis for improving the accuracy,efficacy and safety of surgery.Methods From March 2015 to March 2017,15 female cases of the digital navigation aided intral-oral mandibular angle osteotomy in the past 2 years were collected and compared to the pre-operational image and digital design.Results The postoperative effect of navigation-assisted mandibular angle osteotomy was well matched to that of preoperative design.The mandibular angle was smooth and bilateral symmetrical with no obvious complication occurred.Conclusions Navigation-assisted techniques can solve the problem of limited exposure of intra-oral approach and significantly improve the accuracy,effectiveness and safety in mandibular angle osteotomy.

The Pros and Cons of Computer-Aided Surgery for Segmental Mandibular Reconstruction after Oncological Surgery

Computer-aided surgery (CAS) started being used for head and neck reconstruction in the late 2000s. Its use represented a paradigm shift, changing the concept of head and neck reconstruction as well as mandible reconstruction. Reconstruction using CAS proceeds through 4 phases: planning, modeling, surgery, and evaluation. Thus, it can overcome a number of trial-and-error issues which may occur in the operative field and reduce surgical time. However, if it is used for oncologic surgery, it is difficult to evaluate tumor margins during tumor surgery, thereby restricting pre-surgical planning. Therefore, it is dangerous to predetermine the resection margins during the pre-surgical phase and the variability of the resection margins must be taken into consideration. However, it allows for the preparation of a prebending plate and planning of an osteotomy site before an operation, which are of great help. If the current problems are resolved, its applications can be greatly extended.

Application of computer aided three-dimensional visualization technique in mandibular defect reconstruction with vascularized free fibular flap / 中华显微外科杂志

Objective To summary the application of computer aided three-dimensional visualization technique in different kinds of mandibular detects reconstruction with vascularized free fibular flap.Methods Five patients diagnosed of recurrent mandibular ameloblastoma underwent the virtually operation by software with a thin-slice CT scan,which determined shape and position of the free flap,and preoperative resin model and modules were designed and prefabricated.Then the titanium plates were bent precisely,and the surgical reconstruction proceeded exactly as expected from the modeling process.Results All operations were achieved successfully.The extent of the lesion was coincident with the preoperative CT results,and the vascularized free fibular flaps were harvested and implanted into the defect regions accurately.The mean distance was (0.23 ±2.10) mm compared with the virtual fibula.The mean time of operation was 4.4 hours.Following up the mean 12.8 months,all patients obtained the excellent functional and cosmetic outcomes.Conclusion The procedure of operation was simplified and the time was shortened with reconstruction exactly using computer aided three-dimensional visualization technique,and the clinical therapeutic efficacy of reconstruction of mandibular defect with vascularized free fibular flaps was improved notably.

Evaluation of the accuracy of two different surgical guides in dental implantology: stereolithography fabricated vs. positioning device fabricated surgical guides / 대한치과보철학회지

PURPOSE: Recently implant surgical guides were used for accurate and atraumatic operation. In this study, the accuracy of two different types of surgical guides, positioning device fabricated and stereolithography fabricated surgical guides, were evaluated in four different types of tooth loss models. MATERIALS AND METHODS: Surgical guides were fabricated with stereolithography and positioning device respectively. Implants were placed on 40 models using the two different types of surgical guides. The fitness of the surgical guides was evaluated by measuring the gap between the surgical guide and the model. The accuracy of surgical guide was evaluated on a pre- and post-surgical CT image fusion. RESULTS: The gap between the surgical guide and the model was 1.4 +/- 0.3 mm and 0.4 +/- 0.3 mm for the stereolithography and positioning device surgical guide, respectively. The stereolithography showed mesiodistal angular deviation of 3.9 +/- 1.6degrees, buccolingual angular deviation of 2.7 +/- 1.5degrees and vertical deviation of 1.9 +/- 0.9 mm, whereas the positioning device showed mesiodistal angular deviation of 0.7 +/- 0.3degrees, buccolingual angular deviation of 0.3 +/- 0.2degrees and vertical deviation of 0.4 +/- 0.2 mm. The differences were statistically significant between the two groups (P<.05). CONCLUSION: The laboratory fabricated surgical guides using a positioning device allow implant placement more accurately than the stereolithography surgical guides in dental clinic.

The management of a complex implant case using CAD-CAM technology: A clinical report / 대한치과보철학회지

PURPOSE: The application of computer-aided technology to implant dentistry has created new opportunities for treatment planning, surgery and prosthodontic treatment, but the correct selection and combination of available methods may be challenging in times. Hence, the purpose of this case report is to present a combination of several computer-aided tools as approaches to manage complicated implant case. MATERIAL AND METHODS: A 47 year-old female patient with severe dental anxiety, high expectations, financial restrictions and poor compliance presented for a fixed rehabilitation. A CT scan with a radiographic template obtained with software (SimPlant, Materialize, Leuven, Belgium) was used for treatment planning. The surgical plan was created and converted into a stereolithographic model of the maxilla with bone-supported surgical templates (SurgiGuide, Materialise, Leuven, Belgium), that allowed for the precise placement of 7 implants in a severely resorbed edentulous maxilla. After successful osseointegration, an accurate scan model served as the basis for the fabrication of a one-piece milled titanium framework using the Procera (Nobel Biocare, Gothenburg, Sweden) technology. The final rehabilitation of the edentulous maxilla was rendered in the form of a screw-retained maxillary metal-reinforced resin-based complete prosthesis. RESULTS: Despite challenging circumstances, 7 implants could be placed without bone augmentation in a severely resorbed maxilla using the SimPlant software for pre-implant analysis and the SurgiGuide-system as the surgical template. The patient was successfully restored with a fixed full arch restoration, utilizing the Procera system for the fabrication of a milled titanium framework.