A Novel Design of Computer-Assisted 3D-Printed TMJ Arthrocentesis Guide (Technical Note).

Attempts of needle relocation and extension of the operation time are the most common cause of postoperative edema and swelling after temporomandibular joint arthrocentesis. To facilitate the placement of needles and decrease patient discomfort, a template-based technique that includes design of patient-specific guide was performed to direct access to the temporomandibular joint space for arthrocentesis.

Segmentation of the 3D printed mirror image auricular model to ease sculpture of the costal cartilages in total auricular aesthetic reconstruction.

BACKGROUND: Recently, three-dimensional (3D) models have been used more frequently than the traditional two-dimensional (2D) models as an intraoperative guide to ease sculpture of costal cartilages in total auricular aesthetic reconstruction in cases of microtia. Usually, 3D imaging techniques are used to create compact ear models, however, there is insufficient clinical knowledge of using them to create segmented 3D auricular models for cartilage framework reconstruction. IN THIS STUDY: assessment of the advantages of segmentation of 3D models over the traditional compact 3D models in total auricular aesthetic reconstruction has been discussed. PATIENTS AND METHODS: In the current study, 16 patients who underwent total auricular aesthetic reconstruction using 3D models were included, patients were divided into two groups (Group I, 8 patients had total auricular aesthetic reconstruction using compact 3D printed mirror image model). Whereas (Group II, 8 patients had total auricular aesthetic reconstruction using segmented 3D printed mirror image model into auricular subunits. Then, each subunit was used for reconstruction of the corresponding part of the auricle. In both groups the patient's unaffected ear was mirrored and used as a reference to reconstruct the affected side. RESULTS: The results were evaluated in both groups. The overall operative and carving times were found to be less in Group II; Also, postoperative aesthetic outcome and patient satisfaction were favorable in this group. CONCLUSION: Using segmentation of 3D printed models in total auricular aesthetic reconstruction had less intraoperative time, better aesthetic results, and high postoperative patient satisfaction.

The evaluation of the effect of performing guided lid surgery with enucleation of a cystic lesion; a case report.

INTRODUCTION AND IMPORTANCE: Dentigerous cysts are benign odontogenic cysts of developmental origin. Enucleation and marsupialization are still considered the blueprint of cystic lesion treatment. CASE PRESENTATION: A 23-year-old male patient presented complaining of a minimal swelling in his upper jaw with slight tenderness in his upper anterior teeth. Cone Beam Computed Tomography (CBCT) on the maxilla was requested. The cystic lesion was found to be minimally expansile with intact cortical plates of the maxilla in the affected area. The CBCT was used to fabricate a cutting guide to determine the exact location of the bony window to fully access the lesion. Root canal treatment was done for the affected non-vital teeth. The cuts were done using a piezo-electric device. Complete enucleation was done for the lesion followed by fixation of the cortical bone lid using micro-plates and screws. The case was followed up after 6 months for new bone deposition using CBCT and 1 week, 1 month, and 6 months postoperatively for postoperative pain using the Visual Analogue Scale (VAS). CLINICAL DISCUSSION: Piezo-electric surgery was used due to the selective cutting merit to cut through bone while preserving the cystic lining intact. Lid surgery aims to maximize the volume of bone deposited in place of the defect by converting the cavity of the cystic lesion into a contained defect. CONCLUSION: Guided lid surgery using a piezo-electric device could be a useful technique for cystic enucleation regarding the new bone formation and pain level.

The correction of asymmetry using computer planned distraction osteogenesis versus conventional planned extra-oral distraction osteogenesis: A randomized control clinical trial.

The aim of the current study was to evaluate the effect of the use of computer-guided surgical templates in association with mandibular distraction osteogenesis to correct mandibular asymmetry. In the study group a simulation process was conducted to restore the exact position of the chin skeletally by planning the osteotomy orientation, distractor vector, pin positions, and distraction distance calculation. The Control group was treated with conventional distraction in which an oblique osteotomy was done, and distraction was performed until the midline coincided. Patients were randomly allocated into two groups, study and control. The study included (12) young patients; ten males participated and two females (average age 14 ± 6 years) (Range = 6-23 years)). There was a statistically significant (P = 0.02) improvement in smile orientation in the study with 63.7% ± 19% improvement compared to control, which had only 37% ± 14%. There was a statistically significant (P = 0.02) improvement in ramus height in the study with 93% ± 9% improvement compared to control, which had only 74% ± 16%. There was a non-significant (P = 0.2) improvement in chin deviation in the study with 42% ± 26% improvement compared to control, which had only 25% ± 15%. The secondary outcome results showed that there was statistically significant (P = 0.0001) improvement in smile orientation post distraction 50% ± 21%, there was statistically significant (P= P=0.002) improvement of ramus height post distraction osteogenesis 82% ± 16%, and there was statistically significant (P = 0.0001) improvement in chin deviation 33% ± 22% post distraction osteogenesis. Overall, the current research recommends the use of computer planned distraction instead of conventional planned distraction in order to achieve better symmetry. Distraction failed in correction of chin asymmetry; thus, the authors recommend performing genioplasty post distraction after the patient reaches puberty for more optimum results regarding the chin.

Novel Technique and Step-by-Step Construction of a Computer-Guided Stent for Mandibular Distraction Osteogenesis.

INTRODUCTION: Distraction osteogenesis is an integral part in management of mandibular defects associated with hemifacial microsomia and post-ankylotic mandibular defects. The most difficult part in distraction osteogenesis is the prediction of distraction vector and risk of injury to vital structures as inferior alveolar. The present study aimed to present 3-dimensionally constructed computer-guided splints in distraction osteogenesis to get an ideal vector and minimal risk of vital structures injury. MATERIAL AND METHODS: The technical note presents cases series of 6 patients who had computer-guided distraction osteogenesis surgery using prefabricated splints. RESULTS: The distance between the virtual and physical pins and osteotomy was measured, and the deviation of the vector angle and osteotomy angle was also assessed. Average deviation in pin distance was 3 mm and in vector angle 13.5°. Average deviation in osteotomy distance was 2.6 mm and in osteotomy angle 14.4°. None of the cases had injury to vital structure. There was significant improvement (P = 0.0078) in the medial canthus-buccal commissure distance where the arithmetic mean improved from 59.6 (SD = 10.1) mm pre-distraction in the defective side to 67.1 (SD = 8) mm post-distraction. The degree of correction was 97% compared to the normal side. CONCLUSION: 3D printed surgical stents were successful in transferring the virtual treatment plan of mandibular distraction osteogenesis into the surgical theatre with an acceptable margin of error and without injury to any vital structures.