Analysis of the implementation of a circuit for intra-operative superposition and comparison of the surgical outcomes using ICBCT in maxillofacial surgery.

PURPOSE: This paper describes a novel circuit for intraoperative analysis with ICBCT in maxillofacial surgery. The aim is to establish guidelines, define indications, and conduct an analysis of the implementation of the circuit for intraoperative comparison of surgical outcomes in relation to 3D virtual planning in maxillofacial surgery. METHODS: The study included 150 maxillofacial surgical procedures. Intraoperative actions involved fluoroscopy localization, intraoperative CBCT acquisition, segmentation, and superimposition, among other steps. Surgical times due to intraoperative superposition were measured, including time required for ICBCT positioning and acquisition, image segmentation, and comparison of 3D surfaces from the surgical planning. RESULTS: Successful intraoperative comparison was achieved in all 150 cases, enabling surgeons to detect and address modifications before concluding the surgery. Out of the total, 26 patients (17.33%) required intraoperative revisions, with 11 cases (7.33%) needing major surgical revisions. On average, the additional surgical time with this circuit implementation was 10.66 ± 3.03 min (n = 22). CONCLUSION: The results of our research demonstrate the potential for performing intraoperative surgical revision, allowing for immediate evaluation, enhancing surgical outcomes, and reducing the need for re-interventions.

A state-of-the-art guide about the effects of sterilization processes on 3D-printed materials for surgical planning and medical applications: A comparative study.

Surgeons use different medical devices in the surgery, such as patient-specific anatomical models, cutting and positioning guides, or implants. These devices must be sterilized before being used in the operation room. There are many sterilization processes available, with autoclave, hydrogen peroxide, and ethylene oxide being the most common in hospital settings. Each method has both advantages and disadvantages in terms of mechanics, chemical interaction, and post-treatment accuracy. The aim of the present study is to evaluate the dimensional and mechanical effect of the most commonly used sterilization techniques available in clinical settings, i.e., Autoclave 121, Autoclave 134, and hydrogen peroxide (HPO), on 11 of the most used 3D-printed materials fabricated using additive manufacturing technologies. The results showed that the temperature (depending on the sterilization method) and the exposure time to that temperature influence not only the mechanical behavior but also the original dimensioning planned on the 3D model. Therefore, HPO is a better overall option for most of the materials evaluated. Finally, based on the results of the study, a recommendation guide on sterilization methods per material, technology, and clinical application is presented.

Patient-Specific 3D Printed Soft Models for Liver Surgical Planning and Hands-On Training.

Background: Pre-surgical simulation-based training with three-dimensional (3D) models has been intensively developed in complex surgeries in recent years. This is also the case in liver surgery, although with fewer reported examples. The simulation-based training with 3D models represents an alternative to current surgical simulation methods based on animal or ex vivo models or virtual reality (VR), showing reported advantages, which makes the development of realistic 3D-printed models an option. This work presents an innovative, low-cost approach for producing patient-specific 3D anatomical models for hands-on simulation and training. Methods: The article reports three paediatric cases presenting complex liver tumours that were transferred to a major paediatric referral centre for treatment: hepatoblastoma, hepatic hamartoma and biliary tract rhabdomyosarcoma. The complete process of the additively manufactured liver tumour simulators is described, and the different steps for the correct development of each case are explained: (1) medical image acquisition; (2) segmentation; (3) 3D printing; (4) quality control/validation; and (5) cost. A digital workflow for liver cancer surgical planning is proposed. Results: Three hepatic surgeries were planned, with 3D simulators built using 3D printing and silicone moulding techniques. The 3D physical models showed highly accurate replications of the actual condition. Additionally, they proved to be more cost-effective in comparison with other models. Conclusions: It is demonstrated that it is possible to manufacture accurate and cost-effective 3D-printed soft surgical planning simulators for treating liver cancer. The 3D models allowed for proper pre-surgical planning and simulation training in the three cases reported, making it a valuable aid for surgeons.

Advanced Strategies for the Fabrication of Multi-Material Anatomical Models of Complex Pediatric Oncologic Cases.

The printing and manufacturing of anatomical 3D models has gained popularity in complex surgical cases for surgical planning, simulation and training, the evaluation of anatomical relations, medical device testing and patient-professional communication. 3D models provide the haptic feedback that Virtual or Augmented Reality (VR/AR) cannot provide. However, there are many technologies and strategies for the production of 3D models. Therefore, the aim of the present study is to show and compare eight different strategies for the manufacture of surgical planning and training prototypes. The eight strategies for creating complex abdominal oncological anatomical models, based on eight common pediatric oncological cases, were developed using four common technologies (stereolithography (SLA), selectie laser sinterning (SLS), fused filament fabrication (FFF) and material jetting (MJ)) along with indirect and hybrid 3D printing methods. Nine materials were selected for their properties, with the final models assessed for application suitability, production time, viscoelastic mechanical properties (shore hardness and elastic modulus) and cost. The manufacturing and post-processing of each strategy is assessed, with times ranging from 12 h (FFF) to 61 h (hybridization of FFF and SLS), as labor times differ significantly. Cost per model variation is also significant, ranging from EUR 80 (FFF) to EUR 600 (MJ). The main limitation is the mimicry of physiological properties. Viscoelastic properties and the combination of materials, colors and textures are also substantially different according to the strategy and the intended use. It was concluded that MJ is the best overall option, although its use in hospitals is limited due to its cost. Consequently, indirect 3D printing could be a solid and cheaper alternative.

Accuracy of Virtually Planned Maxillary Distraction in Cleft Patients - An Evaluative Study.

INTRODUCTION: Maxillary distraction may be used to treat severe maxillary hypoplasia in cleft lip and palate (CLP) patients. Three-dimensional (3D) planning has been shown to increase the accuracy of distraction and reduce operative time and complications. The aim of the study was to measure the accuracy of internal maxillary distraction after 3D planning in CLP patients, to add evidence to validate the virtual osteotomy and distraction procedure. MATERIALS AND METHODS: Eleven CLP patients with severe maxillary hypoplasia underwent maxillary distraction using internal distractors. Virtual planning was used to design the osteotomies, the distractor position, and the distraction vector. Cutting and positioning guides transferred this information to the surgical procedure. Four to six month postoperative computed tomography-scan was done before distractor removal; anatomical reference points were compared to the virtual planning to determine accuracy. RESULTS: A high accuracy (point dislocation <1.5 mm) was found in 90% of the points of the surface of the maxilla; the majority of the zygomatic screws were placed within a distance of 0.8-1 mm from their planned position. DISCUSSION: The high accuracy achieved through virtual planning promotes optimal distractor placement; a customized distraction vector has a direct effect on the final position of the maxilla.

Virtual planning in Le Fort III distraction osteogenesis: A case series.

The objective of this study is to determine the value of using 3D planning tools and 3D printed cutting guides in Le Fort III osteotomies with external frame distraction osteogenesis. The process of planning and transfer of the virtual planning to the operating room is illustrated with 5 case. The virtual planning is transferred to the operating room using a 3D-printed supra-orbital reference bar with puzzle connections for the planned osteotomy guides. Different systems are presented to transfer the vector of distraction and the position of the external midface distractor. Three-dimensional planning tools and cutting guides help to design the Le Fort III osteotomy and the distraction vector, to anticipate possible difficulties, and to avoid adverse events.

¿Cuál es su diagnóstico? / What is your diagnosis?

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Auricular Reconstructive Surgery Improvement to the Firmin Technique for Placing an Earring.

Microtia has an incidence of 1 in 7000 to 8000 births. Ear reconstruction has 2 main aims: reconstructive and aesthetic, and a considerable number of patients ask for an earring at the end of their treatment. Herein, we explain our team's modification to the Firmin technique, perforating the lowest part of the autologous cartilage framework (Parri's modification). The orifice is cartilaginous and the skin covering both sides is easily perforable without contacting the rest of the framework. In conclusion, our modification for placing an earring is simple; it does not increase the surgical time and contributes to approach the perfection of auricular reconstructive surgery.

Imaging Evaluation of Pediatric Parotid Gland Abnormalities.

Parotid gland lesions in children can be divided into benign or malignant. The age of the patient helps narrow the differential diagnosis, with vascular and congenital lesions being more frequent in the 1st year of life, while solid tumors are more frequent in older children. Inflammatory disease usually has rapid onset in comparison with that of neoplastic or congenital processes, which have more gradual clinical evolution. Currently, multiple imaging techniques are available to study the parotid region, such as US, CT, and MRI. However, it is still a challenge to distinguish nonmalignant lesions from malignant ones. US is the first-line diagnostic approach in children to characterize the morphology and vascularity of these lesions. CT in children may be indicated for evaluation of abscesses or sialolithiasis. MRI is the imaging modality of choice for investigating the nature of the lesion and its extent. In addition to complete and detailed clinical information, knowledge of parotid gland anatomy and characteristic radiologic features of parotid disorders is essential for optimal radiologic evaluation and avoiding unnecessary interventional diagnostic procedures or treatment. This article illustrates a variety of entities (congenital, inflammatory, vascular, neoplastic) that can occur in the parotid gland, highlighting the most frequent radiologic patterns of manifestation and correlating them with clinical, surgical, and pathologic findings. ©RSNA, 2018.

Maxillomandibular Syngnathia: 3D Planning and Review of the Literature.

Congenital maxillomandibular fusion or syngnathia is a rare craniofacial disorder with only 26 cases reported in the literature. We present a case of a congenital complex zygomatico-mandibular syngnathia associated with a palatal cleft, posterior maxilla and turbinate agenesia, mild hemifacial microsomia, and a disordered dental eruption. The patient has the highest age (15 years) at diagnosis described in the literature. 3D planning of the surgery was performed to study the patient's anatomy and design the necessary osteotomies to separate the jaws. En bloc removal of the fused fragment with bilateral coronoidectomy and aggressive long-term physiotherapy for 3 months led to a stable increase in mouth opening from 0 to 21 mm inter-incisor distance. The patient reported an improvement in speech, was able to eat without restriction regarding food consistency, and could maintain a good oral hygiene.

Surgical Repositioning of the Premaxilla Using a Minimally Invasive Endonasal Approach.

OBJECTIVE: The aim of this study was to evaluate a technique for the surgical repositioning of the premaxilla using a minimally invasive endonasal approach. DESIGN: Retrospective review of clinical records. SETTING: Tertiary care, University Hospital, pediatric maxillofacial surgery unit. PATIENTS: Twenty-one patients (12 boys and 9 girls), ages ranging from 6 to 21 years, with BCLP+A and premaxillary malposition (PM). INTERVENTIONS: Surgical repositioning of the premaxilla (SRP) using a minimally invasive endonasal approach, from November 2007 to November 2015. MAIN OUTCOME MEASURES: Achieving maxillary arch alignment and premaxillary stability was defined as treatment success. Intraoperative and postoperative complications were also recorded. RESULTS: In all cases (100%), the treatment was successful either at first surgery or after reoperation. Two patients (9.5%) were reoperated-one due to premaxillary instability and one due to PM relapse. There were no perioperative complications. CONCLUSIONS: SRP using a minimally invasive endonasal approach is a safe and effective technique that levels and aligns the maxillary arch in preparation for SABG, which minimizes the risk of wound infection and premaxillary vascular compromise. The endonasal approach improves tissue quality of the mucoperiosteal flaps when performing the SABG procedure. Further prospective studies are needed to elucidate the best protocols and techniques for the management of PM in patients with BCLP+ A.

¿Cuál es su diagnóstico?: Obstrucción de la vía aérea superior por mucocele del suelo de la boca / What is your diagnosis?: Upper airway obstruction due to a mucocele on the floor of the mouth

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Obstrucción de la vía aérea superior por mucocele del suelo de la boca / Upper airway obstruction due to a mucocele on the floor of the mouth

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Three-dimensional planning in craniomaxillofacial surgery.

INTRODUCTION: Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results. MATERIALS AND METHODS: We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic). The treatment protocol is exposed step by step from virtual planning, design, and printing of the cutting and positioning guides to patients' outcomes. CONCLUSIONS: 3D planning reduces the surgical time and allows predicting possible difficulties and complications. On the other hand, it increases preoperative planning time and needs a learning curve. The only drawback is the cost of the procedure. At present, the additional preoperative work can be justified because of surgical time reduction and more predictable results. In the future, the cost and time investment will be reduced. 3D planning is here to stay. It is already a fact in craniofacial surgery and the investment is completely justified by the risk reduction and precise results.

Choristoma: A rare congenital tumor of the tongue.

Most congenital masses of the mouth floor are cystic, irrespective of their origin. They may obstruct airway or digestive tract or may present other complications. Recognizing and treating these masses expeditiously is imperative. Choristoma is a mass of normal tissue in an abnormal location; they are classified according to the predominant epithelial lining. Few cases have been reported lined with gastric and respiratory epithelia within the same cyst. This case report presents a 5-month-old boy with an infected choristoma involving the floor of the mouth and its successful management.

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial

Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. OBJECTIVES: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. Study DESIGN: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d'Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients).RESULTS: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences.0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. CONCLUSIONS: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidinegel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial.

UNLABELLED: Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. OBJECTIVES: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. STUDY DESIGN: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d'Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received 0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients). RESULTS: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences. 0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. CONCLUSIONS: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidine gel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance.

Traumatic pseudoaneurysm of the superficial temporal artery: case report and review of the literature.

Pseudoaneurysm of the superficial temporal artery is an uncommon complication of a blunt trauma. It usually presents as a pulsating mass in the frontotemporal area a few weeks after the injury. Doppler ultrasonography, angiography, or computed tomographic angiography can aid or confirm the diagnosis. The treatment of choice is the surgical resection of the pseudoaneurysm and ligation of the vessels. We report a case of a pseudoaneurysm of the frontal branch of the superficial temporal artery and review the literature.

Metástasis parotídea de un carcinoma renal: A propósito de un caso / Parotid metastasis of renal carcinoma: a case report

En la literatura indexada, solo se han descrito 29 pacientes desde 1986. La aparición de metástasis de un carcinoma renal a nivel parotídeo es un fenómeno poco frecuente. Presentamos un paciente de 61 años, que tras cinco años de la realización de una nefrectomía unilateral por un carcinoma renal de células claras, desarrolló una metástasis de localización parotídea(AU)

Metastastic spread of renal cell carcinoma to the parotid gland is rare. In the indexed literature, with only 29 patients recorded since 1986. The case of a 61-year-old patient who developed parotid metastasis of renal cell carcinoma five years after unilateral nephrectomy is reported(AU)

Pansinusitis y afectación intracraneal por implante dental / Pansinusitis and intracranial impact of a dental implant

Las sinusitis odontógenas son una patología relativamente frecuente causada por infecciones dentales, quistes periapicales así como tras procedimientos bucodentales como una endodoncia, una elevación sinusal o la colocación de un implante. A continuación se presenta un caso extremo de una pansinusitis derecha con fistulización a espacio epidural causada por un implante osteointegrado. Ante la sospecha de una sinusitis maxilar de origen odontogénico se debe iniciar rápidamente un tratamiento antibiótico correcto y un seguimiento estrecho ya que pueden tener consecuencias fatales como la pérdida de un ojo, abscesos cerebrales o incluso la muerte(AU)

Odontogenic sinusitis is a relatively common disease caused by dental infections, periapical cysts and oral procedures such as root canal, sinus lift or implant placement. We report an extreme case of a right pansinusitis with an epidural space fistula caused by osseointegrated implants. When maxillary sinusitis of odontogenic origin is suspected, we should quickly start effective antibiotic treatment and monitor the patient closely because odontogenic sinusitis can have serious consequences, such as the loss of an eye, brain abscess or death(AU)