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Evaluation of in-house, haptic assisted surgical planning for virtual reduction of complex mandibular fractures.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Department of Oral and Maxillofacial Surgery, Zealand University Hospital, Denmark.
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology.
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

The management of complex mandible fractures, i.e severely comminuted or fractures of edentulous/atrophic mandibles, can be challenging. This is due to the three-dimensional loss of bone, which limits the possibility for accurate anatomic reduction. Virtual surgery planning (VSP) can provide improved accuracy and shorter operating times, but is often not employed for trauma cases because of time constraints and complex user interfaces limited to two-dimensional interaction with three-dimensional data. In this study, we evaluate the accuracy, precision, and time efficiency of the Haptic Assisted Surgery Planning system (HASP), an in-house VSP system that supports stereo graphics, six degrees-of-freedom input and haptics, to improve the surgical planning. Three operators performed planning in HASP on Computed Tomography (CT) and Come Beam Computed Tomography (CBCT) images of a plastic skull model and on twelve retrospective cases with complex mandible fractures. The result shows an accuracy and reproducibility of less than 2mm when using HASP, with an average planning time of 15 minutes, including time for segmentation in the software BoneSplit. This study presents an in-house haptic assisted planning tool for cranio-maxillofacial surgery with high usability that can be used for preoperative planning and evaluation of complex mandible fractures. 

Keywords [en]
Virtual surgical planning, Haptic technology, Complex mandible fractures.
National Category
Medical and Health Sciences
Research subject
Surgery; Computerized Image Processing
Identifiers
URN: urn:nbn:se:uu:diva-377518OAI: oai:DiVA.org:uu-377518DiVA, id: diva2:1291474
Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2020-01-23
In thesis
1. On Virtual Surgical Planning in Cranio-Maxillofacial Surgery
Open this publication in new window or tab >>On Virtual Surgical Planning in Cranio-Maxillofacial Surgery
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The complex three-dimensional (3D) anatomy of the cranio-maxillofacial (CMF) region makes surgery a challenging task. Virtual surgical planning (VSP) has the potential to increase accuracy, reproducibility and shorten operation time. Key challenges in VSP are to accurately separate, or segment, certain structures of interest, such as the orbit, from the rest of the image, as well as to create an accurate 3D model of the facial bones and dentition for orthognathic surgery planning. The time required for planning and fabrication of guides for trauma surgery is another challenge. The overall aim of this thesis was to develop and evaluate new virtual planning tools for CMF-surgery and to investigate their usefulness. Study I, II discuss and evaluate image fusion of CT/CBCT and intraoral scanning for orthognathic surgery. A method for virtual bite registration in centric relation (CR) was also proposed. The workflow has the potential to eliminate traditional laboratory work, and may facilitate 3D computer-assisted-planning in orthognathic surgery. Study III deals with orbit segmentation and presents a semi-automatic method, using a deformable model tracing the inside of the orbit via haptic 3D interaction. The method was validated in retrospective unilateral orbital fracture cases. The fractured orbits were compared to the intact side by volume and shape analyses. The method showed high accuracy, precision, time-efficiency and thereby potential to be a powerful tool for planning and evaluating reconstruction of orbital fractures. Study IV evaluates an in-house haptic-assisted VSP system for complex mandibular fractures on a series of retrospective cases and an artificial case. The system showed high precision and time-efficiency, but relatively low accuracy. This study proposes a novel, fast and user-friendly way of integrating VSP into planning mandible trauma surgery and could help in reducing operating time and increase accuracy. Study V is a systematic review and meta-analysis studying potential time benefits using VSP in CMF surgery. The study suggests that VSP shortens the operating time and ischemia time for reconstructive surgery. VSP also appears to shorten the preoperative planning time for orthognathic surgery.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 81
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1544
Keywords
Virtual surgical planning. Computer assisted planning. 3D computer model. Orbital segmentation. Craniomaxillofacial surgery planning. Haptics.
National Category
Surgery Medical Image Processing
Research subject
Oral and Maxillofacial Surgery
Identifiers
urn:nbn:se:uu:diva-377726 (URN)978-91-513-0583-7 (ISBN)
Public defence
2019-04-12, Robergsalen, Uppsala University Hospital, entrance 40, 4th floor, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2019-03-19 Created: 2019-02-25 Last updated: 2019-05-07
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