Application of Virtual Surgical Planning with Computer Assisted Design and Manufacturing Technology to Cranio-Maxillofacial Surgery

Computer aided design and manufacturing (CAD/CAM) technology today is the standard in manufacturing industry. The application of the CAD/CAM technology, together with the emerging 3D medical images based virtual surgical planning (VSP) technology, to craniomaxillofacial reconstruction has been gaining increasing attention to reconstructive surgeons. This article illustrates the components, system and clinical management of the VSP and CAD/CAM technology including: data acquisition, virtual surgical and treatment planning, individual implant design and fabrication, and outcome assessment. It focuses primarily on the technical aspects of the VSP and CAD/CAM system to improve the predictability of the planning and outcome.

Keywords

Computer aided design and manufacturing - Computer assisted image processing - Computer-assisted surgery - Reconstructive surgical procedures - Three-dimensional imaging

The VSP+CAD/CAM system presented is partially supported by Face the Future Foundation, and Shriners Hospitals for Children.

Publication History

Received: 11 March 2012

Accepted: 28 March 2012

Article published online:
01 May 2022

• REFERENCES

• 1 Hounsfield GN. Computerized transverse axial scanning (tomography). 1. Description of system. Br J Radiol 1973; 46: 1016-1022
• 2 Ambrose J. Computerized transverse axial scanning (tomography). 2. Clinical application. Br J Radiol 1973; 46: 1023-1047
• 3 Eufinger H, Wehmoller M, Harders A. et al. Prefabricated prostheses for the reconstruction of skull defects. Int J Oral Maxillofac Surg 1995; 24: 104-110
• 4 Metzger MC, Hohlweg-Majert B, Schwarz U. et al. Manufacturing splints for orthognathic surgery using a three-dimensional printer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105: e1-e7
• 5 Vannier MW, Marsh JL, Warren JO. Three dimensional CT reconstruction images for craniofacial surgical planning and evaluation. Radiology 1984; 150: 179-184
• 6 Toth BA, Ellis DS, Stewart WB. Computer-designed prostheses for orbitocranial reconstruction. Plast Reconstr Surg 1988; 81: 315-324
• 7 Robb RA. Biomedical imaging, visualization, and analysis. 2000. New York: Wiley-Liss;
• 8 Woolson ST, Dev P, Fellingham LL. et al. Three-dimensional imaging of bone from computerized tomography. Clin Orthop Relat Res 1986; (202) 239-248
• 9 Solar P, Ulm C, Lill W. et al. Precision of three-dimensional CT-assisted model production in the maxillofacial area. Eur Radiol 1992; 2: 473-477
• 10 Eufinger H, Wehmoller M, Machtens E. et al. Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAD/CAM-manipulated CT-data. J Craniomaxillofac Surg 1995; 23: 175-181
• 11 Wehmoller M, Eufinger H, Kruse D. et al. CAD by processing of computed tomography data and CAM of individually designed prostheses. Int J Oral Maxillofac Surg 1995; 24: 90-97
• 12 Klein HM, Schneider W, Alzen G. et al. Pediatric craniofacial surgery: comparison of milling and stereolithography for 3D model manufacturing. Pediatr Radiol 1992; 22: 458-460
• 13 Housholder R. Molding process. US patent. 4,247,508 Filed December 3, 1979. Published January 27, 1981
• 14 Hull CW. Apparatus for production of three-dimensional objects by stereolithography. US patent. 4,575,330 Filed Aug 8, 1984. Published March 11, 1986
• 15 Deckard C. Method and apparatus for producing parts by selective sintering. US patent. 4,863,538 Filed October 17, 1986. Published September 5, 1989
• 16 McGurk M, Amis AA, Potamianos P. et al. Rapid prototyping techniques for anatomical modelling in medicine. Ann R Coll Surg Engl 1997; 79: 169-174
• 17 Sailer HF, Haers PE, Zollikofer CP. et al. The value of stereolithographic models for preoperative diagnosis of craniofacial deformities and planning of surgical corrections. Int J Oral Maxillofac Surg 1998; 27: 327-333
• 18 Santler G, Karcher H, Ruda C. Indications and limitations of three-dimensional models in cranio-maxillofacial surgery. J Craniomaxillofac Surg 1998; 26: 11-16
• 19 Joffe JM, McDermott PJ, Linney AD. et al. Computer-generated titanium cranioplasty: report of a new technique for repairing skull defects. Br J Neurosurg 1992; 6: 343-350
• 20 Binder WJ, Kaye A. Reconstruction of posttraumatic and congenital facial deformities with three-dimensional computer-assisted custom-designed implants. Plast Reconstr Surg 1994; 94: 775-785
• 21 Tanaka Y, Matsumoto K, Song S. et al. Reconstruction of a cranial bone defect with hydroxyapatite and free flap transfer. J Craniofac Surg 1997; 8: 141-145
• 22 Fukuta F, Jackson IT, McEwan CM. et al. Three-dimensional imaging in craniofacial surgery: a review of the role mirror image production. Eur J Plast Surg 1990; 13: 209-217
• 23 Altobelli DE, Kikinis R, Mulliken JB. et al. Computer-assisted three-dimensional planning in craniofacial surgery. Plast Reconstr Surg 1993; 92: 576-585
• 24 Hildebolt CF, Vannier MW. Three-dimensional measurement accuracy of skull surface landmarks. Am J Phys Anthropol 1988; 76: 497-503
• 25 Hildebolt CF, Vannier MW, Knapp RH. Validation study of skull three-dimensional computerized tomography measurements. Am J Phys Anthropol 1990; 82: 283-294
• 26 Lo LJ, Marsh JL, Vannier MW. et al. Craniofacial computerassisted surgical planning and simulation. Clin Plast Surg 1994; 21: 501-516
• 27 Cavalcanti MG, Vannier MW. Quantitative analysis of spiral computed tomography for craniofacial clinical applications. Dentomaxillofac Radiol 1998; 27: 344-350
• 28 Lo LJ, Lin WY, Wong HF. et al. Quantitative measurement on three-dimensional computed tomography: an experimental validation using phantom objects. Chang Gung Med J 2000; 23: 354-359
• 29 Cavalcanti MG, Rocha SS, Vannier MW. Craniofacial measurements based on 3D-CT volume rendering: implications for clinical applications. Dentomaxillofac Radiol 2004; 33: 170-176
• 30 Lopes PM, Moreira CR, Perrella A. et al. 3-D volume rendering maxillofacial analysis of angular measurements by multislice CT. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105: 224-230
• 31 Moreira CR, Sales MA, Lopes PM. et al. Assessment of linear and angular measurements on three-dimensional conebeam computed tomographic images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 430-436
• 32 Berco M, Rigali Jr PH, Miner RM. et al. Accuracy and reliability of linear cephalometric measurements from conebeam computed tomography scans of a dry human skull. Am J Orthod Dentofacial Orthop 2009; 136: 17.e1-17.e9
• 33 Fleming PS, Marinho V, Johal A. Orthodontic measurements on digital study models compared with plaster models: a systematic review. Orthod Craniofac Res 2011; 14: 1-16
• 34 Cynthia DB, Steven S, Anil M. et al. A survey of interactive mesh-cutting techniques and a new method for implementing generalized interactive mesh cutting using virtual tools. J Visual Comput Animat 2002; 13: 21-42
• 35 Zachow S, Gladilina E, Saderb R. et al. Draw and cut: intuitive 3D osteotomy planning on polygonal bone models. Int Congr Ser 2003; 1256: 362-369
• 36 Westermark A, Zachow S, Eppley BL. Three-dimensional osteotomy planning in maxillofacial surgery including soft tissue prediction. J Craniofac Surg 2005; 16: 100-104
• 37 Lane C, Harrell Jr W. Completing the 3-dimensional picture. Am J Orthod Dentofacial Orthop 2008; 133: 612-620
• 38 Chua CK, Chou SM, Ng WS. et al. An integrated experimental approach to link a laser digitiser, a CAD/CAM system and a rapid prototyping system for biomedical applications. Int J Adv Manuf Technol 1998; 14: 110-115
• 39 Xia JJ, Gateno J, Teichgraeber JF. Three-dimensional computer-aided surgical simulation for maxillofacial surgery. Atlas Oral Maxillofac Surg Clin North Am 2005; 13: 25-39
• 40 MIMICS version 12 reference guide. 2009. Leuven (BE): Materialise N.V.;