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Int Poster J Dent Oral Med 3 (2001), No. 4     15. Dec. 2001

Int Poster J Dent Oral Med 2001, Vol 3 No 4, Poster 105

Computer aided planning and intraoperative navigation in cranio-maxillofacial distraction

Language: English

Authors:  Dr. Dr. Alexander Schramm, Prof. Dr. Dr. Nils-Claudius Gellrich, Dr. Dr. Ronald Schimming, Dr. Dr. Ralf Schön, Dr. Dr. Ralf Gutwald, Prof. Dr. Dr. Rainer Schmelzeisen
MKG-Universitätsklinik, Freiburg i. Br.

Date/Event/Venue: 
14.06.2001 to 16.06.2001
3rd International Congress of Craniofacial and Maxillofacial Distraction
Paris, France

Introduction

Distraction of the facial skeletton in case of severe deformities needs detailed planning. In cranio-maxillofacial surgery advances in imaging techniques (spiral-CT, 3D-imaging) and associated technologies (stereolithographic models, CAD/CAM) have led to an improvement of preoperative planning. Stereolithographic models however do not fulfill the requirements for complex cranio-maxillofacial plastic and reconstructive procedures i.e. preoperative planning with virtual correction, intraoperative navigation and postoperative control. 


Materials and Methods

On the base of a CT data set in our clinic an optical Navigation-System (Stryker-Leibinger) was used for preoperative planning, intraoperative navigation and postoperative control in complex cranio-maxillofacial distraction procedures (fig. 1). Bony and soft tissue contours were measured preoperatively, the surgical approach was marked and the distraction osteotomy and vectors virtually designed. Intraoperatively contours of preoperative planning were navigated. 


Fig. 1a: Frameless stereotaxy with infrared localization. 

Fig. 1b: Surgical tool with infrared diods 

Fig. 1c: Tracking frame 

Fig. 1d,e: Non-invasive registration with an occlusal splint 

Results

In 6 patients computer assisted distraction was performed. For mandibular distraction pre-operative planning was sufficient, intraoperative navigation dispensable. In midface distraction intraoperative navigation allowed guided osteotomies (fig. 2) and positioning of internal distraction devices according to the preplanned vectors (fig. 3). 


Fig. 2a: Midfacial hypoplasia due to cleft-lip-palate: preoperative view 

Fig. 2b: Osteotomy lines and tooth buts are marked preoperatively 

Fig. 2c: Monitor screen of intraoperative navigation: guided osteotomy saving hidden tooth buts 

Fig. 2d: Postoperative clinical view 

Fig. 2e-g: Radiological follow up 

Fig. 3a,b: Crouzon's syndrom with midfacial hypoplasia: preoperative view 

Fig. 3c: Virtual positioning of the distraction vectors 

Fig. 3d: Intraoperative navigation: guided osteotomy in the Le-Fort-III level saving tooth buts 

Fig. 3e: Intraoperative navigation: positioning of the distraction devices according to the preplanned vectors. 

Fig. 3f,g: Postoperative clinical outcome after midface distraction 

Fig. 3h,i: the pre and postoperative clinical comparison (Fig. 3h,i) 

Fig. 3j,k: Radiological pre- and postoperative follow up: side view 

Fig. 3l,m: Radiological pre- and postoperative follow up: axial view 

Discussion

With computer assisted CT evaluation demanding distraction procedures such as midface and mandible distractions in patients with craniofacial syndroms can be prezisely preplanned. Intraoperative the guided osteotomy prevents damaging of vital structures. Vectors and positioning of the internal distraction devices can be navigated according to the preoperative treatment plan. However further software developments are required to fulfill all demands for virtual distraction. 


Bibliography

  • Bettega G., Dessenne V., Raphael B.: Computer-assisted mandibular condyle positioning in orthognathic surgery. J Oral Maxillofac Surg 1996, 54: S. 553-558.
  • Gellrich N.-C., Schramm A., Gutwald R., Schön R., Husstedt H., Schmelzeisen R.: Computer assisted planning and surgery in orbital reconstruction. In: Lemke H.U., Inamura K., Vannier M.W., Farman A.G. (eds). CARS 1999. New York: ELSEVIER, 1999, S. 1042.
  • Schmelzeisen R., Schramm A., Schön R.: Future perspectives in craniomaxillofacial reconstruction. Asian Dentech Proc 2000, S. 7-12.
  • Schramm A., Gellrich N.-C., Gutwald R., Schipper J., Bloss H.G., Hustedt H., Schmelzeisen R., Otten J.E.: Indications for computer assisted treatment of cranio-maxillofacial tumors. Comp Aid Surg 2000, 5, S. 343-352.
  • Schramm A., Gellrich N.-C., Randelzhofer P., Schneider U., Gläser R., Schmelzeisen R.: Use and abuse of navigational surgery in oral implantation. In: Lemke H.U., Vannier M.W., Inamura K., Farman A.G., Doi K. (eds). CARS 2000. New York: ELSEVIER, 2000, S. 923-926.
  • Schramm A.: Navigational procedures in orthognathic surgery. J Kor Assoc Oral Maxillofac Surg 2001, 27, S. 24-26.
  • Villalobos H., Germano I.M.: Clinical evaluation of multimodality registration in frameless stereotaxy. Comp Aid Surg 1999, 4, S. 45-49.
 


Abbreviations

CT = Computed Tomgraphy
STN = Surgical Tool Navigator 


This Poster was submitted by Dr. Dr. Alexander Schramm.

Correspondence address:
Dr. Dr. Alexander Schramm
MKG-Universitätsklinik
Hugstetterstrasse 55
D-79106 Freiburg i. Br.