Abstract
Purpose Cranio-maxillofacial (CMF) surgery to restore normal skeletal anatomy in patients with serious trauma to the face can be both complex and time-consuming. But it is generally accepted that careful pre-operative planning leads to a better outcome with a higher degree of function and reduced morbidity in addition to reduced time in the operating room. However, today’s surgery planning systems are primitive, relying mostly on the user’s ability to plan complex tasks with a two-dimensional graphical interface. Methods A system for planning the restoration of skeletal anatomy in facial trauma patients using a virtual model derived from patient-specific CT data. The system combines stereo visualization with six degrees-of-freedom, high-fidelity haptic feedback that enables analysis, planning, and preoperative testing of alternative solutions for restoring bone fragments to their proper positions. The stereo display provides accurate visual spatial perception, and the haptics system provides intuitive haptic feedback when bone fragments are in contact as well as six degrees-of-freedom attraction forces for precise bone fragment alignment. Results A senior surgeon without prior experience of the system received 45 min of system training. Following the training session, he completed a virtual reconstruction in 22 min of a complex mandibular fracture with an adequately reduced result. Conclusion Preliminary testing with one surgeon indicates that our surgery planning system, which combines stereo visualization with sophisticated haptics, has the potential to become a powerful tool for CMF surgery planning. With little training, it allows a surgeon to complete a complex plan in a short amount of time.
Highlights
Introduction and related workOne fundamental task in cranio-maxillofacial (CMF) surgery is to restore normal skeletal anatomy in patients with extensive fractures of the facial skeleton and mandible from gunshot wounds, work-related injuries, natural disasters, or traffic accidents
When the haptic cursor is in close proximity to a bone fragment, the fragment or group is graphically highlighted indicating that the user may pick it up and manipulate it by moving the handle with the handle button depressed. (See Fig. 2.) When the haptic cursor is further away from the bone fragments, and no fragment is highlighted, the user may translate and rotate the entire 3D volume, again by moving the handle with its button depressed
We describe in more detail the unique feature Snap-to-fit, which complements the contact forces to aid the user in bone fragment alignment
Summary
One fundamental task in cranio-maxillofacial (CMF) surgery is to restore normal skeletal anatomy in patients with extensive fractures of the facial skeleton and mandible from gunshot wounds, work-related injuries, natural disasters, or traffic accidents. Any attempt to restore a bone fragment to its original position poses considerable risk for additional damage to vital anatomical structures. Small errors in the positioning of each fragment may accumulate and result in inadequate reconstruction which in turn may result in poor function and a poor esthetic result. If the planning relies only on visual cues, object contact and object penetration can be difficult to discern because contact surfaces are likely to be occluded by the many bone fragments. Current commercially available CMF surgery planning systems, for example systems by Planmeca [1], Materialise
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