Abstract
Computer modelling techniques and Rapid Prototyping (RP) technologies can be used to enhance applied medicine. This paper decribe the use of these methods to develop computer and physical models which are used to plan and support different surgical treatments such as complex fractures, tumours, maxilla traumas and malformations. This present work reviews the use of segmentation techniques and modelling for planning maxilla facial surgery and particularly to support the treatment of retrognathia which is a malformation where the maxilla or the mandible is further posterior than normal. The surgical process in use to correct this malformation is called distraction osteogenesis. It involves gradual, controlled displacement of surgically created fractures which results in simultaneous expansion of soft tissue and bone volume. The procedure of mandibular osteogenic distraction involves sectioning cortical bone at the site of distraction. The distraction device (the distractor) is mounted on either side of the jaw. The distractor either may be attached directly to the bone or may be partially tooth borne. Gradual distraction is then performed at a rate of 1-2 mm/day, which is done incrementally. Distractors, for intraoral use, have been developed to eliminate extra oral scars. It is complicated and frustrating to position and manipulate these devices during surgery. The use of rapid prototyped models makes the operation easier and more accurate; indeed it is possible to adjust the distractor on the physical model and use the device directly on the patient after sterilization. Moreover pre operative preparation reduce the possibility of damaging the nerve canal during osteosynthesis since the direction of distraction is decided on the model.
Highlights
In principle Rapid Prototyping (RP) technique allow the computer screen image to be accurately reproduced in a few hours as an acrylic model which can be handled by the surgeon, allowing an immediate and intuitive understanding of the most complex 3-D geometry and can be used to accurately plan and practice an awkward operative procedure [1].RP isn’t a new process, it was introduced in the 1980’s to define new techniques for the manufacturing of physical models and was originally introduced in industry to improve design and reduce product development time
Since 2007 at National University Hospital of Iceland Landspitali we have developed an integrated medical modelling service (IMMS) to provide RP models for different medical purposes with the aim of optimizing the clinical processes
The Integrated medical modelling sevice (IMMS) was established in 2008; different clinical applications have been benefiting from this service, though the most successful application is the Mandibular Distraction Osteogenesis (MDO) planning with over 50 operations planned during these years (Figure 6)
Summary
RP isn’t a new process, it was introduced in the 1980’s to define new techniques for the manufacturing of physical models and was originally introduced in industry to improve design and reduce product development time. The development and use of this methodology has been rapidly growing hand in hand with the technological improvement and high resolution achieved by medical modalities such CT and MRI scan. The medical field which has mainly benefiting from the use of 3DM and RP is the Cranio Maxillofacial (CMF) surgery, the development has mainly been over the last fifteen years [3] defining new processes for designing, prefitting and production of surgical implants. The main benefits for using RP models include improving surgical planning, enhancing diagnostic quality, decreased exposure time to general anaesthesia, decreased blood loss and shorter wound exposure time [4]
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