3D Skull Research Articles

Cranioplasty Enhanced by Three-Dimensional Printing: Custom-Made Three-Dimensional-Printed Titanium Implants for Skull Defects.

The authors studied to demonstrate the efficacy of custom-made three-dimensional (3D)-printed titanium implants for reconstructing skull defects. From 2013 to 2015, 21 patients (8-62 years old, mean = 28.6-year old; 11 females and 10 males) with skull defects were treated. Total disease duration ranged from 6 to 168 months (mean = 33.6 months). The size of skull defects ranged from 84 × 104 to 154 × 193 mm. Custom-made implants were manufactured by Medyssey Co, Ltd (Jecheon, South Korea) using 3D computed tomography data, Mimics software, and an electron beam melting machine. The team reviewed several different designs and simulated surgery using a 3D skull model. During the operation, the implant was fit to the defect without dead space. Operation times ranged from 85 to 180 minutes (mean = 115.7 minutes). Operative sites healed without any complications except for 1 patient who had red swelling with exudation at the skin defect, which was a skin infection and defect at the center of the scalp flap reoccurring since the initial head injury. This patient underwent reoperation for skin defect revision and replacement of the implant. Twenty-one patients were followed for 6 to 24 months (mean = 14.1 months). The patients were satisfied and had no recurrent wound problems. Head computed tomography after operation showed good fixation of titanium implants and satisfactory skull-shape symmetry. For the reconstruction of skull defects, the use of autologous bone grafts has been the treatment of choice. However, bone use depends on availability, defect size, and donor morbidity. As 3D printing techniques are further advanced, it is becoming possible to manufacture custom-made 3D titanium implants for skull reconstruction.

Agreement of Dental Students in the Detection of Normal Landmarks When Comparing Digital Lateral Cephalograms and Three-Dimensional Cone Beam Computed Tomography Images

Background: Proper defining of normal landmarks in lateral cephalograms is important for establishing proper orthodontic treatment plan. Objectives: To evaluate the agreement of dental students to identify normal landmarks (NLs) in digital lateral cephalograms and cone beam computed tomography (CBCT) images. Patients and Methods: In this study, lateral cephalograms and CBCT images of 11 orthodontic patients were selected. Three fourth-year dental students were asked to identify 19 NLs after calibrating digital lateral cephalograms and 3D CBCT images. Then, the distances of each landmark from the superior and anterior edges of the images were measured for each observer. Results: The observers’ errors fell within a range of -1.03 to 2.74 in two-dimensional cephalometry and a range of -0.88 to 2.31 in 3D CBCT, showing a 95% limit of agreement. According to the intraclass correlation coefficient (ICC) comparison made by our student observers, only 5% of interobserver assessment in CBCT and 20% in lateral cephalometry showed poor reliability. These same observers showed more agreement when identifying NLs on soft tissue as compared to hard tissue structures and also in detecting NLs located in the midsagittal region rather than on lateral sides in both modalities. Their differences in agreement in detecting midsagittal NLs rather than on lateral sides were statistically significant (P = 0.0001). Conclusions: The training of cephalometric tracing in orthodontic course based on 3D skull models and imaginary methods was deemed successful in increasing the ability of dental students to determine the precise location of NLs, even on CBCT images.

3D Skull Reconstruction with Selective Laser Sintering for Endoscopic Cranial Base Surgical Simulation and Training

Introduction: The training of surgeons is not dissimilar to that of pilots. Each profession has a responsibility to achieve a minimum safety standard and technical proficiency. This in most instances may only be achieved by many hours of experience, as well as practicing in mock or simulated emergency scenarios. Each quality airline provides its pilots with regular simulator events to train for particular emergency scenarios as well as simulator certification requirements. Surgeons have no such training requirement. Since there is no formal assessment of surgical skills for board and state licensure, surgeons are expected to self-regulate their own training. As advancements in medicine are made, surgeons are expected to know more and to be able to perform more types of procedures. In the USA, increasing restrictions on residency work hours are adding a new hurdle to surgical training. Restrictions on resident work hours means that many residents will not have optimum operating experience once they graduate from residency. For this reason, just as pilots spend hundreds of hours training in simulation suites, surgeons may also augment and complement their technical skills with simulation based training. In fields such as neurosurgery or otolaryngology, the endoscope is used in minimally invasive surgery. Junior residents may not have adequate exposure to this as their time practicing with endoscopes is limited by the dynamics of their residency program and case-load. By being able to train these residents in a realistic scenario, patient safety and quality of care can be improved. Data has shown that surgeons trained with simulation systems have shown improved parameters in the operating room such as technical profiency with the endoscope, as well as faster mean operating time. Materials and Methods: Current 3D printed training models on the market are prohibitively expensive and do not have tactile properties which accurately mimic real bone. Current methods also have difficulty in replicating the bony architecture of the skull base. We have developed a method of producing an anatomically accurate and realistic 3D printed skull with selective later sintering (SLS), using a material made from a polymer of polylactic acid (PLA) and limestone (Fig. 1). Our institute is developing the models around a suite of training features: various pathologies will be included, paired with real patient case histories and imaging for surgeons to review before they embark to practice on the skull model. Discussion: Methods for training surgeons in endoscopic surgery include virtual simulators, cadaveric training, and skull model based training. Virtual simulators are limited by the lack of tactile feedback, and cadaveric training is limited by ethical and cost issues. Training with skull based models has been shown to have comparative tactile feedback to the cadaveric model and actual surgery. Conclusion: Our institution has developed a method of manufacturing accurate 3D printed skull based models as part of an endoscopic surgery training suite.

Early changes in condylar position after mandibular advancement: a three-dimensional analysis

The aim of this study was to perform a three-dimensional (3D) assessment of positional changes of the mandibular condyle after bilateral sagittal split osteotomy (BSSO). A prospective evaluation of 22 skeletal class II patients who underwent a BSSO for mandibular advancement was performed. Pre- and postoperative cone beam computed tomography scans were taken. Using the cranial base as a stable reference, the pre- and postoperative 3D skull models were superimposed virtually. Positional changes of the condyles were assessed with a 3D colour mapping system (SimPlant O&O). A Brunner–Langer statistical test was applied to test the null hypothesis that the condylar position remains stable after BSSO. The level of significance was set at 0.05. The mean mandibular advancement in the studied sample was 6.7±1.6mm. Overall, the condylar positional changes after BSSO for mandibular advancement were statistically significant (P<0.05). A positive correlation was found between the displacement of the left condyle and the amount of mandibular advancement (P<0.01). The results of this study suggest that statistically significant changes of condylar position occur after mandibular advancement. Long-term evaluation is needed to assess the capacity of the temporomandibular joint to adapt to these changes.

High-Resolution 3D Magnetic Resonance Imaging of the Sixth Cranial Nerve: Anatomic and Pathologic Considerations by Segment.

Weakness of the sixth cranial nerve is the most common cause of an ocular motor cranial nerve palsy. It is often difficult to identify a corresponding abnormality on neuroimaging to correlate with the clinical examination. High-resolution 3D skull base magnetic resonance imaging (MRI) allows for visualization of the sixth nerve along much of its course and may increase sensitivity for abnormalities in regions that previously were challenging to evaluate. In this review, the authors share their experience with high-resolution imaging of the sixth nerve. For each segment, anatomic features visible on high-resolution imaging are described along with relevant pathologic entities. We present a segmental approach to high-resolution 3D MRI for evaluation of the sixth nerve from the nuclear to the orbital segment.

Validity of 3D Reconstructed Computed Tomographic Image in Using Craniometrical Measurements of the Skull for Sex Differentiation (An Iraqi Study)

The skull offers a high resistance of adverse environmental conditions over time, resulting in the greater stability of the dimorphic features as compared to other skeletal bony pieces. Sex determination of human skeletal considered an initial step in its identification. The present study is undertaken to evaluate the validity of 3D reconstructed computed tomographic images in sex differentiation by using craniometrical measurements at various parts of the skull. Materials and Method: 3D reconstructed computed tomographic scanning of 100 Iraqi subject, (50 males and 50 females) were analyzed with their age range from20-70 years old. Craniometrical linear measurements were located and marked on both side of the 3D skull images. Results: For the all parameters measured for sexes the mean value for Male had significantly greater than females with (p value < 0.001). A receiver operating characteristic curves was obtained for each variable to observe their overall performance in sex determination. The area of mastoid triangle was found the best variable in sex differentiation (ROC area =0.97 for unilateral skull measurements and 0.98 for bilateral measurements).while EU-EU was found to be the least one. Conclusion: 3D reconstructed Computed tomography scanning is a good diagnostic method for analyzing the craniometrical measurements of sex determination. sex differentiation for isolated part of the skull when only the fragmentary crania is available, could be achieved and the highest accuracy in sex determination can be obtained whether part or complete skull available. Keyword: Sex determination, 3D reconstructed computed tomography, mastoid process, sexual dimorphism. (J

Mapping of Craniofacial Traits in Outbred Mice Identifies Major Developmental Genes Involved in Shape Determination.

The vertebrate cranium is a prime example of the high evolvability of complex traits. While evidence of genes and developmental pathways underlying craniofacial shape determination is accumulating, we are still far from understanding how such variation at the genetic level is translated into craniofacial shape variation. Here we used 3D geometric morphometrics to map genes involved in shape determination in a population of outbred mice (Carworth Farms White, or CFW). We defined shape traits via principal component analysis of 3D skull and mandible measurements. We mapped genetic loci associated with shape traits at ~80,000 candidate single nucleotide polymorphisms in ~700 male mice. We found that craniofacial shape and size are highly heritable, polygenic traits. Despite the polygenic nature of the traits, we identified 17 loci that explain variation in skull shape, and 8 loci associated with variation in mandible shape. Together, the associated variants account for 11.4% of skull and 4.4% of mandible shape variation, however, the total additive genetic variance associated with phenotypic variation was estimated in ~45%. Candidate genes within the associated loci have known roles in craniofacial development; this includes 6 transcription factors and several regulators of bone developmental pathways. One gene, Mn1, has an unusually large effect on shape variation in our study. A knockout of this gene was previously shown to affect negatively the development of membranous bones of the cranial skeleton, and evolutionary analysis shows that the gene has arisen at the base of the bony vertebrates (Eutelostomi), where the ossified head first appeared. Therefore, Mn1 emerges as a key gene for both skull formation and within-population shape variation. Our study shows that it is possible to identify important developmental genes through genome-wide mapping of high-dimensional shape features in an outbred population.

Objective classification system for sagittal craniosynostosis based on suture segmentation.

Spring-assisted surgery is an effective and minimally invasive treatment for sagittal craniosynostosis (CSO). The principal barrier to the advancement of spring-assisted surgery is the patient-specific spring selection. The selection of spring force depends on the suture involved, subtypes of sagittal CSO, and age of the infant, among other factors. Clinically, physicians manually judge the subtype of sagittal CSO patients based on their CT image data, which may cause bias from different clinicians. An objective system would be helpful to stratify the sagittal CSO patients and make spring choice less subjective. The authors developed a novel informatics system to automatically segment and characterize sutures and classify sagittal CSO. The proposed system is composed of three phases: preprocessing, sutures segmentation, and classification. First, the three-dimensional (3D) skull was extracted from the CT images and aligned with the symmetry of the cranial vault. Second, a "hemispherical projection" algorithm was developed to transform 3D surface of the skull to a polar two-dimensional plane. Through the transformation, an "effective" projected region can be obtained to enable easy segmentation of sutures. Then, the different types of sutures, such as coronal sutures, lambdoid sutures, sagittal suture, and metopic suture, obtained from the segmented sutures were further identified by a dual-projection technique of the midline of the sutures. Finally, 108 quantified features of sutures were extracted and selected by a proposed multiclass feature scoring system. The sagittal CSO patients were classified into four subtypes: anterior, central, posterior, and complex with the support vector machine approach. Fivefold cross validation (CV) was employed to evaluate the capability of selected features in discriminating the four subtypes in 33 sagittal CSO patients. Receiver operating characteristics (ROC) curves were used to assess the robustness of the developed system. The segmentation results of the proposed method were clinically acceptable for the qualitative evaluation. For the quantitative evaluation, the fivefold CV accuracy of the classification for the four subtypes was 72.7%. This classification system was reliable with the area under curve (in ROC analysis) being greater than 0.8 for four two-class problems. The proposed hemispherical projection algorithm based on backtracking search can successfully segment sutures of the cranial vault. The classification system can also offer a desirable performance. As a result, the proposed segmentation and classification system is expected to bring insights into clinic research and the selection of the spring force to facilitate widespread application of this minimally invasive treatment.

Streamlined, Inexpensive 3D Printing of the Brain and Skull.

Neuroimaging technologies such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) collect three-dimensional data (3D) that is typically viewed on two-dimensional (2D) screens. Actual 3D models, however, allow interaction with real objects such as implantable electrode grids, potentially improving patient specific neurosurgical planning and personalized clinical education. Desktop 3D printers can now produce relatively inexpensive, good quality prints. We describe our process for reliably generating life-sized 3D brain prints from MRIs and 3D skull prints from CTs. We have integrated a standardized, primarily open-source process for 3D printing brains and skulls. We describe how to convert clinical neuroimaging Digital Imaging and Communications in Medicine (DICOM) images to stereolithography (STL) files, a common 3D object file format that can be sent to 3D printing services. We additionally share how to convert these STL files to machine instruction gcode files, for reliable in-house printing on desktop, open-source 3D printers. We have successfully printed over 19 patient brain hemispheres from 7 patients on two different open-source desktop 3D printers. Each brain hemisphere costs approximately $3–4 in consumable plastic filament as described, and the total process takes 14–17 hours, almost all of which is unsupervised (preprocessing = 4–6 hr; printing = 9–11 hr, post-processing = <30 min). Printing a matching portion of a skull costs $1–5 in consumable plastic filament and takes less than 14 hr, in total. We have developed a streamlined, cost-effective process for 3D printing brain and skull models. We surveyed healthcare providers and patients who confirmed that rapid-prototype patient specific 3D models may help interdisciplinary surgical planning and patient education. The methods we describe can be applied for other clinical, research, and educational purposes.

Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas.

To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques. One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils. Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas. Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure.

Quantitative trait loci affecting the 3D skull shape and size in mouse and prioritization of candidate genes in-silico.

We describe the first application of high-resolution 3D micro-computed tomography, together with 3D landmarks and geometric morphometrics, to map QTL responsible for variation in skull shape and size using a backcross between C57BL/6J and A/J inbred strains. Using 433 animals, 53 3D landmarks, and 882 SNPs from autosomes, we identified seven QTL responsible for the skull size (SCS.qtl) and 30 QTL responsible for the skull shape (SSH.qtl). Size, sex, and direction-of-cross were all significant factors and included in the analysis as covariates. All autosomes harbored at least one SSH.qtl, sometimes up to three. Effect sizes of SSH.qtl appeared to be small, rarely exceeding 1% of the overall shape variation. However, they account for significant amount of variation in some specific directions of the shape space. Many QTL have stronger effect on the neurocranium than expected from a random vector that will parcellate uniformly across the four cranial regions. On the contrary, most of QTL have an effect on the palate weaker than expected. Combined interval length of 30 SSH.qtl was about 315 MB and contained 2476 known protein coding genes. We used a bioinformatics approach to filter these candidate genes and identified 16 high-priority candidates that are likely to play a role in the craniofacial development and disorders. Thus, coupling the QTL mapping approach in model organisms with candidate gene enrichment approaches appears to be a feasible way to identify high-priority candidates genes related to the structure or tissue of interest.

Individualized Surgical Approach Planning for Petroclival Meningiomas using a 3D Printer

Objective: This study aims to describe potential benefits and drawbacks using individual 3D skull and tumor models from patients with petroclival meningiomas for surgical planning.

The Manufacture of Custom Made 3D Titanium Implant for Skull Reconstruction

Nowadays, with advanced 3D printing techniques, the custom-made implant can be manufactured for the patient. Especially in skull reconstruction, it is difficult to design the implant due to complicated geometry. In large defect, an autograft is inappropriate to cover the defect due to donor morbidity. We present the process of manufacturing the 3D custom-made implant for skull reconstruction. There was one patient with skull defect repaired using custom-made 3D titanium implant in the plastic and reconstructive surgery department. The patient had defect of the left parieto-temporal area after craniectomy due to traumatic subdural hematoma. Custom-made 3D titanium implants were manufactured by Medyssey Co., Ltd. using 3D CT data, Mimics software and an EBM (Electron Beam Melting) machine. The engineer and surgeon reviewed several different designs and simulated a mock surgery on 3D skull model. During the operation, the custom-made implant was fit to the defect properly without dead space. The operative site healed without any specific complications. In skull reconstruction, autograft has been the treatment of choice. However, it is not always available and depends on the size of defect and donor morbidity. As 3D printing technique has been advanced, it is useful to manufacture custom-made implant for skull reconstruction.

Classifying Craniosynostosis with a 3D Projection-Based Feature Extraction System.

Craniosynostosis, a disorder in which one or more fibrous joints of the skull fuse prematurely, causes skull deformity and is associated with increased intracranial pressure and developmental delays. Although clinicians can easily diagnose craniosynostosis and can classify its type, being able to quantify the condition is an important problem in craniofacial research. While several papers have attempted this quantification through statistical models, the methods have not been intuitive to biomedical researchers and clinicians who want to use them. The goal of this work was to develop a general platform upon which new quantification measures could be developed and tested. The features reported in this paper were developed as basic shape measures, both single-valued and vector-valued, that are extracted from a single plane projection of the 3D skull. This technique allows us to process images that would otherwise be eliminated in previous systems due to poor resolution, noise or imperfections on their CT scans. We test our new features on classification tasks and also compare their performance to previous research. In spite of its simplicity, the classification accuracy of our new features is significantly higher than previous results on head CT scan data from the same research studies.

Craniofacial divergence by distinct prenatal growth patterns in Fgfr2 mutant mice

BackgroundDifferences in cranial morphology arise due to changes in fundamental cell processes like migration, proliferation, differentiation and cell death driven by genetic programs. Signaling between fibroblast growth factors (FGFs) and their receptors (FGFRs) affect these processes during head development and mutations in FGFRs result in congenital diseases including FGFR-related craniosynostosis syndromes. Current research in model organisms focuses primarily on how these mutations change cell function local to sutures under the hypothesis that prematurely closing cranial sutures contribute to skull dysmorphogenesis. Though these studies have provided fundamentally important information contributing to the understanding of craniosynostosis conditions, knowledge of changes in cell function local to the sutures leave change in overall three-dimensional cranial morphology largely unexplained. Here we investigate growth of the skull in two inbred mouse models each carrying one of two gain-of-function mutations in FGFR2 on neighboring amino acids (S252W and P253R) that in humans cause Apert syndrome, one of the most severe FGFR-related craniosynostosis syndromes. We examine late embryonic skull development and suture patency in Fgfr2 Apert syndrome mice between embryonic day 17.5 and birth and quantify the effects of these mutations on 3D skull morphology, suture patency and growth.ResultsWe show in mice what studies in humans can only infer: specific cranial growth deviations occur prenatally and worsen with time in organisms carrying these FGFR2 mutations. We demonstrate that: 1) distinct skull morphologies of each mutation group are established by E17.5; 2) cranial suture patency patterns differ between mice carrying these mutations and their unaffected littermates; 3) the prenatal skull grows differently in each mutation group; and 4) unique Fgfr2-related cranial morphologies are exacerbated by late embryonic growth patterns.ConclusionsOur analysis of mutation-driven changes in cranial growth provides a previously missing piece of knowledge necessary for explaining variation in emergent cranial morphologies and may ultimately be helpful in managing human cases carrying these same mutations. This information is critical to the understanding of craniofacial development, disease and evolution and may contribute to the evaluation of incipient therapeutic strategies.

16 landmarks of the mouse brain have been validated as fiducials for registration to WHS

Event Abstract Back to Event 16 landmarks of the mouse brain have been validated as fiducials for registration to WHS Marina Sergejeva1*, Rembrandt Bakker2, André Gaudnek1, Yuko Okamura-Oho3, Jyl Boline4 and Andreas Hess1 1 Institute of Pharmacology, FAU Erlangen, Germany 2 Radboud University Nijmegen, Netherlands 3 Brain Research Network and RIKEN Advanced Science Institute, Japan 4 Informed Minds, United States A standard space for describing coordinate-based knowledge about the rodent brain is urgently needed. The INCF Digital Atlasing Program has yielded an open access 3D atlas reference system for the mouse brain - Waxholm Space (WHS) and a supporting Digital Atlasing Infrastructure (DAI) – for sharing of multimodal data (genomic, proteomic, imaging) from research groups around the world. We need convenient methods that permit researchers to register their own data to WHS. Existing automatic registration processes are rather complex. In addition, we propose an easier and faster approach: registration based on well recognizable brain landmarks (LMs) or fiducials. Here we present a set of LMs validated as fiducials, as they were reliably identified • by different individuals (anatomy specialists and novice) • in different MR imaging modalities (T1, T2, T2*) • in various specimens • by different cutting directions • by different image resolutions. On coronal MR datasets (T1, T2, T2*, 256x256x128, 80 μm) from an adult C57BL/6J male we defined an initial set of LMs recognizable in all 3 modalities and rendered descriptions how to find them. 15 guessers identified these LMs according to the descriptions on datasets from two C57BL/6J males, visualized in ImageJ as coronal slices. The probability of finding them, mean values for x, y and z coordinates and deviations from the mean were calculated for every LM. Finally, we excluded LMs with a deviation of more than 1,5 voxels in the x and y directions in both animals and ended up with 16 potential fiducials. Their average deviations were: 1,0 (x), 0,6 (y) and 1,5 (z), the probability of finding was > 95%. Further, we located these 16 LMs on the canonical WHS datasets, and presented them in the web-based atlasing tool Scalable Brain Atlas (http://scalablebrainatlas.incf.org/WHS10). WHS images have a four times higher resolution and a different inclination than ours, but despite the differences all LMs were well identifiable according to our definitions. This supports their validity as fiducials. We also evaluated “the classical” LMs, Bregma and Lambda derived from the skull 3D µCT datasets coregistered to brain MRI datasets of five mice. We found that positions of these LMs with respect to brain anatomy vary considerably between the mice. The largest distance between Bregma z-positions was 1,2 mm, and between Lambda z-positions - 1,68 mm. Thus, we cannot accept these two LMs as fiducials. Keywords: digital atlasing, Waxholm Space, neuroinformatics, rodent brain, Open access Conference: 5th INCF Congress of Neuroinformatics, Munich, Germany, 10 Sep - 12 Sep, 2012. Presentation Type: Poster Topic: Neuroinformatics Citation: Sergejeva M, Bakker R, Gaudnek A, Okamura-Oho Y, Boline J and Hess A (2014). 16 landmarks of the mouse brain have been validated as fiducials for registration to WHS. Front. Neuroinform. Conference Abstract: 5th INCF Congress of Neuroinformatics. doi: 10.3389/conf.fninf.2014.08.00028 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 21 Mar 2013; Published Online: 27 Feb 2014. * Correspondence: Dr. Marina Sergejeva, Institute of Pharmacology, FAU Erlangen, Erlangen, Germany, sergeeva@pharmakologie.uni-erlangen.de Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Marina Sergejeva Rembrandt Bakker André Gaudnek Yuko Okamura-Oho Jyl Boline Andreas Hess Google Marina Sergejeva Rembrandt Bakker André Gaudnek Yuko Okamura-Oho Jyl Boline Andreas Hess Google Scholar Marina Sergejeva Rembrandt Bakker André Gaudnek Yuko Okamura-Oho Jyl Boline Andreas Hess PubMed Marina Sergejeva Rembrandt Bakker André Gaudnek Yuko Okamura-Oho Jyl Boline Andreas Hess Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Study of application of surgical navigation assist oral and maxillofacial surgery based on 104 cases

Background and objectives: The temporomandibular joint plays a very important role for the function of the mandible. The delicate and complex anatomy of TMJ area challenges for the reconstructive surgery of this region. The objective of this study is to verify the feasibility and the effectiveness of the intraoperative image-guide navigation for the TMJ surgery. Methods: 45 Patients with TMJ diseases are enrolled in this study, including 30 cases with TMJ ankylosis, 10 with TMJ osteochondorma and 5 with post-surgical deformities due to TMJ ankylosis. The preoperative radiologic examinations involved thin-cut (0.625-mm) spiral CT scans for all patients. Using the DICOM protocol CT data sets, a virtual 3D skull model was created in navigation system TBNavis-CMFS (Shanghai, China). The preoperative individual planning and simulation data sets, including the generation of virtual models with TMJ arthroplasty (gap surgery) in 30 cases, articular fossa remodeling in 4 cases, condylar-ramus unit (CRU) reconstruction with rib graft in 1 cases, endoscopic-assisted osteochondroma resection/condylectomy in 10 cases, were used as a virtual template to guide surgical correction of those deformities by intraoperative instrumentand/or probe-based navigation. Results: Using 4–5 invasive markers for registration, an accurate match between the intraoperative actual position and 3-dimensional virtual model was achieved within a systematic error of 1 mm difference. With the guidance of the real-time navigation system, all the surgical procedures went on smoothly. The average deviation of the morphologic change after surgical correction was less than 1.5 mm with superimposing the preoperative planning and postoperative CT images. The followup evaluation showed that the clinical complaint symptoms were alleviated, and the postoperative function and esthetics improved remarkably. Conclusions: Navigation-guided surgery in the TMJ region provides better precision and safety for the surgeons and can be regarded as an ideal and valuable option for this potentially complicated procedure.

Navigation assisted temporomandibular joint reconstructive surgery

Background and objectives: The temporomandibular joint plays a very important role for the function of the mandible. The delicate and complex anatomy of TMJ area challenges for the reconstructive surgery of this region. The objective of this study is to verify the feasibility and the effectiveness of the intraoperative image-guide navigation for the TMJ surgery. Methods: 45 Patients with TMJ diseases are enrolled in this study, including 30 cases with TMJ ankylosis, 10 with TMJ osteochondorma and 5 with post-surgical deformities due to TMJ ankylosis. The preoperative radiologic examinations involved thin-cut (0.625-mm) spiral CT scans for all patients. Using the DICOM protocol CT data sets, a virtual 3D skull model was created in navigation system TBNavis-CMFS (Shanghai, China). The preoperative individual planning and simulation data sets, including the generation of virtual models with TMJ arthroplasty (gap surgery) in 30 cases, articular fossa remodeling in 4 cases, condylar-ramus unit (CRU) reconstruction with rib graft in 1 cases, endoscopic-assisted osteochondroma resection/condylectomy in 10 cases, were used as a virtual template to guide surgical correction of those deformities by intraoperative instrumentand/or probe-based navigation. Results: Using 4–5 invasive markers for registration, an accurate match between the intraoperative actual position and 3-dimensional virtual model was achieved within a systematic error of 1 mm difference. With the guidance of the real-time navigation system, all the surgical procedures went on smoothly. The average deviation of the morphologic change after surgical correction was less than 1.5 mm with superimposing the preoperative planning and postoperative CT images. The followup evaluation showed that the clinical complaint symptoms were alleviated, and the postoperative function and esthetics improved remarkably. Conclusions: Navigation-guided surgery in the TMJ region provides better precision and safety for the surgeons and can be regarded as an ideal and valuable option for this potentially complicated procedure.

A novel simplified 3D skull model to predict cranial fracture patterns

Skull fracture is a major cause of head injury involving high morbidity and mortality worldwide. The study of fracture patterns is decisive to determine the factors involved in the cause of death or injury. Furthermore, in-depth evaluation of these patterns can generate very valuable knowledge to further design and manufacture more efficient and secure protective equipment, as well as, innovative cranial implants. Fracture propagation has been studied in several works using post-mortem skulls or complex finite element models; however, injury patters resulted to be complicated and very difficult to understand. In this study, a simplification of a real human skull to perform biomechanical tests is considered. In a first step, a 3D model of a cranium is designed, following expert medical indications. The new model is used to simulate and evaluate several impact forces and their fracture patterns. The results obtained confirm the stress propagation shown in previous studies using post-mortem skulls. Moreover, they validate the simplified 3D model as simpler and effective tool to perform mechanical behaviour tests.

Soft-Tissue Manipulation Contributes to Craniofacial Symmetry as Importantly as Does Implant Reconstruction in Cranioplasty for Skull Defects

Soft-Tissue Manipulation Contributes to Craniofacial Symmetry as Importantly as Does Implant Reconstruction in Cranioplasty for Skull Defects