Clinical feasibility of computer-aided surgical simulation (CASS) in the treatment of complex cranio-maxillofacial deformities.
OBJECTIVE
The purpose of this study was to establish clinical feasibility of our 3-dimensional computer-aided surgical simulation (CASS) for complex craniomaxillofacial surgery.


METHODS
Five consecutive patients with complex craniomaxillofacial deformities, including hemifacial microsomia, defects after tumor ablation, and deformity after TMJ reconstruction, were used. The patients' surgical interventions were planned by using the authors' CASS planning method. Computed tomography (CT) was initially obtained. The first step of the planning process was to create a composite skull model, which reproduces both the bony structures and the dentition with a high degree of accuracy. The second step was to quantify the deformity. The third step was to simulate the entire surgery in the computer. The maxillary osteotomy was usually completed first, followed by mandibular and chin surgeries. The shape and size of the bone graft, if needed, was also simulated. If the simulated outcomes were not satisfactory, the surgical plan could be modified and simulation could be started over. The final step was to create surgical splints. Using the authors' computer-aided designing/manufacturing techniques, the surgical splints and templates were designed in the computer and fabricated by a stereolithographic apparatus. To minimize the potential risks to the patients, the surgeries were also planned following the current planning methods, and acrylic surgical splints were created as a backup plan.


RESULTS
All 5 patients were successfully planned using our CASS planning method. The computer-generated surgical splints were successfully used on all patients at the time of the surgery. The backup acrylic surgical splints and plans were never used. Six-week postoperative CT scans showed the surgical plans were precisely reproduced in the operating room and the deformities were corrected as planned.


CONCLUSIONS
The results of this study have shown the clinical feasibility of our CASS planning method. Using our CASS method, we were able to treat patients with significant asymmetries in a single operation that in the past was usually completed in 2 stages. We were also able to simulate different surgical procedures to create the appropriate plan. The computerized surgical plan was then transferred to the patient in the operating room using computer-generated surgical splints.
Gateno
Jaime
J
Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX, USA.
Xia
James J
JJ
Teichgraeber
John F
JF
Christensen
Andrew M
AM
Lemoine
Jeremy J
JJ
Liebschner
Michael A K
MA
Gliddon
Michael J
MJ
Briggs
Michaelanne E
ME
D003198:Computer Simulation; D019465:Craniofacial Abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007573:Jaw Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008953:Models, Anatomic; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000379:methods; D025321:Surgery, Computer-Assisted; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed