title: Complex facial deformity reconstruction with a surgical guide incorporating a built-in occlusal stent as the positioning reference.
abstract: Computer-aided design has gained increasing popularity in clinical practice, and the advent of rapid prototyping technology has further enhanced the quality and predictability of surgical outcomes. It provides target guides for complex bony reconstruction during surgery. Therefore, surgeons can efficiently and precisely target fracture restorations. Based on three-dimensional models generated from a computed tomographic scan, precise preoperative planning simulation on a computer is possible. Combining the interdisciplinary knowledge of surgeons and engineers, this study proposes a novel surgical guidance method that incorporates a built-in occlusal wafer that serves as the positioning reference.Two patients with complex facial deformity suffering from severe facial asymmetry problems were recruited. In vitro facial reconstruction was first rehearsed on physical models, where a customized surgical guide incorporating a built-in occlusal stent as the positioning reference was designed to implement the surgery plan. This study is intended to present the authors' preliminary experience in a complex facial reconstruction procedure. It suggests that in regions with less information, where intraoperative computed tomographic scans or navigation systems are not available, our approach could be an effective, expedient, straightforward aid to enhance surgical outcome in a complex facial repair.
authors.affiliation: Department of Mechanical Engineering, Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Jing-Jing
authors.initials: JJ
authors.lastname: Fang
authors.forename: Jia-Kuang
authors.initials: JK
authors.lastname: Liu
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Wu
authors.forename: Jing-Wei
authors.initials: JW
authors.lastname: Lee
authors.forename: Tai-Hong
authors.initials: TH
authors.lastname: Kuo
mesh_terms: D000293:Adolescent; D003198:Computer Simulation; D017076:Computer-Aided Design; D005146:Facial Asymmetry / Q000601:surgery*; D005260:Female; D005357:Fibrous Dysplasia of Bone / Q000601:surgery; D057918:Fiducial Markers; D018460:Fractures, Comminuted / Q000601:surgery; D005624:Frontal Bone / Q000293:injuries; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007574:Jaw Relation Record / Q000295:instrumentation; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery; D063175:Mandibular Reconstruction / Q000379:methods; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D008953:Models, Anatomic; D009915:Orbit / Q000601:surgery; D009917:Orbital Fractures / Q000601:surgery; D019340:Osteotomy, Le Fort / Q000379:methods; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000379:methods*; D013165:Splints; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods; D014584:User-Computer Interface; D015051:Zygomatic Fractures / Q000601:surgery