title: Preliminary development of a workstation for craniomaxillofacial surgical procedures: introducing a computer-assisted planning and execution system.
abstract: BACKGROUND
  Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation and other related craniomaxillofacial procedures.
  
  
  METHODS
  We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants.
  
  
  RESULTS
  Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging.
  
  
  CONCLUSIONS
  The initial development of the CAPE workstation demonstrated that integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution for numerous types of craniofacial and orthognathic surgical procedures.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore; †The Johns Hopkins Applied Physics Laboratory, Research and Engineering Development Department, Laurel; ‡Engineering Research Center for Computer-Integrated Surgical Systems and Technology, Whiting School of Engineering, Johns Hopkins University, and §Department of Radiology, Johns Hopkins University School of Medicine, Baltimore; and ∥Department of Otolaryngology-Head & Neck Surgery and ¶Naval Postgraduate Dental School, 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Chad R
authors.initials: CR
authors.lastname: Gordon
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Murphy
authors.forename: Devin
authors.initials: D
authors.lastname: Coon
authors.forename: Ehsan
authors.initials: E
authors.lastname: Basafa
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Otake
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Rakan
authors.forename: Erin
authors.initials: E
authors.lastname: Rada
authors.forename: Srinivas
authors.initials: S
authors.lastname: Susarla
authors.forename: Sriniras
authors.initials: S
authors.lastname: Susarla
authors.forename: Edward
authors.initials: E
authors.lastname: Swanson
authors.forename: Elliot
authors.initials: E
authors.lastname: Fishman
authors.forename: Gabriel
authors.initials: G
authors.lastname: Santiago
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.forename: Peter
authors.initials: P
authors.lastname: Liacouras
authors.forename: Gerald
authors.initials: G
authors.lastname: Grant
authors.forename: Mehran
authors.initials: M
authors.lastname: Armand
mesh_terms: D059925:Anatomic Landmarks / Q000033:anatomy & histology; D000818:Animals; D002508:Cephalometry / Q000379:methods; D003195:Computer Communication Networks; D003199:Computer Systems; D054445:Facial Transplantation / Q000379:methods*; D005246:Feedback; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007256:Information Systems; D007430:Intraoperative Care; D008953:Models, Anatomic; D019647:Oral Surgical Procedures / Q000379:methods; D056948:Orthognathic Surgical Procedures / Q000379:methods; D010347:Patient Care Planning; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D013552:Swine; D013556:Swine, Miniature; D014057:Tomography, X-Ray Computed / Q000379:methods; D014584:User-Computer Interface