高精度光学导航辅助颅颌面骨畸形整复的技术方法建立与应用

目的：通过自主建立用于颅颌面手术的高精度计算机导航软硬件系统,模拟和精确设计手术方案,实现术中实时可视化手术导航。方法：（1）创建颅颌面整复手术规划及导航软件（TBNAVIS—CMFS）。（2）建立基于Polaris光学定位仪的导航工作站。（3）临床上对50例复杂颅颌面畸形患者实施导航辅助矫治与修复重建手术。结果：TBNAVIS—CMFS以清晰的界面和简洁的操作．实现了高精度数字化手术规划;导航辅助的颅颌面骨畸形整复术取得了精确可靠的手术效果,减少了手术创伤。结论：计算机导航技术结合颅颌面整复外科,将有利于从疾病诊断、术前模拟、术中导航等方面推动颅颌面外科趋于精确和微创。     

手术导航系统在颅颌面外科的应用

总结术中导航技术的发展历史、基本组成、工作原理和精度影响因素，重点讨论了近年来术中导航技术在颅颌面外科的应用现状，包括神经外科、口腔颌面外科、耳鼻咽喉科、放疗科等。结果显示术中导航将使手术更加个性化，精度更高，更加微创，因而有着良好的应用前景。     

2012年第二次数字化外科技术学习班通知

继第一次"数字化外科技术在口腔颌面外科的应用"学习班成功举办后,北京大学口腔医院将于2012年10月19-20日举办第二次"数字化外科技术在口腔颌面外科的应用"学习班。学习班设置讲座、工作坊(workshop)和手术参观内容。讲座将邀请口腔颌面外科领域及相关学科专家(计算机科学、机器人、先进制造等领域)就数字化外科相关技术进行讲解,内容涉及计算机辅助设计、导航、快速成型等数字技术在颅颌面肿瘤、创伤、修复重建、种植领域的应用。工作坊安排导航技术,计算机辅助设计、快速成型机3个内容的现场操作。学习班还将安排典型病例的导航手术观摩,并授予I类学分4分。工作坊名额有限,需单独报名。     

卢利教授课题组荣获辽宁省科学技术进步奖一等奖

以中国医科大学附属口腔医院卢利教授为第一完成人的课题项目"数字化技术和微创外科技术在颌面外科中的应用"荣获2014年辽宁省科学技术进步奖一等奖。卢利教授带领的课题组团队包括杨鸣良、白晓峰、颜光启、王绪凯和孙长伏等。课题组开展该项目的临床研究历时十年,将数字外科、手术导航和微创外科技术应用于颌面外科。通过整合三维精确测量、手术模拟、预测和配准等技术手段,在围术期完成颅颌面畸形和缺损的数字化手术模拟和个性化修复体的制     

基于混合现实的手术导航系统在颅颌面创伤骨整复中的应用研究

目的 搭建基于混合现实（MR）及红外光学定位的手术导航系统,并评估其在颅颌面创伤骨整复中的临床适用性。 方法 集成基于MR技术和光学定位追踪的软硬件系统,并完善系统工作流程;通过3D打印头颅模型实验,分析该系统的系统误差、目标配准误差和截骨应用误差;进一步通过颧上颌骨复合体（ZMC）复位的模型实验和额骨缺损修复的初步临床应用,探讨该系统的适用性。 结果 本MR手术导航系统的系统误差为（1.23±0.52）mm,目标配准误差为（2.83±1.18）mm,截骨应用误差为（3.13±1.66）mm;ZMC模型虚拟手术规划流畅,复位顺利;本系统引导下的额骨缺损修复重建手术过程顺利,重建效果满意。 结论 本研究搭建的MR手术导航系统具有虚实融合效果佳、动态导航稳定性好的优点,其在颅颌面外科的医患沟通、医学教育、术前规划和术中导航等各方面都具有应用潜力。     

数字化技术在提高颅颌面畸形整复手术精度中的效果评价

目的:探讨数字化外科辅助颅颌面畸形手术相对于传统手术的优势并评价其远期效果.方法:本研究是一项前瞻性队列研究,纳入因肿瘤、感染、先天发育等原因需要进行颅颌面畸形整复的患者,进行数字化辅助手术或传统经验性手术.纳入研究后按计划随访,收集基线期、治疗期及术后随访期的手术相关资料、CT数据,使用Mimics软件色谱误差分析分...     

颅颌面损伤性畸形

颅颌面外科是突破了颅底与颌面部之间的“一板之隔”,开辟了一条颅内与颅外相结合的手术途径 ,使得那些复杂而又难治颅颌面部的先天性畸形与损伤性畸形 ,以及颌面部恶性肿瘤向颅底扩散的病例 ,得到了有效的手术治疗。这是在颌面外科、整形外科的基础上结合神经外科的特点发展起来的。代表了颌面外科、整形外科、神经外科的进步 ,得到了国内外医学界的重视。颅颌面外科的基本手术主要是整形性手术和肿瘤性手术。整形性手术是经颅截断颅面骨 ,重新组建进行修复的手术 ,肿瘤性手术是经颅截除被瘤灶侵蚀颅骨达到彻底根治的手术。主要的适应征为 …     

手术机器人系统在颅颌面外科中的应用及发展

近年来机器人辅助外科手术以其微创、精准、安全的特点受到了越来越多的关注。颅颌面外科传统手术严重影响美观。机器人辅助手术延伸了医生的视觉范围和可操作空间,提高了手术效果及患者术后生活质量。本文对手术机器人系统的发展以及近年来在颅颌面外科的应用进行综述。     

超声联合CT导航行颅颌面颈部金属异物取出术32例临床分析

目的：研究超声联合CT导航行颅颌面颈部金属异物取出术的手术方法和临床疗效。方法：回顾分析32例颅颌面颈部金属异物滞留患者的临床资料,通过超声联合CT导航实施异物取出。结果：32例患者的颅颌面颈部共滞留金属异物194颗,其中通过超声导航取出36颗,通过CT导航取出153颗,取出率达97.4%;术中定位准确,出血量少,术后患者均无明显手术并发症。结论：采用超声和CT导航,可精确定位并安全取出滞留于颅颌面颈部的金属异物,避免损伤重要的生理解剖结构,取得了良好的临床疗效。     

2004年中国口腔颌面修复重建外科学术会议通知

为交流和提高口腔颌面修复重建外科学术水平,加快发展我国口腔颌面外科事业,经中华口腔医学会批准,口腔颌面外科专委会与四川大学华西口腔医学院于2 0 0 4年10月15～17日在成都举办第一届中国口腔颌面修复重建外科学术会议,敬请全国颌面外科及相关专业同行参加。会议内容:先天性口腔颌面畸形的外科治疗及基础研究、口腔颌面部创伤畸形的整复治疗、颌面部肿瘤切除后组织器官缺损的修复再造、颌面部整形美容技术、颅颌面种植外科及赝复修补、微创外科技术在颅颌面外科的应用、牵张成骨技术在颅颌面外科的应用、颅颌面外科手术模拟及虚拟现实技…     

Virtual planning for craniomaxillofacial surgery – 7 Years of experience

Contemporary computer-assisted surgery systems more and more allow for virtual simulation of even complex surgical procedures with increasingly realistic predictions. Preoperative workflows are established and different commercially software solutions are available. Potential and feasibility of virtual craniomaxillofacial surgery as an additional planning tool was assessed retrospectively by comparing predictions and surgical results. Since 2006 virtual simulation has been performed in selected patient cases affected by complex craniomaxillofacial disorders (n = 8) in addition to standard surgical planning based on patient specific 3d-models. Virtual planning could be performed for all levels of the craniomaxillofacial framework within a reasonable preoperative workflow. Simulation of even complex skeletal displacements corresponded well with the real surgical result and soft tissue simulation proved to be helpful. In combination with classic 3d-models showing the underlying skeletal pathology virtual simulation improved planning and transfer of craniomaxillofacial corrections. Additional work and expenses may be justified by increased possibilities of visualisation, information, instruction and documentation in selected craniomaxillofacial procedures.     

Template-based registration for image-guided maxillofacial surgery.

PURPOSE: Fiducial marker registration using bone screws is a proved and tested method for patient-to-image registration for image-guided surgery of the head. The use of intraoral fiducial markers mounted on a template for the maxillary dentition is a less invasive alternative and is in use for intraoral image-guided surgery. The aim of this study was to verify if this method is sufficiently accurate for extraoral use. MATERIALS AND METHODS: Registration was performed using 243 different configurations of fiducial markers mounted on a maxillary template. The accuracy of the identification of artificial skull-mounted targets located in surgically relevant locations was determined for each registration. RESULTS: Targeting accuracy was sufficient for image-guided surgery of the maxilla, the midface, the orbit, and the pterygopalatine fossa. In the regions of the calvarium, however, average target registration error was > or =1.5 mm. Average target registration error was >3 mm. CONCLUSION: Fiducial marker registration based on a maxillary template is a safe and non-invasive alternative to bone-mounted fiducial markers for image-guided surgery in the regions of orbit, face, maxilla, and pterygopalatine fossa.     

Distraction osteogenesis in maxillofacial surgery

With distraction osteogenesis (DOG) formation of new bone is initiated by gradual separation of osteotomized bone fragments. Both external and internal distraction devices are available. Since its first application in craniomaxillofacial surgery in the early nineties, developments in distraction osteogenesis have been tremendous. Important advantages of this technique are: lack of a donorsite and its associated morbidity; increase of the volume of the soft tissue envelop; less surgical trauma compared to conventional craniomaxillofacial procedures; and the usability of the technique in growing individuals. Disadvantages of DOG are: the sofar limited experience and follow-up in craniomaxillofacial surgery; and the unknown influences on growth. The technique will gradually find its niche and the general dentist will therefore be increasingly confronted with its specific indications. In this paper the general principles of DOG and a number of indications in craniomaxillofacial surgery are discussed.     

Evaluation of bone surface registration applying a micro-needle array

AIM: In this study we present and evaluated a new registration technology for the jaw-bone surface. It is based on a micromechatronic device for the generation of a "mechanical image" of the bone surface by means of an array of micro-needles that are penetrating the soft tissue until they touch the surface of the bone. This "mechanical impression image" is aligned with the CT data set. MATERIAL AND METHODS: Based on laboratory measurements on 10 specially prepared jawbone models we evaluate the accuracy of this new registration method. Results: Our measurements of the 10 specimens revealed a maximum overall location error of 0.97 mm (range: 0.35-0.97 mm). CONCLUSIONS: From the technical point of view the presented registration technology has the potential to improve the performance (i.e. accuracy and avoidance of errors) of the registration process for bony structures in selected applications of image-guided surgery.     

Free flap surgery in Europe: an interdisciplinary survey

Free flap surgery is essential for the aesthetic and functional reconstruction of various parts of the body. The aim of this study was to compare current concepts of perioperative flap management between ENT, craniomaxillofacial, and plastic surgeons. A European survey was conducted among 570 surgical departments, covering all aspects of free flap surgery. Focus was placed on antibiotic and antithrombotic drug use, aspects of osseous reconstruction, and flap monitoring strategies. One hundred and seventy-two medical units participated. A broad spectrum of anticoagulant regimens and a trend towards prolonged antibiotic prophylaxis were found. Fixation with (CAD/CAM) reconstruction plates was more popular than monocortical locking with miniplates in the mandible. Visual assessment and Doppler systems were reported to be the most common monitoring modalities. The flap loss rate was stated to be higher after osseous reconstruction. Only a few differences in perioperative flap management were identified between the different surgical fields, and osseous reconstruction appears to be the most challenging.     

Advances and innovations in computer-assisted head and neck oncologic surgery

Over the past years, computer-assisted surgery has gained more importance in craniomaxillofacial surgery, especially in primary and secondary treatment of head and neck malignancies. The basis for oncologic treatment of the head and neck region requires detailed planning using computed tomography, cone-beam computed tomography, or magnetic resonance imaging in combination with computer-assisted, infrared-based navigation system. These techniques allow a preplanned image-guided path to the tumor region for taking biopsies, resection, or reconstruction. The aim of this work was to show the advances and technical benefits for tumor surgery in a daily clinical routine from the view of the craniomaxillofacial surgeon. The target of our working group was to develop and clinically evaluate a novel three-dimensional planning and navigation software solution for treatment of craniofacial tumors. This work was carried out on 5 categories for oncologic surgical procedures in which computer-assisted surgery was applied from 2005 to 2011: preplanned trajectorial-guided tumor biopsy, intraoperative image-controlled tumor resection, tumor mapping, reconstruction after tumor surgery (true to original), and oral rehabilitation (backward planning). Successful preoperative planning, import of image data suitable for navigation, and intraoperative precise infrared-based navigation were obtained for all 5 categories without any complications. Image-guided navigation technique for head and neck oncologic surgery provides a precise, safe surgical method with real-time excellent anatomic orientation. Regarding the advantages of computer-assisted surgery, this technique will play a major part in craniofacial reconstructive surgery and will address widespread general methodologic solutions that are of great interest in multidisciplinary oncologic treatment.