Virtual Surgical Planning and 3D-Printed Surgical Guides in Facial Allotransplantation

Abstract

The complex three-dimensional (3D) anatomy in facial allotransplantation creates a unique challenge for surgical reconstruction. Evolution of virtual surgical planning (VSP) through computer-aided design and computer-aided manufacturing has advanced reconstructive outcomes for many craniomaxillofacial indications. Surgeons use VSP, 3D models, and surgical guides to analyze and to trial surgical approaches even prior to entering the operating room. This workflow allows the surgeon to plan osteotomies and to anticipate challenges, which improves surgical precision and accuracy, optimizes outcomes, and should reduce operating room time. We present the development, evolution, and utilization of VSP and 3D-printed guides in facial allotransplantation at our institution, from guide conception to first clinical case.

Keywords

virtual surgical planning - facial reconstruction - face transplant - craniomaxillofacial surgery - craniofacial surgery - vascularized composite tissue allotransplantation - 3D printing - cutting guides

Publikationsverlauf

Artikel online veröffentlicht:
07. Dezember 2022

• References

• 1 Vyas K, Bakri K, Gibreel W, Cotofana S, Amer H, Mardini S. Facial transplantation. Facial Plast Surg Clin North Am 2022; 30 (02) 255-269
• 2 Vyas K, Gibreel W, Mardini S. Virtual surgical planning (VSP) in craniomaxillofacial reconstruction. Facial Plast Surg Clin North Am 2022; 30 (02) 239-253
• 3 Chim H, Wetjen N, Mardini S. Virtual surgical planning in craniofacial surgery. Semin Plast Surg 2014; 28 (03) 150-158
• 4 Suchyta M, Mardini S. Innovations and future directions in head and neck microsurgical reconstruction. Clin Plast Surg 2017; 44 (02) 325-344
• 5 Mardini S, Alsubaie S, Cayci C, Chim H, Wetjen N. Three-dimensional preoperative virtual planning and template use for surgical correction of craniosynostosis. J Plast Reconstr Aesthet Surg 2014; 67 (03) 336-343
• 6 Tepper OM, Sorice S, Hershman GN, Saadeh P, Levine JP, Hirsch D. Use of virtual 3-dimensional surgery in post-traumatic craniomaxillofacial reconstruction. J Oral Maxillofac Surg 2011; 69 (03) 733-741
• 7 Antony AK, Chen WF, Kolokythas A, Weimer KA, Cohen MN. Use of virtual surgery and stereolithography-guided osteotomy for mandibular reconstruction with the free fibula. Plast Reconstr Surg 2011; 128 (05) 1080-1084
• 8 Sweed AH, Bolzoni AR, Kadubiec A, Beltramini GA, Cherchi A, Baj A. Factors influencing CAD/CAM accuracy in fibula free flap mandibular reconstruction. Acta Otorhinolaryngol Ital 2020; 40 (02) 138-143
• 9 Ciocca L, Marchetti C, Mazzoni S. et al. Accuracy of fibular sectioning and insertion into a rapid-prototyped bone plate, for mandibular reconstruction using CAD-CAM technology. J Craniomaxillofac Surg 2015; 43 (01) 28-33
• 10 Roser SM, Ramachandra S, Blair H. et al. The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results. J Oral Maxillofac Surg 2010; 68 (11) 2824-2832
• 11 Wang YY, Zhang HQ, Fan S. et al. Mandibular reconstruction with the vascularized fibula flap: comparison of virtual planning surgery and conventional surgery. Int J Oral Maxillofac Implants 2016; 45 (11) 1400-1405
• 12 Ciocca L, Mazzoni S, Fantini M, Marchetti C, Scotti R. The design and rapid prototyping of surgical guides and bone plates to support iliac free flaps for mandible reconstruction. Plast Reconstr Surg 2012; 129 (05) 859e-861e
• 13 Cornelius CP, Giessler GA, Wilde F, Metzger MC, Mast G, Probst FA. Iterations of computer- and template assisted mandibular or maxillary reconstruction with free flaps containing the lateral scapular border–evolution of a biplanar plug-on cutting guide. J Craniomaxillofac Surg 2016; 44 (03) 229-241
• 14 Geusens J, Sun Y, Luebbers HT, Bila M, Darche V, Politis C. Accuracy of computer-aided design/computer-aided manufacturing-assisted mandibular reconstruction with a fibula free flap. J Craniofac Surg 2019; 30 (08) 2319-2323
• 15 Wang YY, Fan S, Zhang HQ, Lin ZY, Ye JT, Li JS. Virtual surgical planning in precise maxillary reconstruction with vascularized fibular graft after tumor ablation. J Oral Maxillofac Surg 2016; 74 (06) 1255-1264
• 16 Bover-Ramos F, Viña-Almunia J, Cervera-Ballester J, Peñarrocha-Diago M, García-Mira B. Accuracy of implant placement with computer-guided surgery: a systematic review and meta-analysis comparing cadaver, clinical and in vitro studies. Int J Oral Maxillofac Implants 2018; 33 (01) 101-115
• 17 Manninen AA, Törnwall J, Horelli JC. et al. Virtual 3D planning and prediction accuracy in two bimaxillary face transplantations in Helsinki. J Plast Reconstr Aesthet Surg 2022; 75 (02) 605-612
• 18 Tondin GM, Leal MOCD, Costa ST, Grillo R, Jodas CRP, Teixeira RG. Evaluation of the accuracy of virtual planning in bimaxillary orthognathic surgery: a systematic review. Br J Oral Maxillofac Surg 2022; 60 (04) 412-421
• 19 Goulart ME, Biegelmeyer TC, Moreira-Souza L. et al. What is the accuracy of the surgical guide in the planning of orthognathic surgeries? A systematic review. Med Oral Patol Oral Cir Bucal 2022; 27 (02) e125-e134
• 20 Arias E, Huang YH, Zhao L, Seelaus R, Patel P, Cohen M. Virtual surgical planning and three-dimensional printed guide for soft tissue correction in facial asymmetry. J Craniofac Surg 2019; 30 (03) 846-850
• 21 Chen S, Ou Q, Lin X, Wang Y. Comparison between a computer-aided surgical template and the free-hand method: a systematic review and meta-analysis. Implant Dent 2019; 28 (06) 578-589
• 22 Cho KH, Papay FA, Yanof J. et al. Mixed reality and 3D printed models for planning and execution of face transplantation. Ann Surg 2021; 274 (06) e1238-e1246
• 23 Brown EN, Dorafshar AH, Bojovic B. et al. Total face, double jaw, and tongue transplant simulation: a cadaveric study using computer-assisted techniques. Plast Reconstr Surg 2012; 130 (04) 815-823
• 24 Hashemi S, Armand M, Gordon CR. Development and refinement of computer-assisted planning and execution system for use in face-jaw-teeth transplantation to improve skeletal and dento-occlusal outcomes. Curr Opin Organ Transplant 2016; 21 (05) 523-529
• 25 Jacobs JMS, Dec W, Levine JP. et al. Best face forward: virtual modeling and custom device fabrication to optimize craniofacial vascularized composite allotransplantation. Plast Reconstr Surg 2013; 131 (01) 64-70
• 26 Sosin M, Ceradini DJ, Hazen A. et al. Total face, eyelids, ears, scalp, and skeletal subunit transplant cadaver simulation: the culmination of aesthetic, craniofacial, and microsurgery principles. Plast Reconstr Surg 2016; 137 (05) 1569-1581
• 27 Mehra P, Miner J, D'Innocenzo R, Nadershah M. Use of 3-d stereolithographic models in oral and maxillofacial surgery. J Maxillofac Oral Surg 2011; 10 (01) 6-13
• 28 Li B, Zhang L, Sun H, Yuan J, Shen SG, Wang X. A novel method of computer aided orthognathic surgery using individual CAD/CAM templates: a combination of osteotomy and repositioning guides. Br J Oral Maxillofac Surg 2013; 51 (08) e239-e244