• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.5
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• pp.413-419
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• 2011

Purpose: Reposition of the maxilla is a common technique for correction of midfacial deformities. To achieve the goal of the surgery, the maxilla should be repositioned based on the precisely planned position during surgery. The internal reference points (IRPs) and the external reference points (ERPs) are usually used to determine vertical dimension of maxilla, which is an important factor for confirming maxillary position. However, the IRPs are known to be inaccurate in determining the vertical dimension. In this study, we investigated the correlation of positional change of the modified IRPs with repositioned maxilla. Methods: The study group consisted of 26 patients with dentofacial deformities. For the simulation of the surgery, patient maxillary CT data and 3-D virtual surgery programs (V-$Works^{(R)}$ and V-$Surgery^{(R)}$) were used. IRPs of this study were set on both the lateral wall of piriform aperture, inferior margin of both infraorbital foramen, and the labial surfaces of the canine and first molar. The distance from the point on lateral wall of the piriform aperture to the point on the buccal surface of the canine was defined as IRP-C, and the distance from the point on the inferior margin of the infraorbital foramen to the point on the buccal surface of the $1^{st}$ molar was defined as IRP-M. After the virtual simulation of Le Fort I osteotomy, the changes in IRP-C and IRP-M were compared with the maxillary movement. All measures were analyzed statistically. Results: With respect to vertical movements, the IRP-C (approximately 98%) and the IRP-M (approximately 96%) represented the movement of the canine and the $1^{st}$ molar. Regarding rotating movement, the IRPs changed according to the movement of the canine and the $1^{st}$ molar. In particular, the IRP-C was changed in accordance with the canine. Conclusion: IRPs could be good indicators for predicting vertical movements of the maxilla during surgery.

• KIPS Transactions on Software and Data Engineering
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• v.12 no.6
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• pp.275-284
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• 2023

Virtual reality simulations are used for education and training in various fields, and are especially widely used in the medical field recently. The education/training simulator consists of tactile/force feedback generation and image/sound output hardware that provides a sense similar to a doctor's treatment of a real patient using real surgical tools, and software that produces realistic images and tactile feedback. Existing simulators are complicated and expensive because they have to use various types of hardware to simulate various surgical instruments used during surgery. In this paper, we propose a dental surgical simulation system using a force feedback device and a morphable haptic controller. Haptic hardware determines whether the surgical tool collides with the surgical site and provides a sense of resistance and vibration. In particular, haptic controllers that can be deformed, such as length changes and bending, can express various senses felt depending on the shape of various surgical tools. When the user manipulates the haptic feedback device, events such as movement of the haptic feedback device or button clicks are delivered to the simulation system, resulting in interaction between dental surgical tools and oral internal models, and thus haptic feedback is delivered to the haptic feedback device. Using these basic techniques, we provide a realistic training experience of impacted wisdom tooth extraction surgery, a representative dental surgery technique, in a virtual environment represented by sophisticated three-dimensional models.

• Archives of Craniofacial Surgery
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• v.19 no.3
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• pp.200-204
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• 2018

Fibrous dysplasia (FD) is a rare, benign bone disease with abnormal bone maturation and fibroblastic proliferation. Optimal treatment of zone 1 craniofacial FD is radical resection and reconstruction. To achieve of structural, aesthetic, and functional goals, we use three-dimensionally designed calvarial bone graft for reconstruction of zygomatic defect after radical resection of FD. The authors used a rapid-prototyping model for simulation surgery for radical resection and immediate reconstruction. Donor site was selected from parietal bone reflect shape, contour, and size of defect. Then radical resection of lesion and immediate reconstruction was performed as planned. Outcomes were assessed using clinical photographs and computed tomography scans. Successful reconstruction after radical resection was achieved by three-dimensional calvarial bone graft without complications. After a 12-month follow-up, sufficient bone thickness and symmetric soft tissue contour was well-maintained. By considering three-dimensional configuration of zygomaticomaxillary complex, the authors achieved satisfactory structural, aesthetic and functional outcomes without complications.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.4.1-4.4
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• 2018

Background: Along with the advances in technology of three-dimensional (3D) printer, it became a possible to make more precise patient-specific 3D model in the various fields including oral and maxillofacial surgery. When creating 3D models of the mandible and maxilla, it is easier to make a single unit with a fused temporomandibular joint, though this results in poor operability of the model. However, while models created with a separate mandible and maxilla have operability, it can be difficult to fully restore the position of the condylar after simulation. The purpose of this study is to introduce and asses the novel condylar repositioning method in 3D model preoperational simulation. Methods: Our novel condylar repositioning method is simple to apply two irregularities in 3D models. Three oral surgeons measured and evaluated one linear distance and two angles in 3D models. Results: This study included two patients who underwent sagittal split ramus osteotomy (SSRO) and two benign tumor patients who underwent segmental mandibulectomy and immediate reconstruction. For each SSRO case, the mandibular condyles were designed to be convex and the glenoid cavities were designed to be concave. For the benign tumor cases, the margins on the resection side, including the joint portions, were designed to be convex, and the resection margin was designed to be concave. The distance from the mandibular ramus to the tip of the maxillary canine, the angle created by joining the inferior edge of the orbit to the tip of the maxillary canine and the ramus, the angle created by the lines from the base of the mentum to the endpoint of the condyle, and the angle between the most lateral point of the condyle and the most medial point of the condyle were measured before and after simulations. Near-complete matches were observed for all items measured before and after model simulations of surgery in all jaw deformity and reconstruction cases. Conclusions: We demonstrated that 3D models manufactured using our method can be applied to simulations and fully restore the position of the condyle without the need for special devices.

• Journal of International Society for Simulation Surgery
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• v.1 no.2
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• pp.71-74
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• 2014

Purpose The prominent mandible angle, otherwise known as "square face", has been recognized as an aesthetic problem that needs correction by many in the Asian community. Many surgeons considered that mandible angle ostectomy alone, brings about hypotrophy of the masseter muscle. However, it was only proven indirectly (by clinical experience and histological animal experiments) and not objectively. In this study, we evaluated the volume of masseter muscle to prove the effect, objectively. Materials and method Computed tomography (CT) images were used to measure the masseter muscle volume of normal female group (n=6), and of female patient group n=8, preoperative and early & late postoperative volumes) presenting the symptom of prominent mandible angle. The data was analyzed statistically by two-sample t-test and paired t-test using SAS (version 8.2). Results In normal female group, volume average was $16,142{\pm}2,829.8mm^3$. In patient group, preoperative volume averaged $24,447{\pm}4,544.5mm^3$ (p<0.0001), early postoperative volume measured average of $31,966{\pm}50,421mm^3$ which is a 30% increase from the preoperative volume (p<0.0001). Late postoperative measurement was $20,202{\pm}4,092.3mm^3$, which is a 20% decrease from the preoperative volume (p<0.0006). Conclusion The bone reduction of prominent mandible angle induce the hypotrophic effect of masseter muscle after long term follow up (5 more months). This result mean that the result of mandible angle contouring surgery can be considered as combined effect of bony angle reduction and subsequent masseter muscle hypotrophy.

• Journal of International Society for Simulation Surgery
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• v.3 no.2
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• pp.77-79
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• 2016

Osteoma is one of the benign tumor that occurs on the bones all over the body. Mostly the simple excision is known to be enough. However, sometimes we encounter the troublesome situation where the osteoma is located in very challenging area, which results in the recurrence. 26 year female presented with the intractable intracranial osteoma. Given the disease entity of the osteoma, the simple excision would be enough or conservative management. But this osteoma turned out to be huge and recurrent in spite of the endoscopic resections, which causes the facial disappearance accompanied by the orbital vertical dystopia. Moreover, the patient's main concern was the pain. We performed the intracranial resection of the whole lesion and reconstructed the skull base and frontal bone as well as the part of the orbital wall. In order to restore the original bony anatomy, the 3D printing model was used based on the titanium mesh. I report this unusual case of the intractable intracranial huge osteoma. This report may be helpful for the other surgeons to make a decision on their similar cases in the future.

• Radiation Oncology Journal
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• v.29 no.4
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• pp.277-282
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• 2011

Purpose: This study was performed to evaluate the change in the lumpectomy cavity volumes before and after whole breast radiation therapy (WBRT) and to identify factors associated with the change of volume. Materials and Methods: From September 2009 to April 2010, the computed tomography (CT) simulation data from 70 patients obtained before and after WBRT was evaluated. The lumpectomy cavity volumes were contoured based on surgical clips, seroma, and postoperative changes. Significant differences in the data from pre-WBRT CT and post-WBRT CT were assessed. Multiple variables were examined for correlation with volume reduction in the lumpectomy cavity. Results: The mean and median volume reduction in the lumpectomy cavity after WBRT were 17.6 $cm^3$ and 16.1 $cm^3$, respectively with the statistical significance (p < 0.001). The volume reduction in the lumpectomy cavity was inversely correlated with time from surgery to radiation therapy (R = 0.390). The presence of seroma was significantly associated with a volumetric change in the lumpectomy cavity after WBRT (p = 0.011). Conclusion: The volume of lumpectomy cavity reduced significantly after WBRT. As the time from surgery to the start ot WBRT increased, the volume reduction in the lumpectomy cavity during WBRT decreased. A strong correlation was observed between the presence of seroma and the reduced volume. To ensure appropriate coverage and to limit normal tissue exposure during boost irradiation in patients who has seroma at the time of starting WBRT, repeating CT simulation at boost planning is suggested.

• Journal of International Society for Simulation Surgery
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• v.2 no.1
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• pp.33-39
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• 2015

Purpose The head of infants under 24 months old who has Craniosynostosis grows extraordinarily that makes head shape unusual. To diagnose the Craniosynostosis, surgeon has to inspect computed tomography(CT) images of the patient in person. It's very time consuming process. Moreover, without a surgeon, it's difficult to diagnose the Craniosynostosis. Therefore, we developed technique which detects Craniosynostosis automatically from the CT volume. Materials and Methods At first, rotation correction is performed to the 3D CT volume for detection of the Craniosynostosis. Then, cranial area is extracted using the iterative thresholding method we proposed. Lastly, we diagnose Craniosynostosis by analyzing centroid relationships of clusters of cranial bone which was divided by cranial suture. Results Using this automatical cranial detection technique, we can diagnose Craniosynostosis correctly. The proposed method resulted in 100% sensitivity and 90% specificity. The method perfectly diagnosed abnormal patients. Conclusion By plugging-in the software on CT machine, it will be able to warn the possibility of Craniosynostosis. It is expected that early treatment of Craniosynostosis would be possible with our proposed algorithm.

• The korean journal of orthodontics
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• v.54 no.2
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• pp.89-107
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• 2024

Objective: This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery. Methods: The primary objective was to address the question, "How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?" A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D). Results: Forty-nine articles met the inclusion criteria. The metaanalysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up. Conclusions: Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

• Journal of Mechanical Science and Technology
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• v.20 no.1
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• pp.19-28
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• 2006

This paper describes rapid prototyping (RP) and reverse engineering (RE) application for orthopedic surgery planning to improve the efficiency and accuracy of the orthopedic surgery. Using the symmetrical characteristics of the human body, CAD data of undamaged bone of the injured area are generated from a mirror transformation of undamaged bone data for the uninjured area. The physical model before the injury is manufactured from Poly jet RP process. The surgical plan, including the selection of the proper implant, pre-forming of the implant and decision of fixation positions, etc., is determined by a physical simulation using the physical model. In order to examine the applicability and efficiency of the surgical planning technology, two case studies, such as a distal tibia comminuted fracture and an iliac wing fracture of pelvis, are carried out. From the results of the examination, it has been shown that the RP and RE can be applied to orthopedic surgical planning and can be an efficient surgical tool.