• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.41.1-41.6
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• 2019

Backgrounds: The purpose of this study is to discuss the total joint reconstruction surgery for a patient with recurrent ankylosis in bilateral temporomandibular joints (TMJs) using three-dimensional (3D) virtual surgical planning, computer-aided manufacturing (CAD/CAM)-fabricated surgical guides, and stock TMJ prostheses. Case presentation: A 66-year-old female patient, who had a history of multiple TMJ surgeries, complained of severe difficulty in eating and trismus. The 3D virtual surgery was performed with a virtual surgery software (FACEGIDE, MegaGen implant, Daegu, South Korea). After confirmation of the location of the upper margin for resection of the root of the zygoma and the lower margin for resection of the ankylosed condyle, and the position of the fossa and condyle components of stock TMJ prosthesis (Biomet, Jacksonville, FL, USA), the surgical guides were fabricated with CAD/CAM technology. Under general anesthesia, osteotomy and placement of the stock TMJ prosthesis (Biomet) were carried out according to the surgical planning. At 2 months after the operation, the patient was able to open her mouth up to 30 mm without complication. Conclusion: For a patient who has recurrent ankylosis in bilateral TMJs, total joint reconstruction surgery using 3D virtual surgical planning, CAD/CAM-fabricated surgical guides, and stock TMJ prostheses may be an effective surgical treatment option.

• Archives of Plastic Surgery
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• v.48 no.5
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• pp.518-523
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• 2021

Epignathus is a rare congenital orofacial teratoma that arises from the sphenoid region of the palate or the pharynx. It occurs in approximately 1:35,000 to 1:200,000 live births representing 2% to 9% of all teratomas. We present the case of a newborn of 39.4 weeks of gestation with a tumor that occupied the entire oral cavity. The patient was delivered by cesarean section. Oral resection was managed by pediatric surgery. Plastic surgery used virtual 3-dimensional models to establish the extension, and depth of the tumor. Bloc resection and reconstruction of the epignathus were performed. The mass was diagnosed as a mature teratoma associated with cleft lip and palate, nasoethmoidal meningocele that conditions hypertelorism, and a pseudomacrostoma. Tridimensional technology was applied to plan the surgical intervention. It contributed to a better understanding of the relationships between the tumor and the adjacent structures. This optimized the surgical approach and outcome.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.13.1-13.12
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• 2016

Background: Mandibular motion tracking system (ManMoS) has been developed for orthognathic surgery. This article aimed to introduce the ManMoS and to examine the accuracy of this system. Methods: Skeletal and dental models are reconstructed in a virtual space from the DICOM data of three-dimensional computed tomography (3D-CT) recording and the STL data of 3D scanning, respectively. The ManMoS uniquely integrates the virtual dento-skeletal model with the real motion of the dental cast mounted on the simulator, using the reference splint. Positional change of the dental cast is tracked by using the 3D motion tracking equipment and reflects on the jaw position of the virtual model in real time, generating the mixed-reality surgical simulation. ManMoS was applied for two clinical cases having a facial asymmetry. In order to assess the accuracy of the ManMoS, the positional change of the lower dental arch was compared between the virtual and real models. Results: With the measurement data of the real lower dental cast as a reference, measurement error for the whole simulation system was less than 0.32 mm. In ManMoS, the skeletal and dental asymmetries were adequately diagnosed in three dimensions. Jaw repositioning was simulated with priority given to the skeletal correction rather than the occlusal correction. In two cases, facial asymmetry was successfully improved while a normal occlusal relationship was reconstructed. Positional change measured in the virtual model did not differ significantly from that in the real model. Conclusions: It was suggested that the accuracy of the ManMoS was good enough for a clinical use. This surgical simulation system appears to meet clinical demands well and is an important facilitator of communication between orthodontists and surgeons.

• Archives of Plastic Surgery
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• v.48 no.6
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• pp.723-723
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• 2021

• Journal of International Society for Simulation Surgery
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• v.4 no.1
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• pp.9-12
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• 2017

Purpose Surgery for separating craniopagus twins involves many critical issues owing to complex anatomical features. We demonstrate a 3D printed model and virtual reality (VR) technologies that could provide valuable benefits for surgical planning and simulation, which would improve the visualization and perception during craniopagus surgery. Material & Methods We printed a 3D model extracted from CT images of craniopagus patients using segmentation software developed in-house. Then, we imported the 3D model to create the VR environment using 3D simulation software (Unity, Unity Technologies, CA). We utilized the HTC Vive (HTC & Valve Corp) head-mount-display for the VR simulation. Results We obtained the 3D printed model of craniopagus patients and imported the model to a VR environment. Manipulating the model in VR was possible, and the 3D model in the VR environment enhanced the application of user-friendly 3D modeling in surgery for craniopagus twins. Conclusion The use of the 3D printed model and VR has helped understand complicated anatomical structures of craniopagus patients and has made communicating with other medical surgeons in the field much easier. Further, interacting with the 3D model is possible in VR, which enhances the understanding of the craniopagus surgery as well as the success rate of separation surgery while providing useful information on diagnosing and surgery planning.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.35.1-35.7
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• 2019

Background: The purpose of this study was to measure the time of the conventional surgical planning (CSP) and virtual surgical planning (VSP) in orthognathic surgery and to compare them in terms of cost. Material and method: This is a retrospective study of the patients who underwent orthognathic surgery at the Pusan National University Dental Hospital from December 2017 to August 2018. All the patients were analyzed through both CSP and VSP, and all the surgical stents were fabricated through manual and three-dimensional (3D) printing. The predictor variables were the planning method (CSP vs. VSP) and the surgery type (group I: Le Fort I osteotomy + bilateral sagittal split osteotomy [LFI+BSSO] or group II: only bilateral sagittal split osteotomy [BSSO]), and the outcomes were the time and cost. The results were analyzed using the paired t test. Results: Thirty patients (12 females, 18 males) met the inclusion criteria, and 17 patients were excluded from the study due to missing or incomplete data. There were 20 group I patients (LFI+BSSO regardless of genioplasty) and 10 group II patients (BSSO regardless of genioplasty). The average time of CSP for group I was 385 ± 7.8 min, and that for group II was 195 ± 8.33 min. The time reduction rate of VSP compared with CSP was 62.8% in group I and 41.5% in group II. On the other hand, there was no statistically significant cost reduction. Conclusions: The time investment in VSP in this study was significantly smaller than that in CSP, and the difference was greater in group I than in group II.

• Archives of Plastic Surgery
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• v.43 no.1
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• pp.3-9
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• 2016

The reconstruction of the mandible is a complex procedure because various cosmetic as well as functional challenges must be addressed, including mastication and oral competence. Many surgical techniques have been described to address these challenges, including non-vascularized bone grafts, vascularized bone grafts, and approaches related to tissue engineering. This review summarizes different modifications of the free vascularized fibula graft, which, since its introduction by Hidalgo in 1989, has become the first option for mandibular reconstruction. The fibula free flap can undergo various modifications according to the individual requirements of a particular reconstruction. Osteocutaneous flaps can be harvested for reconstruction of composite defects. 'Double-barreling' of the fibula can, for instance, enable enhanced aesthetic and functional results, as well as immediate one-stage osseointegrated dental implantation. Recently described preoperative virtual surgery planning to facilitate neomandible remodeling could guarantee good results. To conclude, the free fibula bone graft can currently be regarded as the "gold standard" for mandibular reconstruction in case of composite (inside and outside) oral cavity defects as well as a way of enabling the performance of one-stage dental implantation.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.303-308
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• 2008

Purpose: The purpose of this study is to develop three-dimensional computerized anthropometry(3DCA) and to compare its reliability and accuracy 3DCA with manual anthropometry(MA) for measurement of lips and nasal deformities in unilateral cleft lips and palate(UCLP) patients. Methods: Samples were consisted of six UCLP patients whose facial plaster models were available immediately before and 3 months after the cleft lip surgery. MA of the facial plaster models was carried out using an electronic caliper. In 3DCA, three-dimensional auto-measuring program was used to digitize landmarks and to measure three-dimensional virtual facial models (3DVFM), which was generated with a laser scanner and 3D virtual modeling program. Intraclass correlation coefficients(ICC) were calculated to evaluate reliability and reproducibility of the variables in both methods, and Wilcoxon's signed rank test was done to investigate the difference in values of the same variables of facial models of each patient between two methods. Results: All ICC values were higher than 0.8, so both methods could be considered reliable. Although most variables showed statistical differences between two methods(p<0.05), differences between mean values were very small and could be considered not significant in clinical situation. Conclusion: In clinical situation, 3DCA can be an objective, reliable and accurate tool for evaluation of lips and nasal deformities in the cleft patients.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.351-360
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• 2010

Purpose: As the influence of mass media increases, the general standard of attractiveness or beauty of a face also changes. The primary purpose of the study is to find out the factors of the attractive and beautiful face recognized by public. Methods: We picked out standard model photography and operated with Adobe$^{(R)}$ Photoshop$^{(R)}$ and Monariza$^{(R)}$ virtual plastic surgery program. The contour of face, eye, nose, forehead, zygoma, chin and proportion of upper, middle, lower face were changed. The interview survey was conducted through structured standard photo for 310 respondents. That was utilized in the final analysis. Multiple regression analysis was executed by SPSS 12.0. It was used to deal with statistical data and all the other necessary analysis. Results: According to general characteristics of the respondents, many differences were found in preferred face and facial aesthetic subunits. The younger generation preferred the lozenge and inverted triangle shape contour. The respondents over 40 of age preferred the egg shape contour. In chin and zygoma contour, the respondents at the age of 20 preferred distinctly small chin and relatively small lower face. On the other hand, the respondents over 40 of age preferred the wide zygoma relatively. In the proportion of upper, middle, lower face, 51.0% of respondents answered 1 : 1 : 1. If they want to have an aesthetic operation, they preferred protruding forehead. Also they preferred the small chin and V-shaped chin in frontal view. Conclusion: Many respondents preferred to have a plastic surgery for the better facial subunit. The statistical evidence from this study suggests that the harmony and balance of facial aesthetic subunits make attractive and beautiful face.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.4
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• pp.161-167
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• 2014

Purpose: The reconstruction of mandibular defects poses many difficulties due to the unique, complex shape of the mandible and the temporomandibular joints. With development of microvascular anastomosis, free tissue transplantation techniques, such as deep circumflex iliac artery (DCIA) flap and fibular free flap (FFF), were developed. The DCIA offers good quality and quantity of bone tissue for mandibular segmental defect and implant for dental rehabilitation. Virtual surgical planning (VSP) and stereolithography-guided osteotomy are currently successfully applied in three-dimensional mandibular reconstruction, but most use FFF. There are only a few articles on reconstruction with the DCIA that assess the postoperative results. Methods: Three patients admitted during a five month period (April of 2013 to August of 2013) underwent resection of mandible and DCIA musculo-osseous reconstruction using a VSP and stereolithographic modeling and assessment of outcomes included technical accuracy, esthetic contour, and functional outcomes. Results: This technique yielded iliac bone segment with excellent apposition and duplication of the preoperative plan. Flap survival was 100 percent and all patients maintained preoperative occlusion and contour. Conclusion: Based on our experience, we offer considerations and logically consistent protocols by classification of mandibular defects, and demonstrate the benefits in VSP and stereolithographic modeling of mandibular reconstructive surgery with DCIA flap.