• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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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.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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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.

• 한국CDE학회논문집
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• 제21권2호
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• pp.196-203
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• 2016

In this paper, we propose a virtual surgical planning system specialized to mandible reconstruction surgery. Mandible reconstruction surgery is one of the most difficult surgeries, even for experienced surgeons. Compared to the traditional surgical procedures, virtual surgical planning can reduce the operation time in operating room while expecting better surgical outcome with optimized planning. However, with existing software systems, it requires much time and manual operations in virtual surgical planning. To reduce preparation time and improve accuracy of virtual surgical planning, we have developed optimized functions for virtual surgical simulation of mandible reconstruction with user-friendly interface. We found that the proposed system shortened the preparation time by half compared to the existing system from the experiments. The proposed system supports surgeons to make accurate plan faster and easier. The virtually planned results are used to make surgical cutting guide by 3D printing, and this will enhance surgical performance in operating room.

• 대한인간공학회지
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• 제36권1호
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• pp.37-52
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• 2017

Objective: The present study developed a user-centered 3D virtual liver surgery planning (VLSP) system called Dr. Liver to provide preoperative information for safe and rational surgery. Background: Preoperative 3D VLSP is needed for patients' safety in liver surgery. Existing systems either do not provide functions specialized for liver surgery planning or do not provide functions for cross-check of the accuracy of analysis results. Method: Use scenarios of Dr. Liver were developed through literature review, benchmarking, and interviews with surgeons. User interfaces of Dr. Liver with various user-friendly features (e.g., context-sensitive hotkey menu and 3D view navigation box) was designed. Novel image processing algorithms (e.g., hybrid semi-automatic algorithm for liver extraction and customized region growing algorithm for vessel extraction) were developed for accurate and efficient liver surgery planning. Usability problems of a preliminary version of Dr. Liver were identified by surgeons and system developers and then design changes were made to resolve the identified usability problems. Results: A usability testing showed that the revised version of Dr. Liver achieved a high level of satisfaction ($6.1{\pm}0.8$ out of 7) and an acceptable time efficiency ($26.7{\pm}0.9 min$) in liver surgery planning. Conclusion: Involvement of usability testing in system development process from the beginning is useful to identify potential usability problems to improve for shortening system development period and cost. Application: The development and evaluation process of Dr. Liver in this study can be referred in designing a user-centered system.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.309-316
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• 2012

Computer aided design and manufacturing (CAD/CAM) technology today is the standard in manufacturing industry. The application of the CAD/CAM technology, together with the emerging 3D medical images based virtual surgical planning (VSP) technology, to craniomaxillofacial reconstruction has been gaining increasing attention to reconstructive surgeons. This article illustrates the components, system and clinical management of the VSP and CAD/CAM technology including: data acquisition, virtual surgical and treatment planning, individual implant design and fabrication, and outcome assessment. It focuses primarily on the technical aspects of the VSP and CAD/CAM system to improve the predictability of the planning and outcome.

• Archives of Plastic Surgery
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• 제44권3호
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• pp.179-187
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• 2017

Recently, virtual reality (VR) and augmented reality (AR) have received increasing attention, with the development of VR/AR devices such as head-mounted displays, haptic devices, and AR glasses. Medicine is considered to be one of the most effective applications of VR/AR. In this article, we describe a systematic literature review conducted to investigate the state-of-the-art VR/AR technology relevant to plastic surgery. The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training. In addition, future trends of VR/AR technology associated with plastic surgery and related fields are discussed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권5호
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• pp.231-232
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• 2019

• Journal of International Society for Simulation Surgery
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• 제2권2호
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• pp.71-75
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• 2015

To overcome limitations of conventional diagnosis and planning for orthognathic surgery, surgeons have begun to use 3-dimensional (3D) virtual simulation to plan complex orthognathic surgery. In many literatures, it has shown that better surgical outcome achieved with 3D virtual simulation than that with conventional methods. But, there is still lack of data about accuracy of maxillary segmental surgery with 3D virtual simulation. The purpose of this paper was to report the case of maxillary segmental orthognathic surgery with 3D virtual simulation and to assess the actual surgical outcome. Though the result was clinically acceptable, discrepancy between 3D simulation and actual surgery was not superior compared with conventional method. The accuracy of 3D simulation surgery and intermediate wafer fabrication for maxillary segmental surgery needs to be improved. Advancement in 3D software program and careful surgical technique will make it more precise and reliable method.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권4호
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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.

• 대한치과의사협회지
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• 제52권10호
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• pp.596-601
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• 2014

Computer-aided surgery is popular and useful in the field of oral and maxillofacial surgery, because of the possibility of simulation with a high accuracy. In all aspects of surgery, proper planning facilitates more predictable operative results, however before the use of virtual planning, much of this relied on 2-dimensional (2-D) imaging for treatment planning on a 3-dimensional (3-D) object and surgical trial and error. With real-time instrument positioning and clear anatomic identification, a computer-assisted navigation system (CANS) is exceptionally helpful in maxillofacial surgery. These techniques enable performing precise bony ablation and reconstruction, and also decrease surgical time and donor site defect.