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Computer-assisted design and computer-assisted manufacturing
Introduction
Computer-assisted design (CAD) and computer-assisted manufacturing (CAM) can play a unique role in craniofacial surgery because of the intricate three-dimensional (3D) anatomic considerations inherent to this field. Through the use of CAD/CAM techniques, surgeons can uniquely plan for each patient’s procedure by analyzing an unlimited number of iterations and options. By doing so, surgeons can optimize the surgical approach and create patient-specific, customized cutting guides, splints, anatomical models, and implants. Ultimately, using CAD/CAM preoperatively can help to reduce the amount of intraoperative trial and error necessary, to help minimize operative time and maximize patient outcomes both with regard to the craniofacial reconstruction itself and any potential associated donor sites. Especially in increasingly complex cases, CAD/CAM techniques can have enormous benefit in ensuring patient aesthetic and functional outcomes after correction of craniofacial defects.
Since the advent of CAD/CAM techniques in craniofacial surgery, a number of technological advancements have helped to improve and streamline the CAD/CAM workflow specifically in the context of craniofacial surgery. These include enhanced resolution and image quality of computed tomographic imaging and other radiographic techniques, allowing for the creation of more accurate 3D virtual models and patient-specific implants. In addition, novel surgical simulation software packages allow surgeons to virtually manipulate patient anatomy on a 3D plane, and novel manufacturing techniques have allowed for the creation of enhanced 3D models, splints, cutting guides, and patient-specific implants.
Overall, CAD/CAM technology has been successfully implemented for diverse indications in craniofacial surgery, ranging from congenital reconstruction for syndromic conditions (Treacher Collins, Apert, Crouzon, etc.) to secondary maxillofacial trauma reconstruction in patients presenting with complex and/or severe deformities or defects. Though these technologies may increase the time and costs of preoperative planning, they have been demonstrated to result in savings in surgical time and surgical outcomes. Although further work is necessary to truly characterize the cost-utility of these technologies, they continue to represent the forefront of current trends in craniofacial surgery. Therefore, the craniofacial surgeon and trainees must become versatile in its utility to optimize patient clinical care. In this chapter, we will review general principles, definitions, and concepts necessary for the craniofacial surgeon and trainees to understand for the incorporation of this innovative technology in their clinical practice.
Computer-assisted design
CAD involves the use of computer software to assist in the creation, modification, and optimization of a design. In the field of craniofacial surgery, CAD techniques use radiographic data to recreate digitized, manipulable models of patients’ facial skeletal anatomy. This enables virtual preoperative surgical planning through the simulation of surgical procedures (e.g., osteotomies). CAD also allows for the design of patient-specific implants that can be integrated into the computer-assisted surgical plan.
There are a number of technical considerations when using CAD techniques in the context of craniofacial surgery, both with regard to the design process itself and the data acquisition necessary to inform the CAD/CAM process. Software packages used for CAD in craniofacial surgery include Mimics, 3-Matic (Materialize, Leuven, Belgium), and InVesalius (Renato Archer Center for Information Technology of the Ministry of Science and Technology, Campinas, Brazil).
The complete workflow for CAD in craniofacial surgery is demonstrated in Fig. 2.1 . The following sections will review important concepts and the steps necessary for CAD/CAM in the context of craniofacial surgery.
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