Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Robots in craniofacial surgery

Introduction Surgical approaches in craniofacial surgery follow specific principles due to the complex anatomy of the head and neck and the aesthetic sensitivity of the region. The approaches can be categorized into two domains as a result of these factors, which are summarized in Table 25.1 . The first domain includes limited approaches to avoid significant soft tissue disruption that minimizes or avoids incisions within aesthetically sensitive…

Virtual reality and augmented reality in surgery

Introduction Presurgical planning is a broad term, encompassing everything from simple visualization of two-dimensional (2D) radiographic images to a true rehearsal of complex three-dimensional (3D) surgical movements based on computed tomographic (CT) or magnetic resonance imaging (MRI). Over the last few decades, physical model surgery has given way to digital techniques, with 3D reconstruction of CT images now commonplace and the availability of complex software capable…

Virtual surgical planning and computer-assisted design/computer-assisted manufacturing in facial feminization surgery

Introduction Background Facial feminization surgery (FFS) is an essential component of the multidisciplinary treatment of gender dysphoria. First described by Ousterhout in the 1980s, FFS has become increasingly common following recent approval of Medicare reimbursement for gender confirming surgery. , Precision and careful preoperative planning are paramount in FFS due to transformation of normal preoperative masculine anatomy into a feminine appearance rather than restoration of normal…

Computer-assisted surgical planning and navigation in maxillo-mandibular tumor resection

Introduction Surgical treatment of maxillo-mandibular tumors aims for in-sano resection. Besides information about dignity (benign/malignant) and entity of the tumor provided via specimen taking and histopathological examination, the extent of the tumor is crucial for surgical treatment planning. Tumor extent is typically based on the clinical picture and radiological imaging. While localized and sharply circumscribed tumors can be resected relying on the clinical picture alone, more…

Computer-assisted surgical planning and navigation in cranio-orbital tumor resection

Introduction The cranio-orbital region is a complex anatomical area that accommodates structures of great functional importance such as the brain, the internal carotid artery and the cavernous sinus, the optic nerves, and chiasm or the globe. This region can be affected by a variety of tumors that can originate primarily or spread through the anatomical pathways from neighboring structures. Treatment of tumors of the cranio-orbital region…

Computer-assisted surgical planning in craniomaxillofacial trauma: Zygomaticomaxillary complex fractures and secondary reconstruction

Introduction Zygomaticomaxillary complex (ZMC) fractures are one of the most common facial fractures, second only to nasal bone fractures. , The ZMC plays a key functional and aesthetic role for the face—the zygomatic arch serves as the cranial insertion point for the masseter, and the zygomatic complex provides an anatomic separation between the maxillary sinus, orbit, and temporal fossa. Aesthetically, the ZMC provides a normal cheek…

Computer-assisted planning in craniomaxillofacial trauma: Mandibular fractures

Introduction Repair of traumatic mandibular fractures is a complex process requiring assessment of the degree of comminution, extent of soft tissue injury and restoration of preinjury occlusion. Traditionally, mandibular trauma is managed via intermaxillary fixation (IMF) and open reduction-internal fixation (ORIF) using titanium plates bent intraoperatively. This process requires subjective determination of intraoperative occlusion and plate contouring is time consuming and may lack accuracy. Additionally, the…

Computer-assisted planning in craniomaxillofacial trauma: Orbital fractures

Introduction Several indications necessitate posttraumatic orbital reconstruction. For example, restrictive diplopia secondary to entrapment of extraocular muscles can lead to irreversible muscle ischemia and necrosis within hours, thus requiring emergent surgery. In particular, pediatric patients are especially susceptible to extraocular muscle entrapment due to the increased bone elasticity in their orbital floor—resulting in self-reduction as opposed to a fracture. Enophthalmos secondary to orbital herniation or implant…

Computer-assisted planning congenital differences and anomalies: Craniopagus twin separation

Introduction Craniofacial surgery commonly involves carefully orchestrated surgery between plastic surgeons, neurosurgeons and other specialists. In some cases, the neurosurgeons provide a craniotomy for access to the midface. For example, correction of orbital hypertelorism or monobloc frontofacial advancement. In other cases, neurosurgeons are performing craniectomies that the plastic surgeons will remodel and reassemble. Commonly, plastic surgeons and neurosurgeons will work side by side to repair fractures…

Computer-assisted planning congenital differences and anomalies: Pierre robin sequence

Introduction Mandibular distraction osteogenesis (MDO) remains a mainstay of surgical treatment for Pierre Robin Sequence (PRS). Three-dimensional (3D) printing and computer-assisted design/computer-assisted manufacturing (CAD/CAM) technology has revolutionized our ability to visualize, plan, and execute surgical treatment within craniofacial surgery. In this chapter, we will more fully explore the treatment for PRS and the applications for CAD/CAM technology and 3D printing in the context of MDO. PRS…

Computer-assisted surgical planning for craniofacial microsomia

Introduction Craniofacial microsomia is a congenital anomaly that results in the underdevelopment of one half or both sides of the face. It occurs in approximately 1:3000 to 1:5000 live births. Treatment of this condition can involve multiple operations to augment the hard and soft tissue and improve facial symmetry. Two common procedures used for the correction of the skeletal differences in craniofacial microsomia are distraction osteogenesis…

Computer-assisted surgical planning congenital differences and anomalies: Treacher Collins syndrome

Introduction Although classically described as “mandibulofacial dysostosis,” contemporary understanding of the three-dimensional (3D) skeletal dysmorphology in patients with Treacher Collins syndrome (TCS) extends to include midface hypoplasia involving the zygoma and maxilla. The hallmark of severe deficiency is orbitozygomatic hypoplasia with a clockwise rotation deformity of the maxillomandibular complex related to severe mandibular ramus-condyle unit deficiency ( Fig. 14.1 ). This constellation of findings frequently results…

Computer-assisted surgical planning congenital differences and anomalies—nonsyndromic craniosynostosis: A practical workflow

Introduction Nonsyndromic craniosynostosis refers to the premature fusion of cranial sutures in the absence of other congenital anomalies. Fusion typically occurs at only one suture, though in rare nonsyndromic cases, fusion at multiple sutures can occur and is referred to as “complex nonsyndromic craniosynostosis.” The order of frequency for single suture fusion has been well characterized; sagittal synostosis is most common, followed by coronal, metopic, and…

Computer-assisted surgical planning congenital differences & anomalies: Syndromic craniosynostosis – (subcranial) Le Fort III and Le Fort III/I

Introduction Various conditions, congenital and acquired, can limit midface growth resulting in midface hypoplasia. Midface hypoplasia may be a result of developmental maxillary dysplasia, skeletal and dental class III malocclusion, and hard palate narrowing. This can lead to airway obstruction, mastication and speech difficulties, and an altered aesthetic facial cascade. , Affected conditions include, but are not limited to, patients with cleft lip and palate, congenital…

Computer-assisted surgical planning for midfacial surgery in syndromic craniosynostosis

Introduction The care of children with syndromic craniosynostosis is complex and multifaceted, and surgical interventions are a critical component of treatment and an opportunity to provide significant functional and aesthetic improvements in these patients. The use of computer-assisted design and computer-assisted manufacturing (CAD/CAM) in surgery for children with syndromic craniosynostosis has aided in the performance of increasingly complex operations, and while improved functional and/or aesthetic outcomes…

Syndromic craniosynostosis—intracranial/frontofacial reconstruction

Introduction Hypertelorism is defined as increased bony interorbital distance (IOD) and is measured by the interdacryon distance, which is the distance between the most medial osseous aspect of the orbits. Orbital hypertelorism is distinct from telecanthus, which refers to the lateral displacement of the medial canthal tendon. Similarly, interpupillary distance is an inappropriate measure of hypertelorism as it can be significantly impacted by the presence of…

Computer-assisted surgical planning in head and neck reconstruction: Temporomandibular joint replacement

Introduction Total temporomandibular joint replacement (TMJR) is indicated for the treatment of inflammatory arthritis not responsive to other modalities of treatment, recurrent fibrous and/or bony ankylosis, failed tissue grafts, failed alloplastic temporomandibular joint (TMJ) reconstruction, or loss of vertical mandibular height and/or occlusal relationship (secondary to bone resorption, trauma, developmental abnormality, or pathologic lesion). Early joint replacements using autologous tissue had a high rate of complication,…

Computer-assisted surgical planning in head and neck reconstruction: Mandible and dental restoration

Introduction The free fibula flap has become the workhorse for mandible reconstruction. It was popularized by Hidalgo in 1989 and in its early iterations, involved creating intraoperative templates to guide osteotomies and hand-bend plates. Although this involved great artistry and skill, this method also carried a greater margin for error and could be time consuming. In the decades following, advancements have improved the planning, accuracy, and…

Computer-assisted design/computer-assisted modeling in maxillary reconstruction

Introduction The midface is a complex skeletal framework that is composed principally of the maxilla and zygoma. Structural support is provided by a set of horizontal and vertical pillars ( Fig. 7.1 ). The main horizontal buttresses are the maxillary alveolus and the infraorbital rim, while the vertical buttresses are the nasomaxillary and the zygomaticomaxillary buttress. Defects of the midface are reconstructed by bony restoration of…

Computer-assisted surgical planning in head and neck reconstruction: Cranium

Introduction The goal of cranioplasty is to restore structure and function of missing cranial bone while providing support to soft tissues. Choice of surgical approach and reconstructive material depends on the nature and size of the defect, the patient’s history, and surgeon preference. Cranioplasty techniques are broadly divided into two categories: alloplastic and autologous. Alloplastic material is useful for very large defects or when the underlying…