ZIB: Computer Assisted Cranio-Maxillofacial Surgery

Visualization and Data Analysis

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CAS CMF
Computer Assisted Cranio-Maxillofacial Surgery

Description

Below you'll find several clinical cases that have been planned with our planning environment. In all cases surgical osteotomies with bone relocations have been planned under consideration of functional and aesthetic rehabilitation via finite element simulation of soft tissue deformation: Further information is available in the detailed project description.

11. clinical case study: Bimaxillary Osteotomy

Surgical Planning & Soft Tissue Prediction

3D planning of a bimaxillary osteotomy with assessment of its soft tissue implication.

Data: Courtesy of Prof. M.D., D.D.S., Zeilhofer and M.D., D.D.S., Sader, Dept. Reconstructive Surgery, University Hospital Basel, Switzerland.



Conventional Le Fort-I osteotomy, and sagittal split osteotomy of the ascending branches of the mandible. The osteotomized maxilla is advanced by 4.8mm and the setback of the mandible is 6.5mm. Simulation: MPEG Movie (PAL resolution, 25 MB)
Simulation: MPEG Movie (10 MB)

10. clinical case study: Hemifacial Microsomia

Surgical Planning & Soft Tissue Prediction

3D planning of a complex bone rearrangement due to hemifacial microsomia, under consideration of 3D soft tissue implication. The right mandibular ramus has been reconstructed by a mirrored copy of the left ramus.

Data: Courtesy of PhD A. Westermark; Dr. A. Eriksson, Department of Maxillofacial Surgery, Karolinska Hospital, Stockholm, Sweden.



Surgical correction of a severe facial asymmetry due to hemifacial microsomia. The patient has a congenital lateral face cleft and a hemifacial microsomia. An asymmetric high Le Fort-I osteotomy has been performed within the planning as well as a sagittal split osteotomy of the right mandible. The maxilla has been elevated 5mm in the right zygomatic base region and 3mm at the right aperture. The maxilla rotates around a point lateral to the left aperture. The mandible has been rotated forward to achieve dental occlusion.
Simulation: MPEG Movie (22 MB)

Ninth clinical case study: Bimaxillary Osteotomy

Surgical Planning & Soft Tissue Prediction

3D planning of a bimaxillary osteotomy.

Data: Courtesy of Prof. M.D., D.D.S., Neukam, M.D., D.D.S., Nkenke, Dept. of Oral & Maxillofacial Surgery, University of Erlangen-Nuremberg.



conventional Le Fort-I osteotomy with 0.35mm advancement of the maxilla sagittal split osteotomy according to Obwegeser-Dal Pont with 4mm setback of the mandible. Simulation: MPEG Movie (PAL resolution, 26 MB) Simulation: MPEG Movie (10 MB)

Eighth clinical case study: 3D Planning of a Complex Case

Surgical Planning & Soft Tissue Implication

3D planning of a complex bone rearrangement due to hemifacial microsomia, under consideration of 3D soft tissue implication. The planning is intended to find an optimal strategy for a surgical supply including right ear episthesis.

Data: Courtesy of M.D., D.D.S., T. Hierl, Department of Oral & Maxillofacial Surgery, University of Leipzig.



Surgical correction of a severe facial asymmetry due to hemifacial microsomia. An asymmetric high Le Fort-I osteotomy of the maxilla with rotation of the right zygoma has been planned. The zygomatic arch is not connected to the skull, thus stability problems might arise due to the high forces exerted by the masseter. A rotation of the zygomatic arch further leads to an undesired deformation of the soft tissue. An additional distraction of the right ramus will correct the asymmetry of the lower face. Therefore a multidirectional extraoral distraction device is intended to be used. A symmetric correction of the nasal bone as well as an ear episthesis based on a mirrored copy of the right ear will improve the overall aesthetic result. Due to 3D soft tissue prediction alternative strategies can be investigated during the planning phase.
Simulation: MPEG Movie (coming soon ...)

Seventh clinical case study: Bimaxillary Osteotomy vs. Maxillary Advancement

Surgical Planning & Soft Tissue Prediction

3D planning of a bimaxillary osteotomy as well as a maxillary advancement only. Comparison of the impact on the soft tissue arrangement.

Data: Courtesy of Prof. M.D., D.D.S., Zeilhofer and M.D., D.D.S., Sader, Dept. Reconstructive Surgery, University Hospital Basel, Switzerland.



osteotomized maxilla is slightly rotated downwards: sagittal split osteotomy of the mandible with 6mm setback. Bimaxillary Osteotomy: MPEG Movie (9.4 MB)
Maxillary Advancement only: MPEG Movie (9.4 MB)

Sixth clinical case study: Assessment of different Le Fort-I type osteotomies

Surgical Planning & Soft Tissue Prediction

3D planning of a surgical midface distraction under consideration of different kinds of Le Fort-I osteotomies (conventional, high and quadrangular).
Validation of the simulation on basis of post-op CT.

Data: Courtesy of M.D., D.D.S., T. Hierl, Department of Oral & Maxillofacial Surgery, University of Leipzig.



surgical correction of maxillary retrognathism, left) high Le Fort-I osteotomy acc. to Bell as performed with 14mm advancement of the maxilla, middle) conventional Le Fort-I osteotomy and its impact to the facial appearance, right) modified quadrangular Le Fort-I osteotomy acc. to Stoelinga and its soft tissue implication. High Le Fort-I osteotomy: MPEG Movie (5.3 MB)
Conventional Le Fort-I osteotomy: MPEG Movie (5.3 MB)
Quadrangular Le Fort-I osteotomy: MPEG Movie (5.3 MB)
Comparison: Simulation with post-operative result: MPEG Movie (coming soon ...)

Fifth clinical case study: Surgical Correction of Facial Asymmetry

Surgical Planning & Soft Tissue Prediction

3D planning of the surgical correction of a mandibular asymmetry (either a left sided distraction or a right sided osteotomy with bone removal, or even a combination of both.)

Data: Courtesy of M.D., D.D.S., Zeilhofer and M.D., D.D.S., Sader, Department of Oral & Maxillofacial Surgery, University of Technology Munich.


facial asymmetry due to a malformed mandible, either 8 mm distration of the left ramus or removal of an 8 mm fragment of the right ramus, or maybe a combination of both. Simulation: MPEG Movie (6.2 MB)

Fourth clinical case study: Mandibular Distraction Osteogenesis

Surgical Planning & Soft Tissue Prediction

3D planning of a one directional callus distraction.

Data: Courtesy of M.D., D.D.S., Zeilhofer and M.D., D.D.S., Sader, Department of Oral & Maxillofacial Surgery, University of Technology Munich.



Congenital dysgnathia including ankylosis: 7mm callus distraction of the corpus mandibulae. Simulation: MPEG Movie (4.3 MB)

Third clinical case study: Bimaxillary Osteotomy

Surgical Planning & Soft Tissue Prediction

3D planning of a Le Fort I-Osteotomy according to Bell as well as a Sagittal Split Osteotomy according to Obwegeser-Dal Pont under consideration of simulated soft tissue arrangement.

Data: Courtesy of M.D., D.D.S., Zeilhofer and M.D., D.D.S., Sader, Department of Oral & Maxillofacial Surgery, University of Technology Munich.



Congenital dysgnathia: 6mm advancement of the maxilla and 5mm set back of the mandible. Open mouth has been closed for osteotomy planning. 1. simulation: conventional LeFort I osteotomy (MPEG Movie 4.8 MB)
2. simulation: conv. vs. high LeFort I osteotomy (MPEG Movie 6.4 MB)

Second clinical case study: Bimaxillary Osteotomy

Surgical Planning & Soft Tissue Prediction

3D planning of a High Le Fort I-Osteotomy according to Bell as well as a Sagittal Split Osteotomy according to Obwegeser-Dal Pont under consideration of simulated soft tissue arrangement.

Data: Courtesy of M.D., D.D.S., Zeilhofer and M.D., D.D.S., Sader, Department of Oral & Maxillofacial Surgery, University of Technology Munich.



Brackets lead to severe metal artifacts, mouth deformation is due to a respiration tube. Mandibular as well as infraorbital nerves were taken into account for osteotomies. 1. simulation: MPEG Movie (5.6 MB)
2. simulation: MPEG Movie (4.2 MB)

Feasibility Study: Simulation of postoperative Facial Mimics

Soft Tissue Prediction & Muscle Based Mimics

3D simulation of a 'postoperative smile' using a finite element simulation of a single muscle's contraction (e.g. zygomaticus major).

Concepts for surgical planning of muscle or nerve rehabilitation in cases of facial paralysis.


Muscles are segmented from CT-Data. For the zygomaticae major a contraction using our technique of 'virtual fibers' and its impact on the surrounding tissue after surgery simulation has been simulated. 1. simulation: MPEG Movie (3.5 MB)
2. simulation: MPEG Movie (3.8 MB)

First clinical case study: Mandibular Distraction Osteogenesis

Surgical Planning & Soft Tissue Prediction

3D simulation of a bidirectional osteodistraction and finite element soft tissue prediction.

Data: Courtesy of M.D., D.D.S., Zeilhofer and M.D., D.D.S., Sader, Department of Oral & Maxillofacial Surgery, University of Technology Munich.



Bone cuts do not exactly correspond to the surgical guidelines, bone transformation according to the end position of the distraction devices. 1. simulation: MPEG Movie (8.2 MB)
2. simulation with improved model: MPEG Movie (5.3 MB)