BackgroundComputer-assisted surgery (CAS) has been introduced to mandible reconstruction with bular free ap in cutting guide placement. When CAS is cooperated with different plate xations, the results show various degrees of errors by which this study aimed to evaluate. MethodsMock surgeries were conducted in 3D-printed mandibles with either 2 types of defects; limited or extensive, reconstructed from 2 ameloblastoma patients. Three types of xations; miniplate, manually bending reconstruction plate and patient-speci c plates are tested, each of which was performed 3 times in each type of defects, adding up to 18 surgeries. One with the least errors was selected and applied with patients whose 3D-printed mandibles derived. Finally, in vivo errors were compared with the mock. ResultsIn limited defect, average errors show no statistical signi cance among all types. In extensive defect, patient-speci c plate had a signi cantly lower average condylar error than manually bending reconstruction plate and miniplate (8.09±2.52 mm vs. 25.49±2.72 and 23.13±13.54 mm, respectively).When patient-speci c plate was applied in vivo, the errors were not signi cantly different from the mock. ConclusionPatient-speci c plates cooperated with CAS shows the least errors. Nevertheless, manually bent reconstruction plates and miniplates could be applied in limited defects with caution.
Background: Augmented reality (AR) is an imaging technology encompassing an interactive experience of a real-world environment enhanced by computer-generated perceptual information. It has been introduced to current medical practice to help the preoperative planning in many surgical fields. Methods: The authors applied AR to the computed tomography angiography of 8 patient's legs. Computed tomography angiography images were processed into Digital Imaging and communications in Medicine files to make a prefabricated cutting guide and customized titanium plate. Also, three-dimensional reconstruction of the arterial supply of the leg was performed to identify the perforators. Results: Followed by preoperative marking of operative details on patient's skins in antero-posterior view, lateral view, and combination of both views. Inaccuracy of measurement was confirmed by duplex ultrasound which average error of the combination of antero-posterior and lateral viewed of both legs was lowest (0.7 AE 0.2 cm). Followed by lateral view (1.0 AE 0.3 cm) and antero-posterior view (1.2 AE 0.4 cm), respectively. Conclusions: Augmented reality can improve patient's safety by directly locate the perforator and easily to design the skin paddle. Followed by satisfaction and confidence in patients and their relatives. Augmented reality also promoted understanding of operative steps for related assistants, residents, or fellows. Augmented reality can perform with existing equipment, mobile phone application, and can save the cost for preoperative planning. Distortion in the depth view can be more accurate by combining of AR in antero-posterior and lateral view.
Background Computer-assisted surgery (CAS) has been introduced to mandible reconstruction with fibular free flap in cutting guide placement. When CAS is cooperated with different plate fixations, the results show various degrees of errors by which this study aimed to evaluate. Methods Mock surgeries were conducted in 3D-printed mandibles with either 2 types of defects; limited or extensive, reconstructed from 2 ameloblastoma patients. Three types of fixations; miniplate, manually bending reconstruction plate and patient-specific plates are tested, each of which was performed 3 times in each type of defects, adding up to 18 surgeries. One with the least errors was selected and applied with patients whose 3D-printed mandibles derived. Finally, in vivo errors were compared with the mock. Results In limited defect, average errors show no statistical significance among all types. In extensive defect, patient-specific plate had a significantly lower average condylar error than manually bending reconstruction plate and miniplate (8.09±2.52 mm vs. 25.49±2.72 and 23.13±13.54 mm, respectively). When patient-specific plate was applied in vivo, the errors were not significantly different from the mock. Conclusion Patient-specific plates cooperated with CAS shows the least errors. Nevertheless, manually bent reconstruction plates and miniplates could be applied in limited defects with caution.
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