A haptics-assisted cranio-maxillofacial surgery planning system for restoring skeletal anatomy in complex trauma cases

Abstract

Purpose Cranio-maxillofacial (CMF) surgery to restore normal skeletal anatomy in patients with serious trauma to the face can be both complex and time-consuming. But it is generally accepted that careful pre-operative planning leads to a better outcome with a higher degree of function and reduced morbidity in addition to reduced time in the operating room. However, today’s surgery planning systems are primitive, relying mostly on the user’s ability to plan complex tasks with a two-dimensional graphical interface. Methods A system for planning the restoration of skeletal anatomy in facial trauma patients using a virtual model derived from patient-specific CT data. The system combines stereo visualization with six degrees-of-freedom, high-fidelity haptic feedback that enables analysis, planning, and preoperative testing of alternative solutions for restoring bone fragments to their proper positions. The stereo display provides accurate visual spatial perception, and the haptics system provides intuitive haptic feedback when bone fragments are in contact as well as six degrees-of-freedom attraction forces for precise bone fragment alignment. Results A senior surgeon without prior experience of the system received 45 min of system training. Following the training session, he completed a virtual reconstruction in 22 min of a complex mandibular fracture with an adequately reduced result. Conclusion Preliminary testing with one surgeon indicates that our surgery planning system, which combines stereo visualization with sophisticated haptics, has the potential to become a powerful tool for CMF surgery planning. With little training, it allows a surgeon to complete a complex plan in a short amount of time.

Haptic feedback improves surgeons’ user experience and fracture reduction in facial trauma simulation

“…Their system provides unimanual haptic feedback, secondary hand control for camera movement, and a "snap-to-fit" interaction technique that can assist the surgeon to find an optimal fit of bone fractures. One of the differences between Olsson et al's system [17] and the system described here is that ours supports bimanual interaction; empowering both hands improves spatial understanding of the objects and further enhances the similarity to the actual surgical experience. In addition, some commercial haptic devices, including versions of Sensable's Phantom (now sold as Geomagic Touch) and Force Dimension's Delta (Force Dimension; Nyon, Switzerland), are capable of providing 6-DOF forces and torques; for example, Salisbury et al developed a 6-DOF haptic device designed for surgery-specific applications [18].…”

“…However, limitations to surgical training with a haptic feedback simulator were reported in one study; even though haptic feedback enabled a significant improvement in a laparoscopic suturing and knot-tying task with a higher learning rate, the surgeons reached a plateau after 5 h of training with the haptic device [16]. Recent work by Olsson et al reported an immersive virtual environment setup with a colocated visuohaptic display and head-tracking capabilities [17]. Their system provides unimanual haptic feedback, secondary hand control for camera movement, and a "snap-to-fit" interaction technique that can assist the surgeon to find an optimal fit of bone fractures.…”

“…• Marking fracture and dental surfaces: The surgeon can "paint" the fracture surfaces and the surfaces of the teeth using the haptic devices in order to delineate the regions of interest, as proposed by Olsson et al [17].…”

Introduction of an algorithm for planning of autologous fibular transfer in mandibular reconstruction based on individual bone curvatures

“…The fundamental difference of the present approach from published works with similar intentions is that the three‐dimensional bone surface geometries are simplified to curves that follow certain anatomical features. The advantage of using these curves to define the relevant contour of the target shape is that it reduces the overwhelmingly complex task of mandibular reconstruction to a manageable procedure.…”

A review of computer-aided oral and maxillofacial surgery: planning, simulation and navigation

“…presented cranio-maxillofacial surgery planning system that combines stereoscopic 3D visualization with haptic feedback [16]. The system allows the surgeons to plan the restoration of skeletal anatomy in facial trauma patients, and conduct the preliminary testing of alternative solutions for restoring bone fragments to their proper positions.…”