The Use of 3D Imaging Tools in Facial Plastic Surgery

The authors present an overview of 3D computer-aided design and computer-aided modeling tools available to the facial plastic surgeon. They describe the role of 3D tools in all phases of computer-aided surgery including: data acquisition, planning, surgery, and assessment. Applications of these tools include obtaining 3D measurements, using mirror imaging to reconstruct missing areas of the head and neck, and 3D sizing or segmentation of bone and soft tissue. They review of clinical outcomes obtained from studies reviewing 3D tools. These systems have potential value for education, reducing operating room time, and improving clinical outcomes.

Despite the use of sound surgical technique, some outcomes in facial plastic surgery may be viewed as suboptimal to clinician and patient. Recently, there has been an explosion of 3-D imaging tools that have made their way from the research bench to clinical bedside, in an effort to assist surgeons in achieving optimal functional and esthetic results. The innovation of computer-aided design and computer-aided modeling (CAD/CAM) software, initially implemented in neurosurgery and radiology procedures, and the easy acquisition and transfer of Digital Imaging and Communications in Medicine (DICOM) data has facilitated the development of various proprietary software programs for use in the craniomaxillofacial skeleton. Contemporary software allows surgeons to analyze patients by performing 3-D measurements and to manipulate deformed or missing anatomy by mirror imaging, segmentation, or insertion of unaltered or ideal skeletal constructs. The virtual reconstruction may be transferred to reality (the patient) by using custom stereolithographic models (SLMs), implants, cutting jigs, or occlusal splints that are constructed using a CAD/CAM process, or through image-guided surgery in the form of intraoperative navigation (frameless stereotaxy) performed to the idealized virtual image. Finally, the accuracy of the surgical reconstruction may be confirmed using modern portable intraoperative CT scanners. Third-party service providers have made this technology available and accessible to most surgeons.

Computer-aided surgery can be divided into 4 phases:

1.

Data acquisition phase, in which all clinical information, anthropometric measurements, and bite registrations are obtained
2.

Planning phase, in which CT data are imported into a proprietary software program for the purposes of virtual planning before surgery
3.

Surgical phase, which is performed using CAD/CAM-derived SLMs, guide stents, occlusal splints, and/or intraoperative navigation
4.

Assessment phase, in which the accuracy of the treatment plan transfer is evaluated using intraoperative (or postoperative CT imaging).

Recently, basic and patient-oriented research has demonstrated efficacy of this approach in (1) head and neck/skull base surgery; (2) maxillomandibular reconstructive surgery; (3) orbital surgery ( Fig. 1 ), and (4) orthognathic/craniofacial surgery ( Fig. 2 ). The purpose of this article is to describe the authors’ approach to craniomaxillofacial surgery and how 3-D analysis and virtual surgery have affected the workflow process at their institution.