Digital And Clinical Research Of Facial Restoration In Plastic Surgery

Preface: Anatomy is a basic science of surgery, and every new operations or new paths must be checked from anatomy time after time. Along with the era of information, surgery requests a new anatomic technology. So, follow the digital anatomy digital system of surgery was done. Since plastic surgery links with computer technology, it is nearly 20 years, people has worked in the operation of design and simulation. People undergo a long time in the computer assistant measure, MR-9C assistant design and 3D CT reconstruction and so on, but we still haven't seen the digital production effectively applied in clinical work. The CAD unused in lots apartments in hospital. Why digital turned down? Because we cannot found the combinative point of computer with plastic surgery and understand the really meaning of digital imaging, we cannot deepen the research. Therefore, the key to solve this question is to find a good way to get digital plastic surgery.Objective: To evaluate the anatomic basic of temporal region for total auricle reconstruction by grouped human specimen. To relate muscles and arteries of the mandible at different periods of life, providing anatomic data to avoid the complications of mandible osteotomy. Based on the theory of digital anatomy, introduce to obtain soft tissues 3D data accurately to use 3D scanner under the condition of non-contact, and use the area of nasal robit fossa to clarify the purport and the way of 3D standard measuring in clinic of plastic surgery. To exploit the software for rapid measurement, analysis and diagnosis in facial lineament for beauty. This software was named Angel. We used Angel to measure the absent data of mandible soft tissue, to aesthetically estimate between preoperative and postoperative of rhinoplasty, and to build a plat for 3D operation simulation. Maybe this way gives us a new path to complete the simulation.Methods: Materials consisted of 12 fresh human temporal muscle specimens. Vascular infusion was done using latex and 10% formaldehyde solution. The bloodvessels and nerves distributing in galea aponeurotica and temporal fascia were noted. 12 adult specimens of head and 8 mandibles at different periods of life were injected, micro-observed or transparentized. 3D laser scanner and Geomagic software were used to collate 3D facial contour data about normal person. 60 subjects (male: female=l:l) selected from 500 by 200 randomly sampled people (male: female=l:l) consisted of students, administrators.clerks and workers through observing their face photographs, were enrolled in the study. Each subjects performed 3D facial scanning,and 3D facial digital model was then built.lt is a datebase. As this way we build another database about clinic patients for 3D simulation. That 3D Surgery Design Simulation include Orbital Hypertelorism, Progressive Hamifacial Atrophy (Romberg's disease),Orbital and Periorbital Deformities, Aesthetic Facial Contouring and so on. Based on orient classical beauty theories, using Microsoft Visual Studio 6.0 SP4+OCX to write the program. We use this program to measure and analyze the data of nasal robit fossa, mandible which appear beauty face in plastic surgery, and compare the difference between preoperative and postoperative of rhinoplasty. Using 3D Doctor > 3D MAX to reconstruct model of skull and face. 3D carving was carried out on the model using FreeForm software and carving equipment to acquire 3D digital model of facial soft tissue, in order to find a way for 3D operation simulation.Results: ?Temporal region of fascia tissues was divided into about three layers from superficial to deep, superficial temporal fascia, middle and deep temporal fascia. The superficial temporal fascia extends to upwards form the galea aponeurotica. Temporoparietal fascia belongs to SMAS. Sometimes it needs post auricular fascia to cover the more defect. Those three layers have blood vessels and nerves independently, and formed a dense interlacing network. (2)14 muscles attached to the mandible. The inferior alveolar artery and never were the main tissues which in 93.1% adults went through the madiblular foramen to posterior middle of ramus, and the others to anterior. The length of mandibular foramen to anterior ramus was 20.9mm+0.43mm, and the ones to posterior ramus was 13.7mm ± 0.38mm. The angle of the mandible was 119.8° ±6.3° . The rages of the ramus for safe operation was 12.6mm ± 0.33mm, and the safe rages about angle of the body and bottom of the mandible was 22.5+4.3° . There were obvious differences from children to the aged in the mandible physiological and anatomic study. (3) 3D measure can obtain the surface three-dimensional of face shape in every meaningful angle, with the advantages of high precision of 0.01mm. So we built a 3D imaging database for normal human. (4) And we built another 3D model database for clinicalpatients. ?We ensured the low point and the feature of nasal robit fossa in 3D. ? Finished the rapid diagnosis system. There are not difference in measurement between manual and software, but it can improve 34-37 times in speed using the software. And using this software to get a diagnosis in five minutes was come true. (7) To measure in 2D and 3D,mandible soft tissue data such as the angle is (146-153) , and the arc semidiameter is (193.8±28.1)pels. (8) Aesthetic score was increased 2 to 16 percent after rhinoplasty. (9) We achieved the 3D operation simulation of mandibular osteotomy.Conclusion: CD We can accomplish ear reconstruction on one stage by temporoparietal fascia , in which have the blood and feeling nerve. The key is the layers and the quality of the fascia. (2) Post auricular fascia is the first-rate additional fascia as to the ear reconstruction. The muscles, vessels, bones and nerves of mandible have stable relation, and to carry out mandibular osteotomy we must be protect the inferior alveolar artery and nerve. On the other hand, to design operation we must think about the different ages. ? Reverse engineering technology in plastic surgery give us a new method to collate 3D data, and we use 3D scanner to build a standard database of human; ? And another datebase of clinical patients. ? These methods can measure the total relation of nasal robit fossa. ? Facial lineament can be accurately described in digital method, and we can use computer to measure and analyse facial lineament, and can instantly get a diagnosis report. ? Using this software we added some data of mandible soft tissue;? and evaluate postoperative effect;?We found a new method ,Boolean and Freeform software to simulate operation, it is through the operators AND, OR, NOT, IF, THEN, and EXCEPT and so on. In a word, Angel Digital Image Studio Software is a new tool and a new harvest. It broke through the difficult digital problem in plastic and reconstruct surgery. It is a plat for accurate measurement and diagnosis, it is a plat to estimate operation, and it is a basic plat for 3D simulation. Through this we can see a new view for digital teaching, study and clinic, and it is a new way to make preoperative plans, operation simulation.