| BackgroundBesides the development of the facial soft tissue, the facial peripheria is mainly decided by the feature of the superior maxillary bone, inferior maxillary bone and the zygomatic complex,among which the zygomatic complex is the most important factor. The abnormal development of the zygomatic complex not only result in the disproportion of the upper,middle and the below facial width, but also the lacking soft"S"curve of the lateral surface which lead to not good looking face and make the person depressed.Becausc of the different culture background and the different value of appreciate beauty,the western female are keen to owning abnormal protrusion malag surface, while the easgeln female age on the opposite. People with the abnormal protrusion of the zygomatic bone complex age easily be seA:n among the Asia countries especially China,Korea,Japan and Mongolia et al. In ourcountry, people in the Guangdong province, Hainan province and the Fujian province are much moge easily getting an abnormal protrusion of the zygomatic complex. With the changing of the modem medical mode and the upgrading of the health conception, more and more people especially female with abnormal protrusion malar face ale turning to diminution their malag faces through plastic surgery operation. Because of that the diminution operation of the protrusion zygomatic complex is becoming the hot spot in the plastic surgery field in China and other Asian countries. This has been a basic working content in the maxillofacial region plastic surgery of the Guangdong province.There are about twenty years from the zygoma reduction which given with internal incision have been done by Onizuka in the 1983,giving different operative approachs, different methods for malarplasty will be made,but we will face with the common difficults and problems.First is how to sciencely judge the zygomatic complex whether deformity or not,Secondly Because operation vision is not enough,the oscillating saw removing is limited, The position and oblique angles of the osteotomy lines thus designed reasonablely is important for decreasing the complication.CATR is the use of computer technology as a tool for continuous two-dimensional structure of biological images are processed to obtain three-dimensional images of a morphological method. Including the human body two-dimensional image acquisition and processing of information, computer-aided modeling, computer-aided tissue scaffold design and preparation of three aspects. Virtual reality is a newly emerging subject which depends on the integration of computer technology and electronic technology,and it is a simulation circumstance seemingly like a real one.Through many sensing equipments,the user can inspect and perform on the objects in virtual objects and go through it personaly. Meanwhile,it can offer users real sense such as vision,hearing and touch,etc.,macroscopicly and naturally,make participant generate the real sense of interactive simulation.Virtual reality technology have already been utilized from laboratory to actual life.Currently,it has a wide application perspective on military,aerospace,medical, education,commerce,automatic control,and so on, and increasingly show out great potentiality and value on social efficiency and economic efficiency. Medically,virtual reality derived from the medical practitioner's visual need to the sophisticated human 3D medical anatomical data,then develop to perform the visual data real time,and finally set up a virtual circumstance can be used for operating simulated and make preoperative plan.In the '80s of the 20th century,Delp and Rosen created the first virtual artificial surgery simulation system to observe the effect of joint transplantation. Hallermann 2006, CT scans, etc. will be two-dimensional cross-section of the mandible image data into the computer, using image analysis software to build three-dimensional model of the mandible, and the computer simulation of osteotomy procedure to obtain good results.3D skull and virtual surgery is the use of CT, MRI and other image sequence processing, constructed to display three-dimensional geometric model of the skull will not see three-dimensional form of human organs can be "real"to be displayed, you can visualize. Its advantage is a precise positioning in space, you can observe the three-dimensional from all angles and measured the anatomical structure, measuring a variety of data, while the virtual restoration of zygomatic complex variety of procedures, so that the surgeon again on the computer Surgery planning, surgical procedure repeated exercise program and optimize operations, improve surgical skills, improve surgical safety and reduce surgical complications.Currently, the use of modern technology (virtual reality) means of modern imaging, computer image processing, the combination of surgery, cross-disciplinary and cross-disciplinary research and create "real" virtual surgery has become a hot topic. Spiral CT scan how to use the data reconstruction, reconstruction of a truly meet the clinical needs, and can be freely rotated, and the surgical incision and separation of three-dimensional spatial image, and has the feeling of force feedback, and then simulate the operation of its. Such a process of far-reaching practical surgical significance. To this end, the author sub-millimeter imaging technology, digital medical technology into the zygomatic complex surgery in the study reduced to seek high-zygomatic complex deformity to determine the number of sudden, abnormal zygomatic complex visual simulation method of operation, meaning and its possible extension to other operations.Objective:First, the use of sub-millimeter digital imaging technology and other digital medical technology on living human facial contour three-dimensional reconstruction of bony structures, to accurately determine the zygomatic complex deformity to provide a scientific basis. Second, visual simulation technology research complex in the cheekbones narrowing the application of surgery, preoperative surgical plan designed to determine the surgical approach include:grinding method and zygomatic osteotomy, osteotomy, and osteotomy angle to determine the location, etc. To prevent the immersion maxillary osteotomy, postoperative trismus, and bilateral zygomatic asymmetry complications after surgery.Third, through the individual three-dimensional mathematical model, combined with patient's own situation, to meet the operation requirements of individual patients.Research methods and resultsPart 1. Using sub-millimeter digital imaging living human facial contours of bony structures of three-dimensional reconstructionObjective1.Using sub-millimeter digital imaging technology and other digital medical technology, human facial contours of live three-dimensional reconstruction of bone structure2. Three-dimensional mathematical model based on measurements to determine the high penetration of zygomatic complex deformity for the next operation to provide basic information on program design.MethodsMaterials:(1) PHILIPS BRILLIANCE 64-slice helical CT, Image process workstation; (2) binocular tube high pressure injector; (3)computer; (4) DICOM Viewer; (5) ACDSee; (6) Medical Image 3D Visualization System (MI-3DVS); (7) FreeForm Modeling System and PHANTOM.1.Examiners:To randomly selected to Plastic Surgery, Zhujiang Hospital, Southern Medical treatment of 20 patients with sudden high cheekbones, were female, aged 19 to 37 years old, average 26.7 years old, no history of surgery, and other non-facial orthodontic treatment history.2.Using sub-millimeter digital imaging technology for data collection (1) CT scan conditions:Scan parameters:tube voltage 120KV, tube current 300mAs,1 week rotation every time 0.5s, pitch (pitch) 0.984, thickness lmm.(2) CT scan:0.625×64 row detector using portfolios to thickness of 1mm, interval of lmm, pitch (Pitch) 0.984, tube rotation week 0.5s, scan field of vision 40-50cm, matrix 512×512.(3) CT scan data collection:After the scan is complete, the Mxview diagnostic workstation, the use of all of the data DVD. Format DICOM3.0.(4) sub-millimeter three-dimensional reconstruction of digital imaging technology: the data into a personal computer, using the raw data DICOM viewer into the format of JPG format; by ACDSee software, adjust the picture size and converted to BMP format; into the Pearl River of Southern Medical University Medical Images Digital Research Center Hospital of MI-3DVS developed image processing software, the program split reconstruction, and output STL format; the STL model is imported into the FreeForm Modeling System for smoothing, noise reduction, color and other treatment combinations shown.3.Bone structure facial contou of three-dimensional reconstruction.Using MI-3DVS medical image processing software to visualize three-dimensional image reconstruction:the use of the above has been collected a good facial bone structure of the CT contour scan image data sets, will meet the DICOM standard CT scan image sequences medical image into MI-3DVS Processing software in a variety of graphic image processing, data measurement, reconstruction of the target object to STL format (Standard Template Library Standard Template Library) into the FreeForm Modeling System (a free system software design model), the model of smooth, fine Processing, and finally come to facial contours are the perfect bone structure, accurate and realistic three-dimensional model. 3. on the zygomatic complex three-dimensional measurement of bone and clinical evaluationMeasured above the zygomatic width, in breadth, from the zygomatic process, the distance between the cheekbone, zygomatic bone thickness, the thickness of the zygomatic arch, between the coronoid process and zygomatic around the coronoid process and zygomatic arch distance between the top width and the Wide ratio, an objective evaluation of zygomatic complex deformity.Results1.The results of sub-millimeter data acquisition Were collected to obtain the complete data in DICOM format images 20×300sheets, the format of DICOM, converted into BMP format, size 415×303×32b. CT scan results:reconstruction of facial contour model of clear, realistic, three-dimensional sense.2.Facial bone structure contour three-dimensional reconstruction visualization MI-3DVS three-dimensional reconstruction of medical image processing software, after the bone structure facial contours, stereoscopic three-dimensional model, realistic shape, which can reproduce the facial contours and other important anatomical bone structure and bone structure of signs, and can zoom in, zoom, and Full rotation, perspective to observe the facial bone structure and other important contour structure visualization.3. on 11 indicators of zygomatic complex three-dimensional measurementsTop width (108.794±0.424) mm, the wide (134.797±3.812) mm, following wide (99.977±3.825) mm, zygomatic process from (69.586±2.052) mm, the distance between the cheekbones (109.769±5.657) mm, coronal Before and after the conflict and the distance between the cheekbones (13.527±2.521) mm, coronoid process and zygomatic arch distance between (8.372±0.652)mm, zygomatic bone thickness (8.958±1.528) mm, zygomatic arch thickness (2.869±0.178) mm, Above, the ratio of width and in the wide (0.808±0.020), following in the wide width and the ratio of (0.741±0.008).Conclusions 1.submillimeter by digital technology based on the information collection, use three-dimensional medical image visualization system MI-3DVS the digital three-dimensional reconstruction of facial contour model clear, realistic;2.facial contours and objective measurements of bone three-dimensional, three-dimensional, clearly presented, based on the patient side of zygomatic protrusion and sudden situation, cheek bone, the bone thickness of the zygomatic arch, zygomatic, zygomatic arch and coronoid process of the distance, As well as the patients themselves with the requirements proposed osteotomy personalized program.Part2.Application digital simulation of surgery in the zygomatic reductionObjective1.Preoperative surgical plan designed to determine the surgical approach include: grinding method or zygomatic osteotomy, and osteotomy angle to determine the location and so on, to prevent the immersion maxillary osteotomy, postoperative trismus, bilateral cheekbone surgery Asymmetry of complications after2.Through the individual three-dimensional mathematical model, combined with patient's own situation, to meet the operation requirements of individual patients.3.The patient before surgery doctors can repeatedly for three-dimensional mathematical model to improve the success rate of surgery.Methods1. Materials:same as the first past.2. Examiners:Patients with bilateral symmetrical high cheekbones suddenly, female,20 years old, height 1.55M, Weight:40KG3.Collection of CT scan data:same as the first part.4.Develop simulation of surgical instruments FreeForm Modeling System Using the GHOST SDK to develop simulation software for surgery, all surgical instruments used, such as:simulation of scalpel, simulation forceps, bone cutting simulation, the simulation sub-periosteal stripping, simulation right angle turn, the simulation of grinding bone, Simulation hammer, wire simulation, simulation needle holder and so on.。5. PHANTOM force feedback system using virtual osteotomy designFacial bone structure under the three-dimensional model profile, combined with the requirements of patients and the patient's aesthetic design of the model reduce the surgery cheekbone surgery program, osteotomy into the maxillary sinus and damage to avoid joint, three-dimensional model based on measurement results, Maxillary zygomatic process point made by anterolateral wall of the tangent to determine the anatomy of zygomatic complex osteotomy safety line, and measure the joint front-end and the connection point of the tragus distance, to determine the anatomy of zygomatic arch osteotomy line security Line.Results1.Facial bone structure of the three-dimensional profile reconstructionA study of the image segmentation data through self-developed three-dimensional medical image processing software through the FreeForm Modeling System reconstruction and smooth, micro-machining, the facial bone structure contour three-dimensional model results clear, realistic, three-dimensional sense of strong, from different Angle zoom, and full rotation.2. Simulation of the effects of surgical instrumentsSimulation of surgical instruments of the size, shape and basically similar to the real surgical instruments, images, realistic, and we can also perform various operations on their computer, simple, lightweight, flexible, surgical instruments like the feeling of the real operation. But there are also some technical device simulation problems, such as: facial soft tissue reconstruction is not resolved, the important three-dimensional reconstruction of blood vessels and nerves and so on.3. PHANTOM force feedback system used to simulate the effect of facial contour surgerySurgery in a virtual environment system, we adopted the FreeForm Modeling System PHANTOM force feedback devices of three-dimensional reconstruction of facial contour after bony structure of dynamic visual simulation of cutting, osteotomy, surgical procedures such as grinding and the suture, the And basically the same as the real surgical procedure zygomatic complex orthopedic surgical simulation research, strong sense of immersion, interaction and good. Simulation of the facial profile plastic surgery process simulation and high precision real, vivid, and can have "power " of the true feelings, as if giving a real surgical operation on the operating table feeling.4. PHANTOM force feedback system using the virtual osteotomy design effectBy three-dimensional reconstruction of the facial bone structure contour model, depending on the patient's own situation, comprehensive evaluation, the design of the osteotomy, osteotomy line to determine the seat, the amount of osteotomy angle and osteotomy to avoid surgery, Invasion of the maxillary zygomatic osteotomy caused by maxillary sinus inflammation, trismus caused by joint injury, and both sides of the osteotomy and the amount of facial asymmetry caused by different incidence of complications such as clinical operations program to provide objective, accurate and scientific basis Improve the safety and effectiveness of the operation.Part3. Digital medical technology in the zygomatic complex reducingObjectiveCreate personalized design of digital medical surgical simulation platform for preoperative surgery zygamatic reduction design and provide the basis for positioning.Methods3. Materials:same as the first past.4. Examiners:same as the first past.3. Collection of CT scan data: same as the first part.4. Virtual osteotomy design:According to facial contours under the three-dimensional mathematical model of bone structure, combined with the requirements of patients and the patient's aesthetic design of the zygomatic complex model "L" osteotomy surgery reduced surgical programs, measurement of zygomatic complex osteotomy Location, the amount of osteotomy angle and osteotomy.5. three-dimensional measurement and statistical analysis:On the preoperative and postoperative simulated width above (Ft-Ft), in the wide (Zy-Zy), following wide (Go-Go), zygomatic width (Zd-Zd), zygomatic arch width (Za-Za), Zygomatic process from (T-Mz), zygomatic process W (Mz-Mz), coronoid process and zygomatic distance between (Cp-Zd), coronoid process and zygomatic arch distance between the (Cp-Za) Above the ratio of width and in the wide, wide following in the ratio of width and three-dimensional measurements, using SPSS 11.0 statistical software to analyze all the data.Results:1. Three-dimensional mathematical model to obtain the CT data of 22 patients are leading to the digital medical surgical simulation workstation, and can form three-dimensional mathematical model of three-dimensional reconstruction of the cheekbone, MI-3DVS three-dimensional reconstruction of medical image processing software, after the three-dimensional mathematical model of dimension, shape Realistic, which can reproduce the important zygomatic complex anatomical structure and bone signs, and can zoom in, zoom, and full rotation, perspective to observe the structure of the zygomatic complex visual design for digital surgery.2. Zygoma reduce the surgical approach combined with oral incision preauricular incision, "L" osteotomy shaping method, mainly to remove part of the cheekbones.3. through three-dimensional mathematical model, through simulation into the surgical digital medical technology, combined with the patient's own bone structure characteristics, determining the location of osteotomy, osteotomy, and osteotomy angle of approach and avoid the occurrence of surgical complications, preoperative Surgical planning and improve the safety and effectiveness of the operatio4. Comparison of simulated three-dimensional measurement of width after the above, the wide, wide below, zygomatic thickness, the thickness of the zygomatic arch, zygomatic process distance, the distance between the cheekbones, coronoid process and zygomatic distance between the coronoid process and zygomatic arch The distance between the significantly reduced compared with that before, but in the wide width above and below the ratio in the wide width and the ratio of increase before and after surgery, the differences were statistically significant. Conclusion:1. submillimeter by digital technology based on the information collection, use three-dimensional medical image visualization system MI-3DVS the digital three-dimensional reconstruction of facial contour model of bone structure, clear, realistic, three-dimensional sense;2. In middle facial, zygomatic width, zygomatic arch width from the zygomatic process, zygomatic process width, coronoid process and zygomatic distance between the coronoid process and zygomatic arch than the distance between the virtual surgery before the decrease, the top width and Here in the wide width ratio and the ratio were increased in the wide, wide to the front and side were moderately reduced width, the top width, the breadth and width ratio of the following medium, showing that this design method osteotomy The sudden improvement in the high cheekbones are significant and effective3. According to the results of three-dimensional measurements made osteotomy design, provides physicians with objective, accurate and scientific diagnosis, in order to avoid postoperative, due to invasion of the maxillary sinus lateral wall osteotomy, joint damage, resulting in inflammation of the maxillary sinus And mandibular joint dysfunction and other complications, improve surgical safety, good surgical simulation and design, and provide patients with individualized surgical plan. |
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