Clinical Study On Three-Dimensional Printing Technology In Craniomaxillofacial Surgery

PART ? APPLICATION OF THREE DIMENSIONAL PRINTING TECHNOLOGY BASED ARTIFICIAL BONE IMPLANT IN REPAIR OF MANDIBULAR ASYMMETRICAL DEFORMITYBackground Mandibular deformity can be caused by congenital anomalies,trauma and tumors ect.leading to impairment of aesthetic and function such as communication,swallowing and mastication.Aim To assess the clinical value of the computer-assisted design and computer-assisted manufactured(CAD/CAM)technology and evaluate the clinical experience of manufactured artificial bone precision to repair the mandibular asymmetrical deformity.Methods From July 2013 to August 2016,computer-assisted 3D printing technology was applied in 72 patients with mandibular asymmetrical deformity in Craniofacial Department,Ninth People's Hospital,ShanghaiJiao Tong University School of Medicine.The measurement data was conducted and compared with three-dimensional CT result during the 6months of follow-up.To evaluate the effectiveness of the surgery,the distance between the corresponding three anatomical points on the mandible to the mid-sagittal plane were measured and compared by asymmetic ratio Q value and the patients satisfaction survey was carried out.The measurements of mean discrepancy of corresponding three anatomical points between the virtual design and post operative CT during the 6 months of follow up.Results The patients' mandibular asymmetry was improved,the asymmetrical ratio Q value decreases from 13.57%±8.73% to 9.01%±8.18%(P<0.001)with high patients' satisfaction score(score=4.78,Score 5=Completely satisfied).The mean deviation of the preoperative design and postoperative CT was 1.43±0.12 mm,basically similar with the preoperative simulation.Pre-designed implant also decreased the intraoperative time with the mean value of 2.15±0.27 h.All patients were treated successfully without serious complications.Conclusion Three-dimensional design of patients' specific artificial bone implant in repair of mandibular asymmetrical deformity is a valuable technology,by relying on quantitative design and preoperative simulation using the customized CAD/CAM technology,making the complex reconstruction simple and improve the accuracy of surgery,ultimately improve the facial symmetry.The patients showed high satisfaction rate with low surgical complications and long-term efficacy.PART ? EVALUATION OF CLINICAL OUTCOMES OF 3D PRINTING GUIDES COMBINE WITH NAVIGATION TECHNIQUE IN REDUCTION OF ZOM COMPLEX FRACTUREBackground Craniomaxillofacial fractures occur in humongous population worldwide in combination with other severe injuries including airway,spinal,and upper and lower body injuries leading to increasing morbidity and mortality.Of these,ZOM complex fracture is one of the common facial injuries causing severe aesthetic and functional deformities and so forth leads to influence the quality of life.Aim This pilot prospective randomized controlled study was to evaluate the clinical outcomes of the 3D printing guides combine with navigation guided technique and compare with traditional navigation technique in the reduction of ZOM complex fractures.Methods 20 patients diagnosed with unilateral ZOM complex fractures,admitted to our department were randomly divided into Group A and Group B with the use of 3D printing guides combine with navigation aided techniques and with the use of traditional navigation aided technique respectively.All of the patients underwent 1mm thickness preoperative CT scans.Virtual surgical plan and the postoperative 5 days CT data were imported in Mimic software to measure the outcomes.Primary outcomes measures were unoverlapped volumes percentage of the ZOM fracture and secondary measures were intraoperative time,patients' satisfaction rate,mean discrepancy of each 6 points determined by the fracture ends,diplopia severity score,amount of mouth opening and postoperative complications rate.Grouped t test and fisher exact probability test were used for the statistical analysis..Results All cases achieved good results without serious complications in both group A(3D printing guides+navigation)and Group B(navigation)which included 10 cases of unilateral ZOM fractures in each group.Group A resulted with the better accuracy(P<0.001)with reduce operation time with high patients' satisfaction rate and no statistical significance in diplopia outcome and mouth opening outcomes.ConclusionThe combination of the 3D printing guides with navigation techniques provided a more rapid,convenient and intuitive three-dimensional surface reduction compared with the navigation aided technique,there by combination technique is a more safe,convenient method with high accuracy and decrease operation time in the treatment of ZOM fractures.