Combined Use Of 3D-printing And Computer-assisted Navigation In The Clinical Treatment Of Multiple Maxillofacial Fractures

Objective This research is based on computer-aided design(CAD)technology to design personalized surgical guide plate and virtual reconstruction skull model for maxillofacial fracture,and use 3D printing(3DP)to manufacture.During the operation,the head form and guide plate combined with the computer-assisted navigation system(CANS)were used to guide the fracture reduction.To explore the application effect of 3D printing technology combined with a computer aided navigation system in the operation of multiple maxillofacial fractures.Method From September 2020 to December 2022,26 patients with multiple maxillofacial fractures admitted to our hospital in oral and maxillofacial surgery were included in this study.Based on the patient’s computerized tomography(CT)image,a digital model of the patient was established with medical image processing software,virtual reduction was performed on the fracture end of the maxillofacial region,and a fracture reduction guide was designed.Use the software segmentation tool to separate the patient’s maxillary and mandibular virtual reduction posterior dentition,convert it to STL format,and import it into the 3D printer for printing.After confirming the correct occlusion relationship of the maxillary and mandibular dentition model,the occlusal relationship is converted into digital data by oral scanning,and the data is imported into medical image processing software to design and 3D print the occlusal guide plate.26 patients were randomly divided into an experimental group and control group according to the order of admission.The experimental group used 3D printing occlusal guide plate and computer-assisted navigation system during the operation,while the control group used computer-assisted navigation system during the operation.The operation time of the two groups was compared,and CT was performed one week after the operation,and follow-up was performed one month,three months and six months after the operation.The postoperative CT image was modeled and measured as the basis for facial symmetry restoration;The postoperative infection,occlusal relationship and mouth opening of the patients were examined.According to the above four statistical indicators,the healing of patients was divided into four grades: excellent,good,qualified,and poor,for statistical analysis.Results This study included 26 patients,including 18 males and 8 females,with an average age of 35.92 ± 12.88 years.The average time from injury to maxillofacial fracture surgery was 24.62 ± 12.38 days.The average operation duration of the experimental group was 197.23 ± 38.07 minutes,and the average operation duration of the control group was 242.69 ± 59.95 minutes.The use of 3D printing occlusal guide plate reduced the operation duration(Z=-2.083,P<0.05).In the experimental group,12 patients had excellent prognosis and 1 patient had good prognosis;In the control group,there were 7patients with excellent prognosis,3 patients with good prognosis,1 patient with qualified prognosis and 2 patients with poor prognosis.The patients in the experimental group were better than those in the control group(rs=0.448,P<0.05).Conclusion This study describes the design process and use method of occlusal guide plate for multiple maxillofacial fractures,and provides a new idea for the treatment of multiple maxillofacial fractures.The results show that the use of personalized 3D printing occlusal guide plate based on computer-aided design during the operation improves the efficiency and quality of the operation,and makes up for the shortcomings of computeraided navigation system.