The Craniofacial Team of Texas is the leading edge of medicine. Through innovation, virtual surgery, and technology, they are committed to advancing their specialty through education, collaboration, and leadership. They employ individualized state-of-the-art medical modeling from the new industry of virtual surgery and technology. They combine their surgical plan with custom-engineered instrumentation and clinically tested technology to aid surgeries ranging from ear deformities (microtia), orthognathic surgeries (corrective jaw surgeries), and for craniofacial reconstruction due to congenital malformations, trauma or post-resection of tumor.
Advanced Techniques in Craniofacial Surgery
Virtual Surgical Planning
For many years craniofacial surgeons were able to view high resolution MRIs and CTs to help them diagnose and plan treatment for complex craniofacial conditions. But unlike many other industries, the surgeons were limited to visualization of the digital image leaving the actual planning to the surgeon’s mind or pencil and paper. It was much like what an artist would go through to create a model or a statue. A little more than a decade ago, this changed drastically when the storing and transmission of large data files eased and software that allowed the surgeon to manipulate CT and MRI data images mimicking surgical cuts, especially cuts in bone. Although these two advancements made big changes in the way we look at the data and contemplate surgery, the real quantum leap came when surgeons could apply CAD (Computer Aided Design)/CAM (Computer Aided Manufacturing) principles familiar to many engineers and designers of other industries. Digital CT and MRI images could now be manipulated by the design software creating a virtua l surgical plan which could be c linica lly transferred to the operating room to facilitate the execution of the virtual surgical plan by the 3-D printing of a series of clinic al transfer tools (resection guides, positioning splints, positioning guides, custom printed titanium plates, etc.).
So now, much like the manufacturing industries, surgeons could execute complex face, skull and orbital bone movements with precision that manufacturing and construction industries enjoy. Proper craniofacial form is imperative to proper craniofacial function. Being able to establish proper craniofacial proportions in the digital world and then precisely replicate them in the operating room has led to significant improvement in the quality and consistency of many craniofacial procedures that we performed over the last decade. Advancements in virtually aided surgery came first in orthognathic surgery (corrective jaw surgery) and in mandible reconstruction for mandibles resected to cure advanced oral cancers. The experience and knowledge gained in these two areas has now spread to an ever-expanding group of diagnoses creating significant improvements in outcomes, both in terms of quality and consistency. When combined with a competent microsurgical skill set, there are a number of diagnoses that we are able to offer very effective and reliable treatment for the first time. Many patients with complex craniofacial diagnoses of the recent past were sentenced to a life dependent on tracheostomies and gastrostomy tubes and severely debilitated speech and communication. With modern techniques, these patients can lead full and productive lives.
Craniofacial Team of Texas craniofacial surgeons have led the country in virtually-aided craniofacial surgery. Partnering with the Medical Modeling Corp. (Golden, CO), we have performed some of the highest volumes of cases, and especially complex craniofacial cases, in the US. We have helped pioneer many of the concepts and strategies to employ the tools of virtual surgery. For a precise description of the process of virtual planning and clinical transfer, refer to article written by Dr. Kelley. The case examples and images below help explain the process of virtual surgical planning:
Fig 1. Use of Mirror Imaging to create an Ideal Virtual Form post virtual tumor resection
Fig 2. Creating an Ideal Virtual Form for a patient suffering from Neurofibromatosis
Fig 3. Steps for reconstructing a mandible resected for cancer with a free tissue transfer of the fibula
Fig. 4. Series of images demonstrating a large mandible tumor resected and virtually recreated by superimposing a cohort mandible of similar size. The new “ideal virtual form” is used as a template to create cuts in the fibula that are flush at every union and are positioned to replicate the ideal form.
Fig. 5. Complex Hemifacial Microsomia patient plan including double jaw surgery with simultaneous reconstruction of congenitally missing right posterior mandible
If you would like more information about this craniofacial anomaly, please contact the Craniofacial Team of Texas by calling 512-377-1142 or toll free 877-612-7069 to schedule an appointment or complete an online appointment request.