March 16, 2011

The head bone's connected to the...leg bone?  While that's not exactly how the children's song "Dem Bones" goes, surgeons at CAMC are repairing "head bones" with leg bones - as in reconstructing a patient's jaw from part of their own leg bone after a severe head injury.

While this kind of surgery isn't new at CAMC, what is new is how surgeons are doing it: using 3D virtual planning technology, which makes delicate craniomaxillofacial surgery (of the head, neck, face and jaws) faster and more accurate.

 "The more precise you can be when repairing damaged facial bones, teeth, soft tissue and skin, the better the outcome," said David Wise, MD, DDS, an oral and maxillofacial surgeon with CAMC Physicians Group - Facial Surgery at General Hospital.  "Planning facial reconstruction in a computer environment allows us to more accurately predict complex bony movements, repositioning and blood flow before we ever make the first incision."

Neurosurgeons at CAMC have used virtual surgical planning for brain surgeries for many years using the BrainLab navigation system.  It proved to be such a valuable tool that the hospital recently added software to expand BrainLab's capabilities to include craniomaxillofacial applications.

"BrainLab technology allows us to check and confirm positioning of bones and hardware with pinpoint accuracy," Dr. Wise said.  "It's particularly helpful with trauma patients because it allows us to virtually duplicate the 'good' or unaffected side of a person's head to the injured or deformed side."

Craniofacial surgeries are complex because the skull contains irregular bones that could impact delicate brain and head structures when reshaped or moved.  Computed tomography (CT) scans are imported directly into computer systems to create 3D models that show all the bones in a patient's face and skull that could be affected in surgery. Surgeons can ask "What if?" and explore multiple options instantly for correcting facial injuries or defects from the convenience of their computers well ahead of surgery.  And when surgical guides are needed to allow proper instrument positioning, they can be designed digitally - more quickly and precisely.

"We send our virtual plan to a medical device manufacturer to make models of a patient's skull and special surgical templates like cutting guides, which are essentially patterns for where to make bone cuts and how to reposition bones," Dr. Wise said.  "Then we transfer the virtual plan to surgery using the custom plan that perfectly matches each patient's measurements."

"This technology allows us to be more efficient by saving time and potentially alleviating complications (injuring the blood supply) of shaping a bone flap," said Jason Prigozen, MD, a plastic surgeon with CAMC Physicians Group - Plastic Surgery.  "We can know the exact shape and dimensions of a defect that the flap needs to fit and are thus able to shape it while it is still attached in the leg.  This means two teams of surgeons can work at the same time to speed the patient's reconstruction."

Patients who could benefit from the new virtual surgical planning application range from those involved in accidents to children born with craniofacial malformities, such as cleft lip and palate.

"We are continually striving for ways to improve patient care," said Mike Williams, vice president/administrator of CAMC General Hospital.  "This technology will enable physicians to work more effectively in planning better outcomes."


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