Chad R Gordon1, Ryan J Murphy, Devin Coon, Ehsan Basafa, Yoshito Otake, Mohammed Al Rakan, Erin Rada, Srinivas Susarla, Sriniras Susarla, Edward Swanson, Elliot Fishman, Gabriel Santiago, Gerald Brandacher, Peter Liacouras, Gerald Grant, Mehran Armand. 1. From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore; †The Johns Hopkins Applied Physics Laboratory, Research and Engineering Development Department, Laurel; ‡Engineering Research Center for Computer-Integrated Surgical Systems and Technology, Whiting School of Engineering, Johns Hopkins University, and §Department of Radiology, Johns Hopkins University School of Medicine, Baltimore; and ∥Department of Otolaryngology-Head & Neck Surgery and ¶Naval Postgraduate Dental School, 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland.
Abstract
INTRODUCTION: Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation and other related craniomaxillofacial procedures. METHODS: We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. RESULTS: Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. CONCLUSIONS: The initial development of the CAPE workstation demonstrated that integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution for numerous types of craniofacial and orthognathic surgical procedures.
INTRODUCTION: Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation and other related craniomaxillofacial procedures. METHODS: We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. RESULTS: Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. CONCLUSIONS: The initial development of the CAPE workstation demonstrated that integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution for numerous types of craniofacial and orthognathic surgical procedures.
Authors: Chad R Gordon; Srinivas M Susarla; Zachary S Peacock; Curtis L Cetrulo; James E Zins; Frank Papay; Leonard B Kaban; Michael J Yaremchuk Journal: Plast Reconstr Surg Date: 2011-11 Impact factor: 4.730
Authors: Chad R Gordon; Edward W Swanson; Srinivas M Susarla; Devin Coon; Erin Rada; Mohammed Al Rakan; Gabriel F Santiago; Jaimie T Shores; Steven C Bonawitz; Elliot K Fishman; Ryan Murphy; Mehran Armand; Peter Liacouras; Gerald T Grant; Gerald Brandacher; Wei-Ping Andrew Lee Journal: Ann Plast Surg Date: 2013-10 Impact factor: 1.539
Authors: Bohdan Pomahac; Julian Pribaz; Elof Eriksson; Ericka M Bueno; J Rodrigo Diaz-Siso; Frank J Rybicki; Donald J Annino; Dennis Orgill; Edward J Caterson; Stephanie A Caterson; Matthew J Carty; Yoon S Chun; Christian E Sampson; Jeffrey E Janis; Daniel S Alam; Arturo Saavedra; Joseph A Molnar; Thomas Edrich; Francisco M Marty; Stefan G Tullius Journal: N Engl J Med Date: 2011-12-28 Impact factor: 91.245
Authors: Gabriel F Santiago; Srinivas M Susarla; Mohammed Al Rakan; Devin Coon; Erin M Rada; Karim A Sarhane; Jamie T Shores; Steven C Bonawitz; Damon Cooney; Justin Sacks; Ryan J Murphy; Elliot K Fishman; Gerald Brandacher; W P Andrew Lee; Peter Liacouras; Gerald Grant; Mehran Armand; Chad R Gordon Journal: Plast Reconstr Surg Date: 2014-05 Impact factor: 4.730
Authors: Emile N Brown; Amir H Dorafshar; Branko Bojovic; Michael R Christy; Daniel E Borsuk; T Nicole Kelley; Cynthia K Shaffer; Eduardo D Rodriguez Journal: Plast Reconstr Surg Date: 2012-10 Impact factor: 4.730
Authors: Maria Z Siemionow; Frank Papay; Risal Djohan; Steven Bernard; Chad R Gordon; Daniel Alam; Mark Hendrickson; Robert Lohman; Bijan Eghtesad; John Fung Journal: Plast Reconstr Surg Date: 2010-01 Impact factor: 4.730
Authors: Amir H Dorafshar; Branko Bojovic; Michael R Christy; Daniel E Borsuk; Nicholas T Iliff; Emile N Brown; Cynthia K Shaffer; T Nicole Kelley; Debra L Kukuruga; Rolf N Barth; Stephen T Bartlett; Eduardo D Rodriguez Journal: Plast Reconstr Surg Date: 2013-02 Impact factor: 4.730
Authors: Ryan J Murphy; Chad R Gordon; Ehsan Basafa; Peter Liacouras; Gerald T Grant; Mehran Armand Journal: Int J Comput Assist Radiol Surg Date: 2014-09-18 Impact factor: 2.924
Authors: Mohammed Al-Rakan; Jaimie T Shores; Steve Bonawitz; Gabriel Santiago; Joani M Christensen; Gerald Grant; Ryan J Murphy; Ehsan Basafa; Mehran Armand; Pete Otovic; Sue Eller; Gerald Brandacher; Chad R Gordon Journal: J Craniofac Surg Date: 2014-11 Impact factor: 1.046
Authors: Gerald T Grant; Peter Liacouras; Gabriel F Santiago; Juan R Garcia; Mohammed Al Rakan; Ryan Murphy; Mehran Armand; Chad R Gordon Journal: Ann Plast Surg Date: 2014 Impact factor: 1.539
Authors: Jeremy Ciporen; Brandon P Lucke-Wold; Gustavo Mendez; Anton Chen; Amit Banerjee; Paul T Akins; Ben J Balough Journal: Surg Neurol Int Date: 2016-12-26
Authors: Elie P Ramly; Rami S Kantar; J Rodrigo Diaz-Siso; Allyson R Alfonso; Eduardo D Rodriguez Journal: Plast Reconstr Surg Glob Open Date: 2019-08-19
Authors: Andrée-Anne Roy; Johnny I Efanov; Geneviève Mercier-Couture; André Chollet; Daniel E Borsuk Journal: Plast Reconstr Surg Glob Open Date: 2017-02-03