ABSTRACT Background: Two-dimensional surgical planning does not adequately show the 3D aspect, which is important to assess in the planning of orthognathic surgery (OGS). In the last decade, 3D virtual surgical planning (VSP) has become an advantageous method and may replace conventional planning. Aim: To determine if the experience and implementation of VSP in OGS among professionals in oral and maxillofacial surgery in northern Sweden differs from the literature on the subject. Methods: A questionnaire was created for evaluation of the experience and implementation of VSP and a literature search was conducted through PubMed. Results: Fourteen of 17 respondents answered. Only fifty percent used VSP, even though all respondents were familiar with it. A bigger proportion of respondents would use VSP, but availability and lack of training prevented use. A sample of 33 articles were collected and described 1107 patients undergoing OGS, of which 1083 patients had undergone OGS with incorporation of VSP. Sixty-eight percent underwent bimaxillary surgery, 17 % maxillary surgery and 15 % mandibular surgery. Additionally, 169 patients were treated with genioplasty as well. Conclusion: The experience and implementation of VSP in northern Sweden are both in accordance and discordance with the literature. VSP has the advantage of accurate hard tissue prediction, but the literature describes the need of improvement concerning soft tissue imaging and postoperative assessment in VSP. More studies evaluating the accuracy and reliability of VSP software are needed. Disadvantages of VSP need to be resolved before VSP can replace conventional planning.

No description available.

- / We extend the theory for a novel approach for solving Elliptic Partial Differential Equations.

Highly comminuted intra-articular fractures are complex and difficult injuries to treat. Once emergent care is rendered, the definitive treatment objective is to restore the original anatomy while minimizing surgically induced trauma. Operations that use limited or percutaneous approaches help preserve tissue vitality, but reduced visibility makes reconstruction more difficult. A pre-operative plan of how comminuted fragments would best be re-positioned to restore anatomy helps in executing a successful reduction. The objective of this work was to create new virtual fracture reconstruction technologies that would deliver that information for a clinical series of severe intra-articular fractures. As a step toward clinical application, algorithmic development benefits from the availability of more precise and controlled data. Therefore, this work first developed 3D puzzle solving methods in a surrogate platform not confounded by various in vivo complexities. Typical tibial plafond fracture fragmentation/dispersal patterns were generated with five identical replicas of human distal tibia anatomy that were machined from blocks of high-density polyetherurethane foam (bone fragmentation surrogate). Replicas were fractured using an instrumented drop tower and pre- and post-fracture geometries were obtained using laser scans and CT. A semi-automatic virtual reconstruction computer program aligned fragment native surfaces to a pre-fracture template. After effective reconstruction algorithms were created for the surrogate tibias, the next aim was to develop new algorithms that would accommodate confounding biologic factors and puzzle solve clinical fracture cases. First, a novel image analysis technique was developed to segment bone geometries from pre- and post-surgical reduction CT scans using a modified 3D watershed segmentation algorithm. Next, 3D puzzle solving algorithms were advanced to obtain fracture reconstructions in a series of highly comminuted tibial plafond fracture cases. Each tibia was methodically reconstructed by matching fragment native (periosteal and articular) surfaces to an intact template that was created from a mirror image of the healthy contralateral limb. Virtual reconstructions obtained for ten tibial plafond fracture cases had average alignment errors of 0.39±0.5 mm. These novel 3D puzzle solving methods are a significant advancement toward improving treatment by providing a powerful new tool for planning the surgical reconstruction of comminuted articular fractures.

Orientador: Helder Anibal Hermini / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia mecanica / Made available in DSpace on 2018-08-04T09:58:51Z (GMT). No. of bitstreams: 1 Prado_ValmirRodriguesdo_M.pdf: 6943002 bytes, checksum: 3bd8d644a1b48c49ee23443a9b756276 (MD5) Previous issue date: 2005 / Resumo: A prtotipagem Rápida possibita a produção de modelos físicos de peças, produtos ou ferramentas a partir de modelos ou componentes já existentes. Existem várias técnicas de prototipagem disponíveis, como estereolitografica, a sinterização seletiva a laser, e a impressão 3D, cada uma formando objetos pela deposição de material em camadas sucessivas. A principal aplicação dessa técnica ocorre na industria, com a criação ou duplicação de produtos. Outras áreas, como arte, educação, paleontologia e a medicina na confecção de moldes para implante ou no planejamento cirúrgico, utilizando-se modelos de prototipagem da anatomia produzidos a partir de dados obtidos em exames de imagem, como a tomográfica computadorizada ou a ressonância nuclear magnética. O objetivo deste estudo é descrever as principais aplicações da prototipagem rápida em medicina, com a elucidação de casos clínicos onde o processo foi usado. A prdução de um modelo físico 3D com essa técnica tem sido útil na condução de casos complexos, quando os exames de imagem convencionais são duvidosos ou a formação de uma imagem mental é difícil de se fazer. Esse método também tem contribuído para a redução do tempo cirúrgico, risco de infecção e melhora do resultado estético final / Abstract: Rapid Prototyping enable the production of physical bolt models, products or tools from existing ones. There are several prototyping techniques available like Sthereolithography Selective Laser Sintering and 3D Printing, each of them forming objects by material decomposition layer by layer. The major application of this technique is in industry, with the creation or duplication of new products. Other areas, like art, education, paleontology and medicine also start using this technology. The technique has been used in medicine in the manufacturing of implant molds or in the surgical planning, using prototyping anatomy models produced with acquired data from image exams, like computerized tomography or magnetic resonance. The goal of this study is to describe the major applications of Rapid Prototyping in medicine, with the elucidation of clinical cases where the process were used. The production of a physical 3D model with this technique has been useful in the condition of complex cases, when the conventional image exams are doubtful, or the formation of a mental image is difficult to do. This method also has been contributing for the surgical time reduction, lower infection risk end better final aesthetic result / Mestrado / Projeto Mecanico / Mestre em Engenharia Mecânica

Orientador: Cecilia Amelia de Carvalho Zavaglia / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecanica / Made available in DSpace on 2018-08-14T11:41:37Z (GMT). No. of bitstreams: 1 Gouveia_MariadeFatimade_D.pdf: 10651170 bytes, checksum: 76437c6b2c0b158b3dab94e80c7111e7 (MD5) Previous issue date: 2009 / Resumo: A utilização da tecnologia de Prototipagem Rápida (PR) na área médica tem se expandindo a cada dia. Os modelos médicos, ou os chamados biomodelos, utilizados para planejamento cirúrgico são confeccionados por processos de PR, a partir do processamento de imagens médicas de Tomografia Computadorizada. Ao cirurgião esta técnica permite o manuseio de modelos da parte anatômica do paciente, antes da execução do correspondente procedimento cirúrgico de reconstrução. A tecnologia de PR associada à biomodelagem tem se revelado uma ferramenta excepcional para: o planejamento cirúrgico, a confecção de próteses personalizadas e a execução da cirurgia, levando a melhores resultados funcionais e estéticos, bem como a uma diminuição de riscos e custos envolvidos neste processo. Este trabalho foi desenvolvido dentro do Projeto Promed - Prototipagem Rápida na Medicina, no Centro de Tecnologia da Informação Renato Archer - CTI, que atendeu, entre janeiro de 2000 e setembro de 2008, um total de 982 pacientes com necessidade de cirurgias de reconstrução. Este trabalho apresenta um levantamento de dados sobre estes pacientes, classificando-os quanto a: gênero, faixa etária, procedência, regiões anatômicas reproduzidas e aplicações dos biomodelos confeccionados. Os resultados da análise deste levantamento indicaram que 98% dos casos atendidos foram referentes às reconstruções craniofaciais, sendo que 86% destes apresentavam diretamente lesões em um ou mais terços da face. Os biomodelos foram utilizados principalmente em reconstruções de reabilitação bucomaxilar (32%), neoplasias e displasias (18%), fraturas por trauma (13%) e desarmonias faciais (9%). A integração entre biomateriais e PR é examinada no contexto deste estudo, mostrando possibilidades de utilização da PR na confecção direta e indireta de próteses personalizadas, na obtenção de scaffolds para reconstrução anatômica e na engenharia tecidual. Exemplos de planejamento cirúrgico realizado com o auxílio de biomodelos foram incluídos no texto, a título de elucidar os métodos de aplicação desta técnica. / Abstract: The use of Rapid Prototyping (RP) technology in medicine has been expanding every day. The medical models, or so-called biomodels, used for surgical planning, are made by PR processes, based on computed tomography medical image processing. This technique allows the surgeon to handle anatomical models of the patient, before running the reconstruction surgery. The RP technology associated with biomodelling has proved to be an exceptional tool for: surgical planning, customized prostheses manufacturing and surgery accomplishment, leading to better functional and aesthetic results, as well as, a reduction of risks and costs involved in this process. This work was developed within Promed Project - Rapid Prototyping in Medicine, at Center for Information Technology Renato Archer - CTI, who attended, between January 2000 and September 2008, a total of 982 patients in need of surgical reconstruction. This work presents a data survey on these patients, classifying them by: gender, age, origin, anatomical regions and biomodel applications. The results of this survey indicated that 98% of cases referred to craniofacial reconstructions, with 86% of these injuries covering one or more thirds of the face. Biomodels were mainly used in reconstructions of bucomaxilar rehabilitation (32%), neoplasias and dysplasias (18%), trauma fractures (13%) and facial disharmonies (9%). The integration of biomaterials and RP is examined in the context of this study, showing possibilities for the use of RP in the direct and indirect construction of customized prostheses, in obtaining scaffolds for anatomical reconstruction and tissue engineering. Examples of surgical planning with the aid of biomodels were included in the text, for elucidating the method of application of this technique. / Doutorado / Materiais e Processos de Fabricação / Doutor em Engenharia Mecânica

Osteoid osteomas are common, painful, osteoblast tumors that frequently present in adolescents and young adults. Surgical management is indicated for cases with associated symptoms, such as headaches, dizziness, diplopia, proptosis, sinusitis, and facial deformity. The authors report a case of a 15-year-old male with an enlarging frontal sinus osteoma. Virtual surgical planning was utilized to design a KLS Martin Resorbable plate for the graft site, as well as a cutting guide for the graft procedure. A split-calvarial bone graft was used to reconstruct the central bony defect in the anterior table of the frontal sinus. Virtual surgical planning sessions were initiated with KLS Martin biomedical engineers to design a graft. Design cutting guides were created for frontal craniotomy, and an interlocking cutting guide was created for the split calvarial bone graft. The graft was harvested from the non-dominant right parietal hemisphere to best match the curvature of the frontal bone. Post-operatively, the patient has not had any complications to date. This procedure proves to be a valuable consideration for the surgical treatment of pediatric osteomas.

No description available.

Objetivo: Validar a proposta de cálculo do volume de seios maxilares, utilizando-se de imagens trans-axiais geradas por meio de tomografia computadorizada por feixe cônico, analisando as mesmas em software para edição de imagens, e comparando os volumes aferidos, com os obtidos por meio de molde dos seios maxilares com silicone de condensação fluido. Métodos: Foram utilizados 05 crânios secos com osteotomia axial, pertencentes ao acervo do Laboratório de Anatomia da Universidade Cidade de São Paulo, de modo que se pudesse observar os seios maxilares em vista superior, totalizando 6 sítios. Os sítios foram moldados com silicone de condensação flúido por meio da injeção do mesmo com uma seringa para elastômero, e modelos dos seios maxilares foram confeccionados por meio da imersão dos moldes de silicone em gesso. Os modelos de gesso foram hidratados e preenchidos com água até que se atingisse a altura de 10mm e esse volume de água foi removido por meio de uma pipeta graduada na qual pôde-se fazer a leitura do volume. A amostra foi então submetida a tomografia computadorizada por feixe cônico, para posterior reformatação em cortes trans-axiais, que foram analisados no software Photoshop CS3 Extended® e o cálculo do volume foi feito com auxílio do software Excel®. Resultados: Os dados obtidos pelos dois métodos foram comparados estatisticamente por meio de gráficos de perfis individuais, diagrama de dispersão (Bussab e Morettin), coeficiente de correlação intraclasse (Fleiss) e gráfico de Bland-Altman. Após análise dos métodos estatísticos se observou reprodutibilidade de ambos os métodos e forte correlação entre os mesmos. Conclusão: Os cortes trans-axiais da maxila, obtidos por meio da tomografia computadorizada por feixe cônico, podem ser utilizados para cálculo dos volumes de seios maxilares, quando da análise dos mesmos em software Photoshop CS3 Extended®, fornecendo valores de volume próximos e estatisticamente compatíveis aos obtidos por meio do molde dos seios maxilares com silicone de condensação (padrão ouro), de maneira sistematizada e de fácil reprodução. / Purpose: To validate the proposal for measurement of maxillary sinus volume, using cross-sectional images generated by cone beam computed tomography, which were analyzed with an image editor software, and comparing the estimated volumes with those obtained through impression with fluid condensation silicone. Methods: Five dry skulls axially osteotomized, from the São Paulo University City Anatomy Laboratory, were used to allow an upper view of the maxillary sinuses, totaling 6 sites. The sites were molded com fluid condensation silicone injected with an elastomer syringe, and maxillary sinus models were produced by immersing the silicone mold into plaster. The plaster casts were hydrated and fulfilled with water reaching 10 mm height, which was removed with a graduated pipette to determine the water volume. The sample underwent cone beam computed tomography and the images were reformatted to produce cross-sectional views, which were analyzed with Photoshop CS3 Extended®, and the volume was calculated using Excel®. Results: Data obtained by both methods were statistically compared based on individual profile graphic, dispersion diagram (Bussab and Morettin), intraclass correlation coefficient (Fleiss) and Bland-Altman plot. After being analyzed, the two statistical methods showed reproducibility and strong correlation. Conclusion: Cross-sectional views generated by cone beam computed tomography and analyzed with Photoshop CS3 Extended® are useful to calculate the maxillary sinus volume, in order to help in planning the maxillary sinus floor elevation surgery.

Objetivo: Validar a proposta de cálculo do volume de seios maxilares, utilizando-se de imagens trans-axiais geradas por meio de tomografia computadorizada por feixe cônico, analisando as mesmas em software para edição de imagens, e comparando os volumes aferidos, com os obtidos por meio de molde dos seios maxilares com silicone de condensação fluido. Métodos: Foram utilizados 05 crânios secos com osteotomia axial, pertencentes ao acervo do Laboratório de Anatomia da Universidade Cidade de São Paulo, de modo que se pudesse observar os seios maxilares em vista superior, totalizando 6 sítios. Os sítios foram moldados com silicone de condensação flúido por meio da injeção do mesmo com uma seringa para elastômero, e modelos dos seios maxilares foram confeccionados por meio da imersão dos moldes de silicone em gesso. Os modelos de gesso foram hidratados e preenchidos com água até que se atingisse a altura de 10mm e esse volume de água foi removido por meio de uma pipeta graduada na qual pôde-se fazer a leitura do volume. A amostra foi então submetida a tomografia computadorizada por feixe cônico, para posterior reformatação em cortes trans-axiais, que foram analisados no software Photoshop CS3 Extended® e o cálculo do volume foi feito com auxílio do software Excel®. Resultados: Os dados obtidos pelos dois métodos foram comparados estatisticamente por meio de gráficos de perfis individuais, diagrama de dispersão (Bussab e Morettin), coeficiente de correlação intraclasse (Fleiss) e gráfico de Bland-Altman. Após análise dos métodos estatísticos se observou reprodutibilidade de ambos os métodos e forte correlação entre os mesmos. Conclusão: Os cortes trans-axiais da maxila, obtidos por meio da tomografia computadorizada por feixe cônico, podem ser utilizados para cálculo dos volumes de seios maxilares, quando da análise dos mesmos em software Photoshop CS3 Extended®, fornecendo valores de volume próximos e estatisticamente compatíveis aos obtidos por meio do molde dos seios maxilares com silicone de condensação (padrão ouro), de maneira sistematizada e de fácil reprodução. / Purpose: To validate the proposal for measurement of maxillary sinus volume, using cross-sectional images generated by cone beam computed tomography, which were analyzed with an image editor software, and comparing the estimated volumes with those obtained through impression with fluid condensation silicone. Methods: Five dry skulls axially osteotomized, from the São Paulo University City Anatomy Laboratory, were used to allow an upper view of the maxillary sinuses, totaling 6 sites. The sites were molded com fluid condensation silicone injected with an elastomer syringe, and maxillary sinus models were produced by immersing the silicone mold into plaster. The plaster casts were hydrated and fulfilled with water reaching 10 mm height, which was removed with a graduated pipette to determine the water volume. The sample underwent cone beam computed tomography and the images were reformatted to produce cross-sectional views, which were analyzed with Photoshop CS3 Extended®, and the volume was calculated using Excel®. Results: Data obtained by both methods were statistically compared based on individual profile graphic, dispersion diagram (Bussab and Morettin), intraclass correlation coefficient (Fleiss) and Bland-Altman plot. After being analyzed, the two statistical methods showed reproducibility and strong correlation. Conclusion: Cross-sectional views generated by cone beam computed tomography and analyzed with Photoshop CS3 Extended® are useful to calculate the maxillary sinus volume, in order to help in planning the maxillary sinus floor elevation surgery.