Facial rejuvenation, aesthetic surgery and sculpturing

406 Pages·2012·10.02 MB·English

by  Duke Nukem

k
o

o

bb

tt
cc
aa
a bstr act book rr
cover
tt
ss
bb
aa
xxi Congress of the
European Association for
Cranio–Maxillo–Facial
Surgery
11 − 15 September 2012
Dubrovnik, Croatia
A tribute to John Lowry
1
[email protected]
Foreword

Dear friends and colleagues,

It is a great honour for me to have been elected the President and given the chance to
host the 21st Congress of the EACMFS in Dubrovnik, Croatia. We have done our best to
offer a great scientific and clinical conference, but also to give you the chance to get to
know Croatia.

The scientific programme has 24 masterclasses, 8 keynote lectures, 10 symposia of
guest societies, 6 panels as well as over 400 free papers and 500 poster presentations.

The times have changed and it became more usual to have the abstracts in the digital
form and to refrain from a classic printed edition. The abstracts are published as a pdf
document and can be downloaded from the congress site as well as the EACMFS site
www.eurofaces.com.

This book comprises abstracts of all the free papers to be presented during the Con-
gress. This covers the individual oral presentations and the posters as well. The abstract
book has been arranged in such a way that you should be able to follow individual ses-
sions quite easily since the abstracts have been grouped accordingly. In addition to the
abstracts, complete poster presentations can be viewed online. Just follow the link at
www.eacmfs2012.com

I would like to thank the Scientific Committee for reviewing the abstracts in a very short
time. Authors were notified that their abstract will be included as sent without language
corrections. However with the help of Peter Ramsey-Baggs, some important corrections
were made.

On behalf of the Organizing Committee we trust that you will leave Dubrovnik with fond
memories of your stay in Croatia. At the same time we I hope that in addition to the aca-
demic pursuits, new friendships will have been formed and new liaisons created.

Welcome to Dubrovnik.

Mišo Virag, MD, PhD, FRCS
President EACMFS 2010-2012
Committees

President EACMFS 2010-2012
XXI EACMFS Congress President
Mišo Virag , Croatia EACMFS Executive Committee

President
Mišo Virag, Croatia
Immediate Past President
Maurice Mommaerts, Belgium
EACMFS organizing committee Senior President Elect
Daniel Hrusak, Czech Republic
Naranđa Aljinović Ratković, Croatia President Elect
Josip Bill, Germany Ian Martin, United Kingdom
Emil Dediol, Croatia Treasurer
Andrej Kansky, Slovenia Joachim Obwegeser, Switzerland
Predrag Knežević, Croatia Editor in Chief
Dinko Leović, Croatia Jörg Wiltfang, Germany
Ivica Lukšić, Croatia Secretary General
Darko Macan, Croatia Henri Thuau, United Kingdom
Aleksandar Milenović, Croatia Assistant Secretary
Željko Orihovac, Croatia Nick Kalavrezos, United Kingdom
Riccardo Tieghi, Italy Training & Education Officer
Vedran Uglešić, Croatia Julio Acero, Spain
Media Development Officer
Hans-Peter Howaldt, Germany
Scientific Committe Executive Adviser
Karsten Gundlach, Germany
Naranđa Aljinović Ratković, Croatia Executive Adviser
Nataša Ihan Hren, Slovenia Carlos Navarro-Vila, Spain
Predrag Knežević, Croatia Executive Support – Secretariat Adminis-
Vitomir Konstantinović, Serbia trator
Ivica Lukšić, Croatia Jill McFarland, United Kingdom
Darko Macan, Croatia
Peter Ramsay-Baggs, UK
Manlio Galiè, Italy
EACMFS Secretariat
Mrs. Jill McFarland
Abstract Book Editorial Board PO Box 85
Midhurst West Sussex
Mišo Virag , Croatia GU29 9WS United Kingdom
Peter Ramsay-Baggs, UK Phone: [phone]
Naranđa Aljinović Ratković, Croatia Fax: [phone]
Email: [email protected]
ORAL PRESENTATIONS

3. Assess the type and incidence of post- operative com-
plications.
Session 1. FACIAL REJUVENATION, 4. Quantify the Length of Hospital Stay (LOS).
AESTHETIC SURGERY AND Methods: A retrospective analysis was conducted on all
SCULPTURING Endoscopic Brow lift case notes looking at complications,
LOS and referral base. Patient satisfaction rates were
assessed using a qualitative self-report questionnaire
utilising a modification of the Facial Clinimetric Evalua-
O-0101 tion Scale (FaCE) scoring system.
MODERN CULTURAL PERCEPTIONS OF BEAUTY;
Results : Unilateral or bilateral endoscopic brow lift was
RACIAL PRESERVATION OR TRANSFORMATION? A
performed on 36 patients (Male : Female 1:2, Age range:
LITERATURE REVIEW
31-74 years) over a 2-year period (2008-2010). Some
Atheer Ujam1, *, Navin Vig1 patients had synchronous additional facial procedures
1The Hillingdon Hospital, UK which included blepharoplasty, face lift or a combination
of both.There was a 5% relapse rate and post- operative
It is widely accepted that there are established standards
complication rate included temporary Temporal Branch
for the ideal facial proportions regardless of racial back-
nerve injury and forehead paresthesias. The average LOS
ground. However, changing population demographics of
was 3 days (Range 1-8). Interestingly our referral base was
the UK require that the facial surgeon must have a robust
from Plastic Surgery(40%), Ophthalmology (10%), Neu-
understanding and appreciation of the needs of patients
rosurgery (32%) and others (GP, OMFS 18%). The modi-
seeking cosmetic surgery. In a multicultural society, pa-
fied FaCE survey demonstrated improved visual fields and
tients have different perceptions of beauty and will seek
social behaviour score.
facial surgery to correct perceived abnormalities.
Conclusion : This study demonstrates that Endoscopic
Historically, it appears that racial transformation - a desire
Brow Lift is well tolerated by the patient, having minimal
to change one‘s natural appearance to that of the predomi-
complications. It has also been shown to improve quality
nant culture - was the overwhelming philosophy adopted
of life. We believe that this procedure has a position in the
by patients and surgeons. However, it appears now that
management of Post-traumatic and Post-Ablative surgery
there is a shift towards racial preservation of facial identi-
facial paralysis and in the aging face with functional defi-
ty. These behaviours may be diverse and particular to a
cit.
culture at a specific period of time. What is important is
that the outcome of any surgery is satisfactory to the pa-
tient.
O-0103
We undertook a literature review to identify current racial
SECURING THE BROW USING ENDOTINE®
behaviour with regards to seeking facial cosmetic surgery
and furthermore, what aspects of facial beauty are univer- Geert Van Hemelen1, *, Nasser Nadjmi1, Joël Defrancq1,
sal to all races. By understanding the differences and Lieven Renier1, Bruno Vanassche1, Jan Van de Perre1,
similarities of cultural aesthetic taste, the facial surgeon Herman Vercruysse1
will be better equipped to provide successful surgery. 1Department of Cranio-Maxillofacial Surgery - AZ MONICA
ANTWERP, Belgium
Endoscopic release of the forehead is widely accepted as a
O-0102 well tolerated technique to lift the brow. The different
ENDOSCOPIC BROW LIFT FOR FACIAL fixations methods though differ from bandaging to exter-
REANIMATION. OUR EXPERIENCE. nal screw fixation.
Thomas Barry1, *, Austen Smith1, Aidan Fitzgerald1, Afshin We retrospectively examined 17 patients ( all F) about
Yousefpour1 pain, hair loss, sensitivity of the fore head up to one year
1Sheffield Teaching Hospitals, UK postoperatively.We noted no infection, some tenderness
was present for the first 3 months. One patient noted itch-
Introduction: Traditionally, the correction of brow ptosis
ing sensation in the hair line. Two patients suffered tempo-
resulted in facial and scalp scaring and morbidity. Mini-
rary hair loss (1 cm2).
mally invasive approaches have reduced such problems.
Endoscopic Brow Lift is an established procedure in the Discussion: There are different techniques to anchor the
management of brow ptosis in the aging face and in facial brow and variable success rate is shown. We feel that this
palsy.. We present our experience with this procedure. resorbable device can offer a dual benefit. It fixes well and
Aims disappears in time. The initially used Endotine® plates are
1. Evaluate our referral base. now reduced in size (Triple™). Since the use of these very
2. Qualify patient satisfaction. tiny plates the sensation in the hairline is hardly present.
3
XXI. Congress EACMFS, Abstracts - Oral presentations Facial rejuvenation, aesthetic surgery and sculpturing
Conclusion: Endotine Triple™ is accepted as a reliable the nasojugal groove. It allows the cosmetic surgeon to
and well tolerated anchoring system in endoscopic improve the relative abundance of fat tissue in the lower
browlifting procedure. Minimal morbidity in a transient lid, avoiding the incision over the skin and the muscle and
zone of two months postoperative recovery can be ex- therefore, without modifying the lower lid position that
pected. gives the patient and unnatural appearance. Minimal exci-
sion combined with resuspension of the fat pad to fill the
nasojugal groove, improves the aesthetic results achieving
a more natural and youthful appearance. In those cases
O-0104
with lower lid skin redundancy, a skin excision without
FOREHEAD CONTOURING
AND BROW BOSSING
involving the muscle could be performed.
RESHAPING OF OLD MALUNITED FRACTURES IN
TWO CASES. Materials and methods: We present our experience with
the transconjunctival SOOF pad lift blepharoplasty ap-
Hisham Fattah1, *
proach over the last two years. A revision of the benefits
1National Cancer Institute, Cairo University, Egypt
of this procedure, compared with the classic blepharoplas-
Fractures of the frontal bone pose certain treatment di- ty techniques is done detailing surgical tips and pitfalls.
lemmas for the facial trauma surgeon. Their mismanage-
Results: The application of this surgical approach results
ment may lead to potentially life-threatening intracranial
in a less traumatic injury reducing the morbidity and the
complications.
recovery time. Without modifying the orbicularis position,
This study reviewed two male patients referred to the less ectropion and scleral show is achieved with a more
department of oral and maxillofacial surgery at the Na- natural effect. The results in all cases were excellent with
tional Cancer Institute, Cairo University on 2007 with a no complications during the follow-up.
large painless swelling in the forehead and eyebrows area
Conclusions: More than a decade after it was first de-
on the left side covered by normal skin. Their ages were
scribed, the transconjunctival SOOF pad lift blepharoplas-
12 and 28 years.
ty remains as a reliable procedure with optimal aesthetic
Clinical examination revealed a large mass in the forehead and functional results in the correct selected patients.
and eyebrows region of the face. The swellings were hard,
painless to palpation and covered by normal skin. The
swelling gradually increased over the years to the present O-0106
size. Patients past medical history were not significant
AESTHETIC IMPROVEMENT OF THE FLAT
except history of past automobile accidents. They were
FOREHEAD USING METHYL METHACRYLATE
admitted to the hospital for treatment of a cerebral contu-
sion or cerebral haematoma associated with facial fracture. Yong Tai Song1, *
In both patients priority was given to the treatment of 1Jawgak Plastic Surgery Clinic, Republic of Korea
cerebral contusion and its complications neglecting the
Purpose: There is a tendency to aspire to protruding, more
facial fractures. Photos were taken at different stages of
rounded foreheads in Asians with flat ones. For the pur-
treatment.
pose of augmenting these planar foreheads, various meth-
A three-dimensional computed tomogram revealed a well- ods using alloplastic implants have been reported. The
demarcated intracortical lesion. Symmetry and facial author presents a relatively simple and easy procedure of
projection and height must be re-established with harmo- correcting the forehead by inserting methyl methacrylate
nious alignment. Cranioplasty of the frontal region was which has been proven to be one of the safest and most
carried out. Masses in the scalp and skull are not always effective materials.
neoplastic. The management of cranio-maxillary fractures
Materials & Methods: From July of 2006 to March of
takes considerable time and thought. Skilful and experi-
2012, 180 patients underwent forehead augmentation with
enced personnel are mandatory, as is collaboration by the
methyl methacrylate. There were 42 male patients (23%)
anesthesiologist, maxillofacial surgeon, ENT specialist or
and 138 female patients (77%) whose ages ranged from 20
general surgeon, in order to have an outcome with mini-
to 65 years, with a mean of 33 years. The procedure was
mal risks and maximal success.
performed under local anaesthesia. A 5-6 cm-long incision
However we have also come to realize that each fracture was made in the scalp behind the hairline. Subperiosteal
must be assessed on an individual basis. dissection was done into parts of the frontal bone above
the supraorbital ridges. To make the methyl methacrylate
putty, methyl methacrylate copolymer powder and liquid
monomer are mixed thoroughly until saturation. After two
O-0105
to five minutes, the methyl methacrylate develops a
TRANSCONJUNCTIVAL SOOF PAD LIFT
doughy consistency. When a doughy consistency was
BLEPHAROPLASTY
achieved, the methyl methacrylate was inserted into the
Miguel Burgueño Garcìa1, *, Jorge Guiñales Dìaz de desired location of the forehead through the incision. The
Cevallos1 soft methyl methacrylate putty was molded into the de-
1University Hospital La Paz,Spain sired shape, manually with the aid of wet gauze, through
the skin, until it hardened. The amount of methyl methac-
Introduction: The term transconjunctival sub–orbicularis
rylate used ranged from 10 to 40 g, with a mean of 25 g,
oculi fat (SOOF) pad lift blepharoplasty was first intro-
and varied according to the degree of flatness of the fore-
duced by Sean Freeman in 2000 as a new approach to
head. The scalp incision was closed in layers with absorb-
perform a lower lid blepharoplasty in a plane between the
able sutures and surgical staples.
septum and the orbicularis muscle. This procedure is
principally indicated in those patients with depression on Results: The average follow-up period was 18 months.
4
XXI. Congress EACMFS, Abstracts - Oral presentations Facial rejuvenation, aesthetic surgery and sculpturing
Comparative imaging analysis was conducted using pho- Summary: The authors overview the application of struc-
tographs before and after the procedure. The aesthetic tural fat grafting in the management of volumetric deficit
appearances of all patients were much improved and no in the cranio-orbito-facial area.
major complications occurred.
Introduction: Autologous transplantation of fat tissue is
Conclusion: The author has used methyl methacrylate for not a new technique. Structural fat grafting was introduced
cosmetic correction of the flat forehead and believes that as a way to improve facial aesthetics, and in recent years
the method of forehead augmentation using methyl meth- has evolved into applications in cranio-orbito-facial recon-
acrylate is a highly safe and effective surgical method. structions.
Methods: The fat is aspirated using very thin liposuction
cannulas attached to a 10 cc syringe. The fat must be
O-0107 gently woven in several layers to pick up a blood supply,
DECISION MAKING IN FACIAL WASTING allowing the fat cells to survive and maintain the filamen-
REHABILITATION tous architecture. The fat is slowly absorbed by the body,
Raffaele Rauso1, *, Gianpaolo Tartaro1 although the amount of reabsorption is sometimes unpre-
dictable; however, this percentage varies from patient to
1Second University of Naples, Italy
patient. If a significant amount of fat is reabsorbed, a
Introduction: The development of effective antiretroviral second or third procedure may be considered to improve
therapies for the treatment of human immunodeficiency the final result. In fact, using more fat tissue in a single-
virus (HIV) has drastically changed management for step corrective procedure can cause poor vascularization
infected patients, with treatment approaches now similar and more resorption, particularly in areas covered by a
to those of chronic disease rather than fatal illness. As thin layer of soft tissue, such as the maxillofacial area.
rates of opportunistic infections and other conditions
Results: The primary indications for structural fat grafting
associated with immunodeficiency are minimized, patients
to the cranio-orbito & maxillofacial area are for restoration
are able to live longer, more fulfilling lives. However,
and rejuvenation of different facial defects. Recent appli-
these therapies are not without side effects, some of which
cations include the correction of localized tissue atrophy,
can be quite debilitating. A medication-associated condi-
loss of substance due to trauma, post tumour, and congeni-
tion that has become prevalent among HIV-infected pa-
tal complex orbito craniofacial deformities, burns and
tients is HIV-associated lipodystrophy. The physical fea-
hemifacial atrophy such as Romberg syndrome and scle-
tures of the condition, especially facial lipoatrophy, also
roderma.
known as facial wasting, can have a significant psycholog-
ical impact on affected patients, both in serving as a visi- Conclusion: Fat grafting can be an excellent means for
ble reminder of the disease and in association with the facial recontouring. Recent studies have proved that hu-
social stigma of HIV infection. man adipose tissue represents a rich source of mesenchy-
mal stem cells. The Authors overview some indications
Material and Methods :Between July 2007 and January
for volumetric soft tissue restoration in the cranio-orbito-
2012, 89 patients (52M, 37F) affected by facial wasting
facial area.
where treated at the Head & Neck Dept., II Univ. of Na-
ples, with structural fat graft, permanent and semi-
permanent dermal fillers. Pre and post operative photos
were taken to compare the results during the follow up. O-0109
THE AUTOLOGOUS FAT GRAFT FOR THE
Results :A high degree of satisfaction was reached in all
TREATMENT OF LOWER LIP INCOMPETENCE
the cases, no major complications were registered.
Jordi Rodrìguez Flores1, *, Cecilia Mazzara Bou1, Óscar
Conclusion: Because of the decrease in morbidity and González Sarrión1, Esther Montané Sala1, José Javier
mortality associated with HIV infection, an increasing Bara Casaus1
number of people with HIV receiving highly active an-
1Hospital Universitari Capio Sagrat Cor, Spain
tiretroviral therapy are presenting to facial plastic surgeons
requesting the improvement of the side effects of their Aim : Autologous fat grafting is a common procedure in
treatment protocol. maxillofacial reconstructive surgery widely used to fill up
the soft tissue defects. The purpose of this presentation is
Authors presents their experience in facial wasting reha-
to show a method to improve oral competence and cos-
bilitation and discuss about the decision making process
metic appearance by autologous fat grafting.
between structural fat graft, permanent and semi-
permanent dermal fillers. Material and methods: Two patients who undergone lower
lip cancer ablation and complicated genioplasty resulting
in oral incontinence were treated with a structural and
intramuscular fat grafting technique in order to enhance
O-0108
vertical dimension of the chin and lower lip competence.
STRUCTURAL FAT GRAFTING OF THE CRANIO
ORBITO FACIAL AREA. VOLUMETRIC & MORPHO- Results: The autologous fat graft in the lower perioral
AESTHETIC IMPLICATIONS region presented a resorption of 50% 6 months after the
Riccardo Tieghi1, *, Luigi C. Clauser1 procedure. An improvement of the oral continence and
good contour was achieved in both patients.
1Unit of Cranio Maxillo Facial Surgery, S. Anna Hospital &
University- Ferrara, Italy Conclusions: The autologous fat grafting technique is
useful for the revision of lower lip incompetence. The
Key words: Lipostructure,fat grafting, regenerative medi-
dynamicity of the oral region and the postsurgical fibrosis
cine, stem cells, facial reconstruction
decrease the maintenance of the transplanted fatty tissue.
5
XXI. Congress EACMFS, Abstracts - Oral presentations Facial rejuvenation, aesthetic surgery and sculpturing
O-0110 Out of 152 - 127 were performed by means of piezoelec-
RECONTOURING OF THE AGED FACE tric saw. 86 osteotomies were limited to the frontal interfo-
raminal area
Nasser Nadjmi1, *
1Craniofacial Association Antwerp, Belgium 46 osteotomies involved the entire lower border of the
mandible and were performed with the piezo equipment.
The evaluation of the aging process of the face is complex
Plating, compression screws and lines were employed as
and multifactorial. The soft tissue problems that a maxillo-
fixation system.
facial surgeon encounters in rejuvenating of the face are:
The authors present the surgical procedure, discuss the
1. The dermal component in relation to the intrinsic and
results and present various cases.
extrinsic facial aging (dermal elastosis).
Results: In all patients esthetic and functional improve-
2. Descent of the facial fat, with jowling and deep nasola-
ment was achieved. The lower border osteotomy allowed
bial fold as the result.
for major (up to 15mm) chin advancement together with a
3. Increase or decrease of the facial fat during the aging marked improvement of the frontal facial contour (widen-
process.
ing elongation or shortening). Bone healing, nerve func-
Each individual patient shows different degree of the tion recovery was uneventful.
above mentioned problems at the time of consultation for
Conclusion: Osteotomy of the lower mandibular border
facial rejuvenation. The specific need of each patient lies
performed by piezoelectric saw gives new possibilities in
on the basis of the correction of the mentioned aging
facial aesthetics.
components.
New powerful piezoelectric systems with special cutting
Our experience in facial recontouring with Extended
tips make this procedure relatively simple with low com-
SMAS Facelift in combination with eyelid surgery and
plication rate.
endoscopic brow lifting is presented.
The above mentioned procedure has been used in our
department for the last 12 years in more. No major com-
O-0112
plications occurred except a post-operative haematoma in
UP-DATE IN GENIOPLASTY STRATEGIES
one patient, which healed uneventfully after drainage.
Giuseppe Consorti1, *, Riccardo Tieghi1, Manlio Galiè1,
Utilizing extended SMAS technique enables the aesthetic
Stefano A Denes1, Luigi C Clauser1
surgeon to deal with the challenging reconstruction of the
1Unit of Cranio Maxillo Facial Surgery, Centre for Craniofacial
aged face, without compromising the natural facial ap-
Deformities & Orbital Surgery - S. Anna Hospital and University.
pearance.
Ferrara, Italy
Introduction: The chin is an important structure of the
maxillofacial complex, principally in harmony and esthet-
O-0111
ic proportion into various areas of the face. In general, a
LOWER BORDER OSTEOTOMY - NEW
retruded chin is associated with femininity; a prominent
PERSPECTIVES FOR GENIOPLASTY
chin with masculinity. The chin is one of the movable
Maciej Jagielak1, *, Andrzej Wojtowicz1, Marcin Socha2, physical characteristics of the face and may have been
Anna Jagielak3, Wojciech Lambrecht3 useful to display aggression and strength in more primitive
1Department of Dental Surgery Medical University of Warsaw, 2 times. The stronger mandible and more protuberant chin
Private surgical practice, Warsaw, Poland, 3Ortognatyka private are distinctive features of the male face.
surgical and orthodontic practice, Raszyn, Poland
Therefore, genioplasty is an important procedure particu-
Introduction: Contemporary cosmetic surgery employs larly in male aesthetic skeletal surgery.
two methods of genioplasty: augmentation with implants
The chin is one of most prominent and visible structures of
and various types of osteotomy.
the face, and the surgical modifications should pay atten-
The first method improves of the facial profile as well as tion in alterations in dentofacial deformities.
widens the en-face contour with very minor functional
Material and Methods: Osteotomies of the chin have been
improvement.
described as the simplest of all the craniomaxillofacial
The second - usually limited to the anterior aspect of the osteotomies. Yet, genioplasty should not be considered a
mandibular border changes the profile with limited im- trivial or incidental procedure.
provement of the frontal appearance, although functional
The face is divided into thirds; the lower third is further
results are usually satisfactory (lip closure, periodontal
divided into thirds with the labial commissure demarcating
health improvement etc).
the upper third border. The chin is the largest variable in
The presented method of genioplasty combines the ad- the lower two-thirds of the lower third of the face.
vantages of these two surgical procedures.
Cephalograms are not mandatory but are useful for the
Material and Methods: In the years 2006-2012 the authors less practiced clinical eye and when aesthetic improve-
performed 152 genioplasties. In 107 cases genioplasty was ment requires movement in more than one dimension.
an adjunctive procedure in other osteotomies in treatment Digital imaging software is part of the up-date in gen-
of different types of the facial skeletal deformities. In 45 ioplasty strategies.
cases genioplasty was solitary procedure with neither
Results: Certainly, the low rate of complications reported
other surgical nor orthodontic treatment.
in large series of craniofacial operations must be met and
6
XXI. Congress EACMFS, Abstracts - Oral presentations Facial rejuvenation, aesthetic surgery and sculpturing
exceeded in aesthetic procedures. Our experience has
shown that careful planning; adequate surgical exposure,
good technique, rigid fixation, autogenous graft materials,
and respect for soft tissue and its blood supply can reduce
complications to a level acceptable for aesthetic facial
skeletal surgery.
Skeletal changes are truly structural and architectural
modifications of the face. One should remember that
―form ever follows function‖.
Conclusion: It is a technique used with esthetic finally, to
good facial balance. The importance of facial analysis and
the objectives of cephalometric and predictive analysis
were confluents to obtain facial harmony.

7
XXI.Congress EACMFS, Abstracts - Oral presentations Imaging and simulation

Nicolai Adolphs1, *, Hannes Haberl2, Weichen Liu1, Erwin
Session 2. IMAGING AND SIMULA- Keeve1, Horst Menneking1, Bodo Hoffmeister1
11 Klinik für Mund-, Kiefer- und Gesichtschirurgie, Centrum 9 für
TION
Unfall- und Wiederherstellungschirurgie, Rudolf-Virchow-
Klinikum, Charité Berlin, Germany, 22 Pädiatrische
Neurochirurgie, Centrum 15 für Neurologie, Neurochirurgie,
Psychiatrie, Rudolf-Virchow-Klinikum, Charité Berlin, Germany
O-0201
SIMULATION GUIDED NAVIGATION IN CRANIO- Introduction: In complex craniomaxillofacial procedures
MAXILLO-FACIAL SURGERY individual 3D models may be required for visualisation of
skeletal problems and consecutive treatment planning.
Alberto Bianchi1, *, Giovanni Badiali1, 3, Lorenzo Model production however is cost and time consuming.
Lancellotti1, 3, Claudio Marchetti1, 2, 3
Modern computer assisted surgery systems more and more
1Oral & Maxillofacial Surgery Unit, Policlinico S. Orsola allow for virtual simulation of even complex surgical
Malpighi, University of Bologna, 2Oral Surgery Dept., Dental
procedures which might overcome the known drawbacks
School, University of Bologna, 3Postgraduate School of
of the classic surgical models. The potential of a commer-
Maxillofacial Surgery, University of Bologna, Italy
cially available software application should be evaluated
Purpose: Navigation is a way to reach your aim, using according to various craniomaxillofacial procedures.
knowledge and experience to let reality and your map
Materials & Methods: For surgical planning of complex
meet each other. Three-dimensional (3D) technologies are
craniomaxillofacial procedures patient specific models
continuously improved and increasingly applied to many
have been produced by SLS-technique based on CT-
field of cranio-maxillofacial surgery for diagnosis, surgi-
acquired DICOM data. With the same data-sets virtual
cal planning and surgical aid. We present our experience
patient models and simulation of the surgical procedure
in transferring individualized 3D virtual plan of surgery in
was performed using Materialises` Surgicase CMF / Syn-
the operating room, using a Navigation system (Simula-
thes ProplanCMF software by online cooperation between
tion-Guided Navigation). Our aim was to evaluate if this
surgeon and engineer. Virtual simulation was performed
new method can provide an increase in intraoperative
for secondary correction of dish-face deformity, mandibu-
reproducibility of the preoperative 3D virtual plan.
lar distraction in severe growth deficiency, pediatric max-
Methods and Materials: We applied this technique to the illary distraction in CLP, and craniofacial correction of
main fields of maxillofacial surgery: oncology, traumatol- hypertelorism.
ogy, pediatric surgery, but we predominantly applied this
Results: Information of both planning tools was used in a
technique to orthognathic surgery.
synergistic way in all patients. Simulation of the procedure
We studied 44 patients affected by facial deformities. All corresponded well with the real surgical result. Transfer of
the patients have been investigated with a preoperative the planning was mainly dependent on individual anatomy
Cone-Beam CT of the facial skeleton and soft tissues, although surgical cutting guides proved to be helpful.
which let us obtain a 3D model of the deformity. An or- Main advantage of the software planning certainly is the
thognathic plan was performed in conjunction with the possibility to ―play around‖, simulate different types of
orthodontist (3D Surgical Treatment Objective) paying skeletal displacements and visualise their expected effect.
attention to functional and aesthetic issues. 3d models however feature a certain ―haptic‖ component
and are easy to handle.
The surgical procedure was performed virtually on the 3D
model with a dedicated software, which elaborates the Conclusion: There was a synergistic effect of both plan-
postoperative appearance of patient‘s soft tissues. Then the ning tools. Additional work and expenses may be justified
virtual plan was loaded on the Navigation system. This by increased possibilities of visualisation, information,
way we were able to directly see the extent of movements instruction and documentation.
applied to the mobilized segments of the facial skeleton
and check their correct position intraoperatively. All the
procedures were as well performed with surgical splints.
O-0203
After surgery all the patients underwent a new Cone-Beam VIRTUAL MODEL SURGERY AND FABRICATION OF A
CT, which was matched with the preoperative 3D virtual SURGICAL WAFER SPLINT FOR CORRECTION OF A
planning, providing this way an evaluation of the repro- SEVERE MANDIBULAR ASYMMETRY
ducibility of the procedures.
Lászlo Seres1, *, Endre Varga1, Zoltán Raskó1, András
Conclusion: According to our results, we can assume that Kocsis2
Simulation-Guided Navigation is a helpful procedure to 1Department of Oral & Maxillofacial Surgery, University of
improve reproducibility of the preoperative virtual surgical Szeged, Hungary, 2Andras Kocsis Orthodontic Clinic, Szeged,
planning in every field of maxillofacial surgery, especially Hungary
in orthognathic surgery, where our experience is stronger. Background: Surgical correction of mandibular asym-
metry can be a challenging task for both the orthodontist
and the maxillofacial surgeon. Traditional two-
O-0202
dimensional cephalometric analysis is of limited value in
VIRTUAL PLANNING OF CRANIOMAXILLOFACIAL
treatment planning. In case of complex two-jaw proce-
SURGERY – IS THERE STILL A NEED FOR “REAL”
dures manual model surgery can be complicated, time-
MODELS? EXPERIENCES OF ONE CENTRE USING
consuming and may contain potential errors. The introduc-
COMMERCIALLY AVAILABLE SOFTWARE
tion of high resolution computed tomography and sophis-
ticated virtual planning software technologies opened up a
8
XXI.Congress EACMFS, Abstracts - Oral presentations Imaging and simulation

new avenue for visualizing and planning of orthognathic plant placement.
procedures. The aim of this study was to report a case of
Results: we used this method in two patients with satisfac-
facial asymmetry where two-jaw surgery was planned tory results. The resection was performed according to
virtually. preoperative planning. In both cases, the implants were
perfectly adapted to the defect thus reconstructing the
Patient and methods: A 26-year-old male complained of
anatomical shape of the cranio-orbito-facial region in
severe facial asymmetry. Clinical evaluation revealed
continuity with the cranial vault.
severe right-sided hemimandibular elongation with small
compensatory transverse canting of the maxillary occlusal Conclusions: Individual implants are especially suitable
plane. Cross bite was observed on the left side and scissor for complex or large-surface defects in the cranio-orbito-
bite on the affected side. Technetium isotope scan did not facial region. They guarantee simultaneously a perfect
show increased uptake in the condylar regions. Following aesthetic result with a high stability also saving surgical
presurgical orthodontics virtual Le Fort I osteotomy was time.
performed and the symmetry of the maxilla was corrected
with the help of an in-house developed three-dimensional
surgery planning software. A virtual intermediate surgical
O-0205
wafer was designed and fabricated with a three-
ADVANCED DIGITAL PLANNING FOR HEAD AND
dimensional printer. The mandible was rotated into the
NECK RECONSTRUCTION.
correct position with virtual bilateral sagittal split osteot-
omy to visualize the movements of the osteomized seg- Kavin Andi1, *, Ahmed Tahomy1, Jean-Pierre Jeannon1,
ments. The two-jaw osteotomy procedure was performed Mark McGurk1
according to the virtual plan. 1Guy's and St Thomas' NHS Foundation Trust, UK
Results: In surgery the splint fitted well. The facial sym- Introduction:Innovations in computer technology in engi-
metry was improved significantly after the operation. The neering, entertainment and industry have spear-headed the
development of a variety of advanced clinical tools now
occlusion is stable and the patient is satisfied with his
available to the head and neck surgeon. We will introduce
facial appearance. There is no sign of relapse after 6
the tools, techniques and methodology for planning com-
months following the procedure.
plex head and neck reconstruction within our institution
using a multidisciplinary approach.
Conclusions: Latest computerized and rapid prototyping
technologies let us fully imagine, design and control or- Methods :43 consecutive patients had volumetric recon-
thognathic procedures without information loss among the struction of contrast computer tomography data which
surgeons, orthodontists and dental technicians. Although were used to precisely measure the dimensions of the
this is a single case, it supports the usage of three- potential ablative defect. The tumour volume and required
dimensional surgical planning software for the correction resection margins were calculated in 3-dimensions using
of facial asymmetries. threshold segmentation techniques in order to determine
the volume of hard and soft tissue required for free tissue
transfer. Templates were also constructed to guide the
O-0204 surgeon with bony and soft tissue resections margins.
VIRTUAL PLANNING AND NAVIGATION GUIDED
Where free tissue transfer was required the length of the
RECONSTRUCTION IN FRONTOORBITAL TUMOURS.
pedicle from the ablative site to potential donor vessels
PRESENTATION OF 2 CASES.
was also calculated as well as the diameter of potential
Cristina Maza1, *, Julio Acero1, Carlos Navarro1, Roberto recipient vessels. Pedicle positions were also simulated
Garcia1, Santiago Ochandiano1, Rodolfo Asensio1 using virtual surgery techniques.
1Hospital General Universitario Gregorio Marañón, Spain Clinical Relevance: By using advanced digital technology
Introduction: bone reconstruction of the craniofacial re- for head and neck reconstruction the surgeon has an op-
gion is technically complex. Bone grafts have a limited portunity to build a repertoire of quantitative information
surface and higher morbidity than artificial implants. for long term functional and aesthetic outcome analysis.
Moreover, a detailed planning of the reconstruction is
necessary in order to achieve good aesthetic and functional
results. Virtual planning and computer assisted designed O-0206
implants can improve the reconstruction of complex de- VIRTUAL SURGERY SIMULATION (V.S.S.) FOR
fects of the cranio-orbital region. ORBITAL RECONSTRUCTION
Objective: we present two cases of complex of cranio- Giorgio Novelli1, *, Gabriele Tonellini1, Fabio Mazzoleni1,
orbito-facial resections due to meningioma showing the Davide Sozzi1, Luca Ferrari1, Alberto Bozzetti1
virtual preoperative planning of the resection and the 1Department of Maxillofacial Surgery (Head: Prof. Alberto
reconstruction method. Bozzetti), University of Milano-Bicocca, San Gerardo Hospital,
Monza, Italy
Materials and methods: preoperative 3D virtual planning
of the resection and the reconstruction was made accord- Introduction: First introduced in craniofacial surgery in
ing to Materialize Synthex procedure. A CAD-CAM the early nineties, surgical navigation has increasingly
PEEK prosthesis was produced according to the planned played a wider role in medical practice in Maxillofacial
resection. Digital data including the virtual planning and Surgery Units. In the orbital region, it is very important to
MRI of the patient were download in the navigation sys- obtain an adequate reconstruction that preserves both
tem (Brainlab) thus allowing for a exact resection accord- function and aesthetics.
ing to the previous planning and a quick and precise im-
9