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News Americas

Cephalometric analysis on a cadaver after Le Fort-based face-jaw-teeth transplantation. (Image: Johns Hopkins Medicine)
0 Comments Aug 7, 2015 | News Americas

New technology improves jaw and teeth alignment in face transplant patients

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BALTIMORE, USA: A team of physicians and engineers at Johns Hopkins University and Walter Reed National Military Medical Center has developed a computer platform that provides rapid, real-time feedback before and during facial transplant surgery. The new technology aims to improve face-jaw-teeth alignment between donor and recipient.

Surgeons performed the first successful transplant of facial features, including the jaw and teeth, in 2008, mainly relying on visual judgment. Since then, approximately 30 facial transplants have been conducted worldwide. These transplants have led to the improvement of patient survival and enhancement of physical appearance. However, current surgical methods often leave patients with some undesired residual deformities and abnormalities in function.

The new computer-assisted development aims to make it less likely to misalign the new set of bones, jaw and teeth, and prevent other reconstructive abnormalities for patients with severe craniofacial trauma, the researchers reported.

The platform, called the computer-assisted planning and execution (CAPE) system, is first used to help plan the surgery once a donor has been identified for transplantation. Using information from CT scans, the donor's and the recipient's anatomy are matched in order to optimize form, appearance, and functions, such as chewing and breathing, said study author Dr. Chad Gordon, assistant professor of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine and co-director of the Multidisciplinary Adult Cranioplasty Center at Johns Hopkins.

Moreover, the technology can be applied during surgery, using a novel feature known as real-time cephalometry (RTC), Gordon explained. RTC provides the surgeon with objective measurements and angles related to ideal jaw–teeth positions, with instantaneous visual feedback in the operating room.

"Every time the donor's jaw–teeth segment moves during facial transplant inset, the computer recalculates its movements in comparison to the face transplant recipient, meaning the surgical team can have unprecedented visual data in achieving ideal alignment of the face, jaw and teeth," Gordon explained. The preciseness of the technology will likely reduce the need for patients to undergo revision surgery and will help to improve outcomes in various areas, Gordon added.

He and his colleagues have jointly filed for eight patents related to the system, which has various applications in the field of cranio-maxillofacial surgery. For the study, the team performed donor–recipient, Le Fort-based face-jaw-teeth transplantation on two plastic models and two human cadavers using the CAPE system.

"CAPE and RTC can be adapted for use in other surgical disciplines, such as oral-maxillofacial surgery, head and neck surgery, and neurosurgery," added co-author Dr. Mehran Armand, director of the Biomechanical- and Image-Guided Surgical Systems laboratory at John Hopkins.

For the team members at Walter Reed National Military Medical Center, the system will be especially useful for treating victims of improvised explosive device blasts who have survived, but are severely deformed and need reconstruction, according to Professor Gerald Grant, service chief of the 3D Medical Applications Center at Walter Reed. "RTC will provide our team with a much-needed advantage when it comes to reconstructing wounded warriors with devastating maxillofacial or mandibular injuries, both for transplant surgery and for routine reconstruction," he said.

The study report, titled "Optimizing Hybrid Occlusion in Face-Jaw-Teeth Transplantation: A Preliminary Assessment of Real-Time Cephalometry as Part of the Computer-Assisted Planning and Execution Workstation for Craniomaxillofacial Surgery," was published in the August issue of the Plastic and Reconstructive Surgery journal.

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