Computer-assisted face-jaw-teeth transplantation
Inventors
Gordon, Chad • Armand, Mehran • MURPHY, RYAN • GRANT, Gerald • LIACOURAS, Peter • WOLFE, Kevin
Assignees
United States, Defense, Secretary of • Johns Hopkins University • US Department of Navy • Walter Reed Army Institute of Research • US Office of Naval Research
Publication Number
US-10537337-B2
Publication Date
2020-01-21
Expiration Date
2034-11-25
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Abstract
A computer-assisted surgical system can include a donor sub-system and a recipient sub-system. The donor sub-system includes a first reference unit having a first trackable element, a fragment reference unit having a second trackable element, and a first detector configured to provide at least one of a first signal corresponding to a detected location of one or more of the first trackable element and the second trackable element. The recipient sub-system includes a second reference unit having a third trackable element, and a second detector configured to provide at least one of a second signal corresponding to a detected location of at least the third trackable element.
Core Innovation
The invention describes a computer-assisted surgical system designed for craniomaxillofacial surgery, particularly for face-jaw-teeth transplantation. The system integrates both donor and recipient sub-systems, each equipped with trackable reference units and detectors that provide signals corresponding to detected locations of these elements. This creates a seamless integration of pre-operative planning, intraoperative navigation, and real-time feedback, facilitating the precise transfer and placement of anatomical segments between donor and recipient.
The system addresses the challenge of discrepancies in skeletal, aesthetic, and dental structures between donor and recipient in facial transplantation, a complex surgical scenario. Existing computer-assisted surgery approaches either focus on pre-operative planning using surgical guides or provide intraoperative feedback relative to preoperative imaging but lack real-time placement feedback for difficult anatomical areas like the three-dimensional facial skeleton. Additionally, known systems do not offer a fully integrated platform combining both planning and navigation with features customized for the increased complexity of facial transplantation. There is also a deficiency in validated methods to optimize outcomes related to anthropometric mismatches between donor and recipient, a major hurdle in this field.
The system overcomes these challenges by providing two or more networked workstations to concurrently plan and navigate donor and recipient surgeries, advanced tracking through electromagnetic or optical means for bones and soft tissues, patient-specific cutting guides with navigation capabilities, and dynamic intraoperative feedback including cephalometric measurements and biomechanical simulations. The approach includes segmentation and volumetric reconstruction of donor and recipient anatomy, generation of virtual surgical plans, fabrication of custom cutting guides, registration of models to patient anatomy, and real-time tracking and assessment to improve form and functional outcomes in transplantation. This integrated platform also allows for intraoperative plan updates and revisions when necessary.
Claims Coverage
The patent contains several independent claims which define the core inventive features relating to a computer-assisted surgical system and related transplantation methods involving tracking, navigation, and real-time updates during surgical procedures.
Integrated donor and recipient surgical sub-systems with trackable reference units and detectors
The system includes a donor sub-system having a first reference unit with a first trackable element, a fragment reference unit with a second trackable element, and a detector providing signals indicative of locations of these elements; and a recipient sub-system with a second reference unit having a third trackable element and a detector providing location signals for this element. These enable simultaneous spatial tracking during surgery.
Computers executing instructions to update and display anatomical reconstructions based on detected trackable elements
The first computer accesses and displays a computer-readable reconstruction of the donor anatomy updated by physical locations of trackable elements detected by the first detector. Similarly, the second computer accesses and displays recipient anatomy updated by the detected location of its trackable element, allowing real-time visualization of both donor and recipient anatomical models.
Patient-specific cutting guides with trackable elements and manufacturing control
The system includes the use of planned cutting planes superimposed on the donor reconstruction to generate virtual cutting guides whose geometry corresponds to intersections with anatomical structures. Instructions control manufacturing devices (e.g., 3D printers) to fabricate these customized cutting guides that also include trackable elements detected intraoperatively for surgical navigation.
Superimposition and tracking of virtual donor fragments on recipient anatomy with orientation updates
The system forms virtual donor fragments segmented along planned cutting planes, with orientations updated based on tracking data. These fragments are superimposed on the recipient's anatomical reconstruction, enabling hybrid visualization and aiding surgical placement with automated cephalometric and biomechanical analyses.
Computer-assisted transplantation method with reference unit attachment and location detection
The method includes attaching trackable reference units to donor and recipient anatomical features, detecting their locations with respective detectors, accessing and updating computer reconstructions based on these locations, and superimposing virtual donor fragments onto recipient reconstructions to guide transplantation.
Osteotomy guided by tracking-enabled cutting guides and fragment transfer with tracking
The method entails forming a cutting guide based on a planned cutting plane and attaching it to donor anatomy, tracking its location during surgery, performing osteotomy along the guide, monitoring the detached donor fragment during transfer, and attaching it to the recipient, using tracking data to minimize size mismatches and deformities.
Assessment and minimization of size mismatches at donor-recipient interfaces during transplantation
The method involves measuring inconsistent skeletal interfaces, such as dorsal maxillary interface, between donor and recipient anatomies and selecting fragment placement that minimizes step-off deformities at osteosynthesis sites, improving anatomical congruity.
Use of tracking-enabled recipient cutting guides
The method further comprises attaching a second cutting guide with its own trackable element to the recipient anatomy, enabling tracking and navigation of recipient surgical preparation in conjunction with donor fragment placement.
Collectively, the claims cover an integrated computer-assisted surgical system and method that provide simultaneous tracking and navigation of donor and recipient anatomies during transplantation, enabling customized cutting guides, real-time anatomical model updates, intraoperative plan revisions, and improved accuracy and outcomes through detailed spatial registration and feedback.
Stated Advantages
Provides a fully integrated platform combining pre-operative planning, intraoperative navigation, and dynamic instantaneous feedback to overcome shortcomings of existing systems.
Enables precise tracking and real-time visualization of donor and recipient anatomy and surgical tools, enhancing accuracy in complex facial transplantation procedures.
Improves surgical outcomes by optimizing donor-recipient alignment through automated cephalometric assessments and biomechanical simulations.
Reduces operative times by using pre-bent fixation plates and tracking-enabled customized cutting guides.
Allows intraoperative updates and revisions to the surgical plan, increasing flexibility and robustness during surgery.
Includes modular design permitting continuous addition of functionality and safeguards for verifying system accuracy intraoperatively.
Documented Applications
Face-jaw-teeth transplantation including complex craniomaxillofacial and orthognathic surgeries, such as Le Fort-based, double-jaw, and cross-gender facial transplantation.
Preoperative planning and intraoperative navigation in neurosurgery, ENT/head and neck surgery, oral maxillofacial surgery, and orthognathic surgical procedures affecting dental alignment.
Craniomaxillofacial trauma reconstruction including fracture reduction, bone fragment assessment, and restoration of pre-trauma facial skeletal relationships.
Osseointegrated dental and craniofacial implants and prosthetics placement with real-time cephalometric feedback for ideal positioning and biomechanical predictions.
Congenital craniofacial deformity correction including cases of premature suture fusion and major skeletal abnormalities.
Single-stage customized craniofacial implant (CCI) cranioplasty following tumor resection or large cranial defects requiring precise and timely implant positioning.
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