Haptic-Assisted Surgical Planning (HASP) in a Case of Bilateral Mandible Fracture

Roya Moafi,1 Fredrik Nysjö,2 Johan Kämpe,1 Christopher Riben,1 Andreas Thor1 1Department of Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden; 2Department of Information Technology, Centre for Image Analysis, Uppsala University, Uppsala, SwedenCorrespondence: Roya Moafi, Department of Oral and Maxillofacial Surgery, Uppsala University Hospital, Akademiska Sjukhuset. Käkkirurgi, Uppsala, 751 85, Sweden, Tel +46  018 6116450, Fax +46  018 559129, Email [email protected]: Restoring normal skeletal anatomy in patients with complex trauma to the mandible can be difficult, the difficulty often increasing with an edentulous mandible. This study describes a case of a displaced edentulous bilateral mandibular fracture, which was preoperatively planned with the in-house haptic-assisted surgery planning system (HASP). A model of the virtually restored mandible was 3D-printed at the hospital and a reconstruction plate was outlined beforehand with the printed mandible as a template and served as a guide during surgery. This case suggests HASP as a valuable preoperative tool in the planning phase when dealing with maxillofacial trauma cases. With the application of virtual planning, the authors could analyze the desired outcome and were further supported in surgery by the guidance of the reconstruction plate outlined on the restored model of the mandible.Keywords: case report, trauma, virtual planning, 3D-printing, reconstructio

Recurrent Barrett's esophagus and adenocarcinoma after esophagectomy

<p>Abstract</p> <p>Background</p> <p>Esophagectomy is considered the gold standard for the treatment of high-grade dysplasia in Barrett's esophagus (BE) and for noninvasive adenocarcinoma (ACA) of the distal esophagus. If all of the metaplastic epithelium is removed, the patient is considered "cured". Despite this, BE has been reported in patients who have previously undergone esophagectomy. It is often debated whether this is "new" BE or the result of an esophagectomy that did not include a sufficiently proximal margin. Our aim was to determine if BE recurred in esophagectomy patients where the entire segment of BE had been removed.</p> <p>Methods</p> <p>Records were searched for patients who had undergone esophagectomy for cure at our institution. Records were reviewed for surgical, endoscopic, and histopathologic findings. The patients in whom we have endoscopic follow-up are the subjects of this report.</p> <p>Results</p> <p>Since 1995, 45 patients have undergone esophagectomy for cure for Barrett's dysplasia or localized ACA. Thirty-six of these 45 patients underwent endoscopy after surgery including 8/45 patients (18%) with recurrent Barrett's metaplasia or neoplasia after curative resection.</p> <p>Conclusion</p> <p>Recurrent Barrett's esophagus or adenocarcinoma after esophagectomy was common in our patients who underwent at least one endoscopy after surgery. This appears to represent the development of metachronous disease after complete resection of esophageal disease. Half of these patients have required subsequent treatment thus far, either repeat surgery or photodynamic therapy. These results support the use of endoscopic surveillance in patients who have undergone "curative" esophagectomy for Barrett's dysplasia or localized cancer.</p