Virtual Planning and Intraoperative Navigation in Craniomaxillofacial Surgery

Surgery planning assisted by computer represents one important example of the collaboration between surgeons and engineers. Virtual planning allows surgeons to pre-do the surgery by working over a virtual 3D model of the patient obtained through a computer tomography. Through surgical navigation, surgeons are helped while working with deep structures and can check if they are following accurately the surgical plan. These assistive tools are crucial in the field of facial reconstructive surgery. This paper describes two cases, one related to orbital fractures and another one related to oncological patients, showing the advantages that these tools provide, specifically when used for craniomaxillofacial surgery

Impact of goal directed therapy in head and neck oncological surgery with microsurgical reconstruction: free flap viability and complications

Background: Surgical outcomes in free flap reconstruction of head and neck defects in cancer patients have improved steadily in recent years; however, correct anaesthesia management is also important. The aim of this study has been to show whether goal directed therapy can improve flap viability and morbidity and mortality in surgical patients. Methods: we performed an observational case control study to analyse the impact of introducing a semi invasive device (Flo Trac®) during anaesthesia management to optimize fluid management. Patients were divided into two groups: one received goal directed therapy (GDT group) and the other conventional fluid management (CFM group). Our objective was to compare surgical outcomes, complications, fluid management, and length of stay between groups. Results: We recruited 140 patients. There were no differences between groups in terms of demographic data. Statistically significant differences were observed in colloid infusion (GDT 53.1% vs. CFM 74.1%, p = 0.023) and also in intraoperative and postoperative infusion of crystalloids (CFM 5.72 (4.2, 6.98) vs. GDT 3.04 (2.29, 4.11), p < 0.001), which reached statistical significance. Vasopressor infusion in the operating room (CFM 25.5% vs. GDT 74.5%, p < 0.001) and during the first postoperative 24h (CFM 40.6% vs. GDT 75%, p > 0.001) also differed. Differences were also found in length of stay in the intensive care unit (hours: CFM 58.5 (40, 110) vs. GDT 40.5 (36, 64.5), p = 0.005) and in the hospital (days: CFM 15.5 (12, 26) vs. GDT 12 (10, 19), p = 0.009). We found differences in free flap necrosis rate (CMF 37.1% vs. GDT 13.6%, p = 0.003). One-year survival did not differ between groups (CFM 95.6% vs. GDT 86.8%, p = 0.08). Conclusions: Goal directed therapy in oncological head and neck surgery improves outcomes in free flap reconstruction and also reduces length of stay in the hospital and intensive care unit, with their corresponding costs. It also appears to reduce morbidity, although these differences were not significant. Our results have shown that optimizing intraoperative fluid therapy improves postoperative morbidity and mortalit

Use of surgical bone cement to increase the projection of the nasomaxillary buttress in a case of orthognathic surgery. Technical note

The soft tissue outcome of the projection at the level of the nasomaxillary buttress is difficult to manage in cases of severe hypoprojection, being orthognathic surgery resolutive at the occlusal level but sometimes insufficient at the level of esthetic outcome. The literature describes the use of alloplastic prostheses and autologous bone grafts, but there are few documented cases of the use of premolded surgical cement for this purpose. The main advantage of the use of bone cement over the alternatives described is its ability to be premolded for customization, low cost, easy availability, speed of preparation and minimal comorbidity. This technical note describes the surgical steps and outcome of the use of surgical bone cement for projection augmentation at this level, including notes on preparation, premolding and fixation. Key words:Orthognathic surgery, maxillary surgery, surgical bone cement, nasomaxillary buttress

IJIMAI Editor's Note - Vol. 4 Issue 5

Although Medicine has always been considered a Health Science, today it is not possible to obviate its relationship with other disciplines as Humanities and Basic Sciences. Doctors from everywhere and everyday work with the most sophisticated technology are trying to make their profession more accurate and precise, taking in consideration, at the same time, the human part of their daily labour. In this volume of the Journal, we will try to explore the relation between different medical specialities, basic science and engineering. In fact, modern Medicine requires the participation of these professionals who are involved with doctors in multidisciplinary teams. In this sense, Medical Engineering, is a new degree that is offered in a vast number of Universities along the world. This relationship between Medicine and Sciences can be found in any medical speciality so that, our aim in this volume, is to show different examples of doctors working together with other scientifics in any area of Medical sciences.The volume consists on twelve papers. Each paper explores a particular area of this multidisciplinary approach

IJIMAI Editor's Note - Vol. 4 Issue 5

Although Medicine has always been considered a Health Science, today it is not possible to obviate its relationship with other disciplines as Humanities and Basic Sciences. Doctors from everywhere and everyday work with the most sophisticated technology are trying to make their profession more accurate and precise, taking in consideration, at the same time, the human part of their daily labour. In this volume of the Journal, we will try to explore the relation between different medical specialities, basic science and engineering. In fact, modern Medicine requires the participation of these professionals who are involved with doctors in multidisciplinary teams. In this sense, Medical Engineering, is a new degree that is offered in a vast number of Universities along the world. This relationship between Medicine and Sciences can be found in any medical speciality so that, our aim in this volume, is to show different examples of doctors working together with other scientifics in any area of Medical sciences.The volume consists on twelve papers. Each paper explores a particular area of this multidisciplinary approach

Virtual Planning and Intraoperative Navigation in Craniomaxillofacial Surgery

Surgery planning assisted by computer represents one important example of the collaboration between surgeons and engineers. Virtual planning allows surgeons to pre-do the surgery by working over a virtual 3D model of the patient obtained through a computer tomography. Through surgical navigation, surgeons are helped while working with deep structures and can check if they are following accurately the surgical plan. These assistive tools are crucial in the field of facial reconstructive surgery. This paper describes two cases, one related to orbital fractures and another one related to oncological patients, showing the advantages that these tools provide, specifically when used for craniomaxillofacial surgery

Masticatory System Biomechanical Photoelastic Simulation fot the Comparision of the Conventional and Uni-Lock Systems in Mandibular Osteosynthesis

The biomechanical consequences of the interaction between titanium trauma plates and screws and the fractured mandible are still a matter of investigation. The mathematical and biomechanical models that have been developed show limitations and the experimental studies are not able to reproduce muscle forces and internal stress distributions in the bone-implant interface and mandibular structure. In the present article we show a static simulator of the masticatory system to demonstrate in epoxy resin mandibular models, by means of 3D (three-dimensional) photoelasticity, the stress distribution using different osteosynthesis methods in the mandibular angle fractures. The results showed that the simulator and 3D photoelasticity were a useful method to study interactions between bone and osteosynthesis materials. The “Lock” systems can be considered the most favourable method due to their stress distribution in the epoxy resin mandible. 3D photoelasticity in epoxy resin models is a useful method to evaluate stress distribution for biomechanical studies. Regarding to mandibular osteosynthesis, “lock” plates offer the most favourable stress distribution due to being less aggressive to the bon

Masticatory System Biomechanical Photoelastic Simulation fot the Comparision of the Conventional and Uni-Lock Systems in Mandibular Osteosynthesis

The biomechanical consequences of the interaction between titanium trauma plates and screws and the fractured mandible are still a matter of investigation. The mathematical and biomechanical models that have been developed show limitations and the experimental studies are not able to reproduce muscle forces and internal stress distributions in the bone-implant interface and mandibular structure. In the present article we show a static simulator of the masticatory system to demonstrate in epoxy resin mandibular models, by means of 3D (three-dimensional) photoelasticity, the stress distribution using different osteosynthesis methods in the mandibular angle fractures. The results showed that the simulator and 3D photoelasticity were a useful method to study interactions between bone and osteosynthesis materials. The “Lock” systems can be considered the most favourable method due to their stress distribution in the epoxy resin mandible. 3D photoelasticity in epoxy resin models is a useful method to evaluate stress distribution for biomechanical studies. Regarding to mandibular osteosynthesis, “lock” plates offer the most favourable stress distribution due to being less aggressive to the bon

Fruit volatile profile of two Citrus hybrids is dramatically different from their parents

Volatile compounds released from the fruit of two hybrid Citrus genotypes (FxCh90 and FxCh77) were compared to those from their parental varieties, Fortune mandarin and Chandler pummelo. A series of 113 compounds were identified, including 31 esters, 23 aldehydes, 20 alcohols, 17 monoterpenoids, and other compounds. The differences in the volatile profile among these four genotypes were essentially quantitative. The most striking result was that the volatile profile of the hybrids was not intermediate between their parents and completely differed from that of Chandler, but came closer to Fortune. This was because 56 of the 113 volatile compounds in the hybrids showed significantly higher or lower levels than in any of the parents. Such transgressive behavior in these hybrids was not observed for other fruit quality traits, such as acidity or soluble solid content. The combination of volatile profiling and chemometrics can be used to select new Citrus genotypes with a distinct volatile profileThis work has been supported by Projects GVPRE/2008/164 of Conselleria d'Educacio of the Valencian Community and RTA2011-00132-C02 of INIA. M.C.G.-M. is contracted by the Fundacion Agroalimed (Conselleria d'Agricultura of VC).Rambla Nebot, JL.; Gonzalez Más, MC.; Pons, C.; Bernet, GP.; Asins Cebrian, MJ.; Granell Richart, A. (2014). Fruit volatile profile of two Citrus hybrids is dramatically different from their parents. Journal of Agricultural and Food Chemistry. 62(46):11312-11322. doi:10.1021/jf5043079S1131211322624