First-in-man application of a cold ablation robot guided laser osteotome in midface osteotomies

The aim of the study was to assess the clinical applicability of robot guided laser osteotomy for clinical application. This is the initial report on 14 consecutive patients requiring an orthognathic procedure with a midface osteotomy (no restrictions made on the surgical indication itself) who have undergone surgery by means of the Cold Ablation Laser Osteotome CARLO (R) (AOT Advanced Osteotomy Tools, Basle, Switzerland), which is an integrated system, functionally comprising: an Er:YAG laser source, intended to perform osteotomies using cold laser ablation, a robot arm that controls the position of the laser source, an optical tracking device that provides a continuous and accurate measurement of the position of the laser source and of reference elements attached to instruments or bones, a navigation system (software) that is able to read preoperatively defined planned osteotomies, and - under the control of a surgeon - performs the planned osteotomies. Safety was assessed by unimpaired postoperative healing and the absence of device related injuries; performance was assessed as ability to cut the maxilla along the preoperatively planned cutting path with a rage of accuracy of 2mm. Cold ablation robot-guided laser osteotomy could successfully be performed in 14 consecutive patients. No intraoperative complications or technical failure occurred. All osteotomies were within an average deviation of 0.80 mm (+/- 0.26 mm) of the virtually preplanned location. The registration procedure to set up the robot at the beginning of the operation required a mean time of 4.6 min (+/- 5.3min). In this report we describe the effective and successful routine use of Cold ablation robot-guided laser osteotomy in an actual clinical setting. It is a promising technical innovation that has the potential to set new standards for accuracy and safety in orthognathic surgery. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of European Association for Cranio-Maxillo-Facial Surgery

Scientific Reports / Changes of temporomandibular joint position after surgery first orthognathic treatment concept

Orthognathic surgery treatment (OGS) after orthodontic treatment of dentofacial deformities is a widely performed procedure, often accompanied by a bilateral sagittal split osteotomy (BSSO). Positioning of the condyle during this procedure is a crucial step for achieving optimal functional and anatomical results. Intraoperatively poorly positioned condyles can have a negative effect on the postoperative result and the patients well-being. Changes of the condylar position during OGS Procedures and its effects on the temporomandibular joint in orthognathic surgical interventions (OGS) are subject of scientific discussions. However, up to date, no study has investigated the role of condyle position in the surgery first treatment concept. The aim of this study was to investigate the influence of OGS on the three-dimensional position of the condyle in the joint in a surgery first treatment concept without positioning device and to record the change in position quantitatively and qualitatively. Analysis of our data indicated that OGS in surgery first treatment concept has no significant effect on the position of the condyle and the anatomy of the temporomandibular joint.(VLID)492859

Scientific Reports / Morphometric analysis of sinus depth in the posterior maxilla and proposal of a novel classification

The aim of this study was to analyse the posterior maxillary sinus based on its extension into the alveolar process and to provide a simple clinical classification. A retrospective cohort study was conducted in CT scans of 200 dentate and 200 edentulous patients (100 women and 100 men, respectively). After manual placement of 12 reference points morphometric analysis was performed and sinus depth, residual alveolar ridge height (RH) and the sinus opening angle were calculated. Sinuses were classified according to the quartiles of sinus depth: class I (above the hard palate), class II (06mm below the hard palate) and class III (>6mm below the hard palate). Sinus depth was found to be a reliable anatomical landmark and did not vary significantly between gender (p=0.8940) or dentition groups (p=0.9723). Alveolar height varied significantly between sinus classes (p<21016) and dentition groups (p<21016) but not between genders (p=0.5178). The sinus opening angle was significantly different between sinus classes (p<2.21016) but not between gender or dentition groups. We propose a novel classification built upon the quartiles of sinus depth, dividing the sinuses into three classes. Our classification is the first one that represents the anatomy of the patient independent of gender and dentition.(VLID)470183

Lab-on-chip, Innovative approach towards telemedicine in primary care

This paper describes the innovative approach to point of care applications developed in the EU-funded POCEMON IP Project, taking advantage of telemedicine concepts and microsystem technologies

Enabling an unimpeded surgical approach to the skull base in patients with cranial hyperostosis, exemplarily demonstrated for craniometaphyseal dysplasia

Craniometaphyseal dysplasia is an extremely rare, genetic bone-remodeling disorder. Comparable to osteopetrosis, fibrous dysplasia, and other infrequent conditions, craniometaphyseal dysplasia is characterized by progressive diffuse hyperostosis of the neuro- and viscerocranium. Affected patients present with a pathognomonic dysmorphia: macrocephalus, hypertelorism, bulky facial skeleton, and a prominent mandible. Progressive thickening and petrification of the craniofacial bones can continue throughout life, often resulting in neurological symptoms due to obstruction of the cranial nerves in the foramina and therefore immediately requiring neurosurgical interventions to avoid persistent symptoms with severe impairment of function. Treatment is largely infeasible given the lack of suitable tools to perform a craniotomy through the gross calvarial bone. In this paper, the authors present a complete process chain from the CT-based generation of an individual patient's model displaying his pathology to optimized preoperative planning of the skull's shape with a thickness of about 6-7 mm. For concise verification of the surgical plan in an operating room environment, a 3D real-time navigation prototype system was utilized. To guarantee realization of the surgery in a reasonable time frame, the mechanical tools were preoperatively selected for optimizing the ablation rate in porcine and bovine bone, which were comparable to that in the patient. This process chain was developed in a modular way, so that it could be easily adopted completely or partially for other surgical indications. A 21-year-old man was treated according to this sophisticated concept. Skull bone more than 50 mm thick in some regions was reduced to physiological thickness. The patient was thus in a stage that neurosurgical interventions could be performed with a regular risk within a reasonable time of treatment

Testing the effects of photobiomodulation on angiogenesis in a newly established CAM burn wound model

Abstract Burn wounds are a common challenge for medical professionals. Current burn wound models hold several limitations, including a lack of comparability due to the heterogeneity of wounds and differences in individual wound healing. Hence, there is a need for reproducible in vivo models. In this study, we established a new burn wound model using the chorioallantoic membrane assay (CAM) as a surrogate model for animal experiments. The new experimental setup was tested by investigating the effects of the auspicious biophysical therapy, photobiomodulation (PBM), on the wound healing of an induced CAM burn wound with a metal stamp. PBM has been shown to positively influence wound healing through vascular proliferative effects and the increased secretion of chemotactic substances. The easily accessible burn wounds can be treated with various therapies. The model enables the analysis of ingrowing blood vessels (angiogenesis) and diameter and area of the wounds. The established model was used to test the effects of PBM on burn wound healing. PBM promoted angiogenesis in burn wounds on day 4 (p = 0.005). Furthermore, there was a not significant trend toward a higher number of vessels for day 6 (p = 0.065) in the irradiated group. Changes in diameter (p = 0.129) and the burn area (p = 0.131) were not significant. Our results suggest that CAM can be a suitable model for studying burn wounds. The novel experimental design enables reproducible and comparable studies on burn wound treatment