Jawbone reconstruction – or orthognathic surgery – is a complex medical procedure that involves replacing damaged or diseased bone tissue with an implant, typically a titanium plate or prosthesis.
The surgery involves treating the jaw of a person for significant trauma, such as from a car accident or gunshot wound, or diseases such as oral cancer, with recovery lasting as long as 12 weeks. Complications such as implant failure and infections are common, possibly requiring repetitive procedures that can place a significant burden on a patient.
In recent years, biomedical engineers have developed a new generation of medical implants designed to not only replace bones, but to help regenerate tissue back to its original state with 3D-printed tissue scaffold fixation systems.
These devices enhance the innate healing potential of human tissue, using a scaffold as a temporary support structure for the surrounding cells to attach to and grow. Eventually, it is expected to dissolve more in the bloodstream, leaving new tissue in place.
A digital twin
Ben Ferguson, a PhD student at the University of Sydney’s School of Aerospace, Mechanical and Mechatronic Engineering, is developing a surgical planning tool to assist surgeons in planning complex jawbone reconstruction procedures with these new generation devices.
With advanced computer technology and decision-making algorithms, the tool works by generating a ‘digital twin’ of the patient using CT scan data. It then quickly simulates different implant designs before the final, optimal 3D printing design, allowing surgeons to perform a digital ‘rehearsal’ prior to theater.
“Nowadays, it would not be conceivable to build a building without performing a technical simulation on it in advance. This is the industry standard in civil engineering – the same expectation should be applied to surgery on a human, “said Ferguson, who is due to submit his PhD in September.
“The jaw is a complex area – necessary to speak, eat, chew and perform tasks that require both finesse and strength. Because of its complexity, we want to give orthognathic surgeons the best tools so that they are set for success – hopefully reducing repeat surgery and improving patient outcomes, ”he said.
A bone graft design may work in one patient, but it may fail in another. If it were you, you would probably want a team of surgeons and biomedical engineers to perform a simulation and assessment of the medical device in your body before it really is implanted.
Optimizing device design
The surgical planning tool combines computer-aided design (CAD) tools with high fidelity computer-aided engineering models and optimization algorithms that can accurately simulate the medical device under physiological load.
Ferguson’s supervisor, Professor Qing Li, said: “In addition to pre-surgical planning, these simulation data can also help the surgeon optimize the design of the medical device, and help solve their problems that inevitably arise when designing a medical device. device that must meet multiple design and medical purposes. “
“It’s a careful balancing act,” Ferguson said. “For example, an implant may mechanically stimulate the surrounding tissue to improve healing, but mechanical stimulation may then increase the risk of implant failure. Our algorithms and data-driven approach help surgeons develop an optimal design without relying solely on intuition.
Professor Qing Li and Ben Ferguson.
Transforming technology into clinical reality
The researchers recently partnered with Professor Jonathan Clark, chair of reconstructive head and neck surgery at Chris O’Brien Lifehouse, to help translate the new technology into a clinical reality.
Clark said: “Australia has been a leader in maxillofacial reconstruction since Dr Ian Taylor’s 1974 breakthrough mandibular reconstruction. Since then, maxillofacial reconstruction has evolved substantially: digital tools have been incorporated into pre-surgery planning, allowing surgeons to create more accurate devices with better aesthetic and functional outcomes. patients.
“What’s really exciting about this tool and data is that they offer the opportunity to develop the technology out of shape, to also incorporate biomechanical modeling, which can help to predict the response of bone tissue to physiological loads. This kind of analysis – called CT-based finite element modeling – will be of great importance as we move away from using the patient’s own bone for reconstruction and start incorporating custom scaffolding in the future.
Images courtesy of the University of Sydney.
Planning tool lets surgeons perform digital rehearsals
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