Simulation Surgery Using 3D 3-layer Models for Congenital Anomaly

Abstract

We made realistic, three-dimensional, computer-assisted 3-layered elastic models of the face. The surface layer is made of polyurethane, the intermediate layer is silicone, and the deep layer is salt, representing the skin, subcutaneous tissue, and the bone. We have applied these 3-layer models to congenital anomaly cases and have understood that these models have a lot of advantages for simulation surgery.

Methods: We made 8 models. The models consisted of 2 models of 2 cases with Crouzon disease, 1 model of Binder syndrome, 1 model of facial cleft, 2 models of one case with Goldenhar syndrome, 1 model of cleft lip and palate, and 1 model of the hemifacial macrosomia.

Results: We could try several methods, could recognize whether the graft size is adequate, and could visualize the change of the facial contour. We could analyze how to approach the osteotomy line and actually perform osteotomy. The changes of the lower facial contour can be observed. We grafted the models of the graft and confirmed that the incisions could be closed well. We were able to visualize the change in the soft tissue contour by simulating distraction.

Conclusions: The most versatile merit of our models is that we could visualize the change of the soft tissue by movement of the hard tissue with bone graft, distraction osteogenesis, and so on. We must improve the model further to make it more realistic.

Fig. 1.

Case 1. A 21-year-old woman with Binder syndrome. We planned a nasal bone graft for the saddle nose.

Fig. 2.

A 3-layer model for this case.

Fig. 3.

Wooden simulation models for bone graft in rhinoplasty.

Fig. 4.

Simulation surgery using 3D 3-layer model. We grafted the wooden models from the approach of oral and rim incision into the 3-layer model.

Fig. 5.

Postoperative photograph of the patient 6 months after surgery.

Fig. 6.

Case 2. Simulation surgery using a 3-layer model of a 22-year-old woman with Tessier No.0 cleft. Using the model, a skin patch measuring 15 × 45 mm could be resected by adding incisions of the bilateral alar bases.

Fig. 7.

Case 2. The actual operation. A bigger skin patch of 18 × 52 mm could be resected. The resected skin was used as the full-thickness skin graft for the pigmented donor site of the scalping flap.

Fig. 8.

Case 3. A 11-year-old girl with Crouzon disease who had undergone Le Fort III osteotomy and distraction at the age of eight; however, sleep apnea recurred.

Fig. 9.

Photograph demonstrating a simulation surgery using the model. Horizontal mental osteotomy attaching suprahyoid muscles to bring forward the hyoid bone to the chin was planned.

Fig. 10.

Photograph showing a post-surgical simulation: 13 mm advancement of mental mandible. We confirmed the incision line for the approach could be closed and the changes to the lower contour of the face could be viewed.

Fig. 11.

Case 3. The actual operation of advancing the mandibular mental region.

Fig. 12.

Case 4. Silicone models of the cartilage graft. A preoperative simulation surgery of rib cartilage graft for logophthalmos on a 25-year-old man with Crouzon disease.

Fig. 13.

Photograph demonstrating a simulation surgery using the 3-layer model. The protruded part of the salt mandibular bone model was cut and the cut part was grafted to the depressed area of the mandible.

Fig. 14.

Photograph showing a simulation surgery using the 3-layer model. From the lower eyelid sutures performed previously, we grafted the silicone model into the 3-layer model and confirmed that the sutures are closed well. The contour of the chin of the model was confirmed to have improved.

Fig. 15.

Case 4. The actual operation of grafting the silicone model into the 3-layer model. We adopted the same approaches and nearly the same size of the rib cartilage grafts.

Fig. 16.

Case 5. A 25-year-old male patient with hemifacial microsomia.

Fig. 17.

Case 5. Simulation surgery using the model. To obtain adequate improvement of the lower facial contour, the chin should be advanced more than the full thickness of the mandible.

Fig. 18.

Photograph depicting the actual operation of Case 5, where the rib graft was interposed between the advanced mandibular part and the mandible.

Fig. 19.

Case 5. The patient 6 months after surgery.