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. 2024 Nov 14;16(11):e73698.
doi: 10.7759/cureus.73698. eCollection 2024 Nov.

A Soft Tissue-Borne Patient-Specific Guide for Foreign Body Removal in the Facial Region

Amjad Shhadeh  1   2 , Shadi Daoud  1   2 , Adeeb Zoabi  1   2 , Samer Srouji  1   2 , Fares Kablan  1   2
Affiliations

A Soft Tissue-Borne Patient-Specific Guide for Foreign Body Removal in the Facial Region

Amjad Shhadeh et al. Cureus. .

Abstract

Foreign body removal in the facial region poses significant challenges due to the complex anatomy and the proximity to critical structures. This study introduces a soft tissue-borne patient-specific guide (PSG) designed to enhance precision and minimize invasiveness in foreign body removal. Four patients underwent foreign body removal using PSGs, with CT and cone-beam computed tomography (CBCT) imaging employed for segmentation and detailed analysis of both hard and soft tissues. This approach enabled the planning and design of stable and personalized guides. Ultrasound tracing was used for intraoperative verification. All procedures were successful, with minimal scarring, no complications, and reduced operative time. The use of PSGs improved surgical accuracy and efficiency, highlighting their potential for foreign body removal in other regions of the body and for broader clinical applications in maxillofacial surgeries.

Keywords: foreign bodies; minimally invasive surgery; patient-specific guide; soft tissue-borne guide; virtual surgical planning.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of the Galilee Medical Center issued approval NHR-0183-23. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Detailed segmentation and analysis of foreign body and adjacent soft tissues in the facial region.
(A) Axial CBCT slice indicating the metallic foreign body (yellow marker) in the left cheek area. (B) Coronal slice illustrating the foreign body embedded in the subcutaneous tissues. (C) Segmentation of the bone (green) and foreign body (blue), extracted from the CBCT scan. (D) Segmentation of the facial soft tissue (purple). (E) Combined segmentation of bone, soft tissue, and foreign body with a transparent overlay of the soft tissue. (F) Soft tissue thickness assessment displayed as a heat map, revealing that the periorbital and nasal region is the thinnest and has the most bony support. (G) Hounsfield Unit (HU) evaluation of the adjacent soft tissue, highlighting the more elastic tissue on the medial side of the foreign body. CBCT: cone-beam computed tomography The images belong to Case 1.
Figure 2
Figure 2. Guided foreign body removal using soft tissue-borne patient-specific guide.
(A) The designed guide was positioned on the facial soft tissue, incorporating key soft tissue features and anatomical morphology. (B) Guide visualization without the facial soft tissue, highlighting the location of the foreign body (blue). (C) Intraoperative application of the guide, demonstrating a positive fit on the patient’s facial soft tissue. (D) Minimally invasive removal of the foreign body using the guide. (E) Postoperative view of the patient-specific printed guide and the extracted foreign body. The images belong to Case 1.
Figure 3
Figure 3. CT imaging of metallic foreign bodies in cases 2-4.
CT images showing the precise locations of metallic foreign bodies (yellow arrows) in the facial regions of cases 2-4. (A, B) Case 2: Axial and coronal slices reveal three metallic fragments in the left zygomatic area. (C, D) Case 3: Axial and coronal views display a single metallic fragment in the left buccal region. (E, F) Case 4: Axial and coronal sections highlight a metallic fragment in the right zygomatic area.
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