Fiction no more: Computer-assisted oral and maxillofacial surgery

Prof. Nils-Claudius Gellrich, Congress President of the German Society for Oral and Maxillofacial Surgery (DGMKG) explained how computer assistance can help in extensive facial restoration after severe accidents or tumors.

More courage needed in the search for innovative solutions

Prof. Nils-Claudius Gellrich, Congress President of the German Society for Oral and Maxillofacial Surgery (DGMKG) explained how computer assistance can help in extensive facial restoration after severe accidents or tumors.

Could faces be nearly restored after serious accidents or tumors with the help of computer assistance? This is already possible today, according to Professor Dr. Nils-Claudius Gellrich, Congress President of the German Society for Oral and Maxillofacial Surgery (DGMKG). In a press conference on the occasion of the 138th Congress of the German Society for Surgery (DGCH) taking place April 12-16, 2021, the medical expert used two examples to demonstrate why healthcare systems should aim for a more courageous approach when investing in surgical design and reconstruction.

Virtual planning, template-guided drilling, real-time navigation and additive manufacturing techniques (ie 3D printing): Options like these can help alleviate the health as well as visual consequences of severe tumor or accident cases in the oral or maxillofacial regions. Dr. Gellrich, who heads the Clinic and Polyclinic for Oral and Maxillofacial Surgery at Hannover Medical School (original name: Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie an der Medizinischen Hochschule Hannover), is a strong advocate for these new procedures. In the context of the 138th DGCH Congress, the physician presented the already-existing realm of possibilities for patient-specific 3D implants, using two examples from the fields of trauma and tumor treatment.

As in other medical fields, inventiveness and creativity in surgical design and reconstruction is being driven by the current COVID-19 pandemic, Dr. Gellrich argued. Computer-assisted oral and maxillofacial surgery, however, is not a fundamentally new approach, he said, adding that it has already been a focus of research for two decades, with both patients and surgeons benefitting from the outcomes. "Surgeons today can plan preoperatively and create virtual blueprints for surgery thanks to state-of-the-art imaging techniques; they can produce patient-specific implants from titanium in a 3D printer and insert them into the patient using intraoperative navigation," Dr. Gellrich stated in the congress’ press release. 

Improved quality assurance from the preoperative phase to the follow-up period 

As a first example, Dr. Gellrich reported on a patient who suffered a severe traumatic brain injury. One year after primary care, correction of the midface and right orbit resulted in only a partial function. Interdisciplinary collaboration between computer-assisted surgery and radiology proved far more successful. With the help of 3D imaging and digital workflow, therapy could be customized to the patient and the orbit was reconstructed via 3D printing. A one-time corrective surgery that took full advantage of digital planning, manufacturing, surgical and procedural control capabilities ultimately also restored the patient's functions to an almost full extent.

Dr. Gellrich sees major advantages here: The expanded use of 3D imaging created for medical applications ensures improved quality assurance from the preoperative phase to the follow-up period, he says. "More than almost any other technology, computer-assisted craniofacial surgery and navigation offers the possibility of consistent quality assurance for a specialized field," he emphasizes. Medical professionals could digitally reconstruct what needs to be readjusted, and patients could be given digitally supported explanations of exactly what procedures are being performed.

Surgeries will be shorter and less frequent

As a second example of the benefits of computer-assisted surgery, Dr. Gellrich refers to a patient with extensive maxillary carcinoma with additional multiple myeloma. Using a single-fit construct, the patient's full chewing ability was restored within one day. Thus, the surgeon also sees an important factor in time management: patients would need shorter and less frequent surgeries due to preoperative planning options. "We no longer have to operate on patients multiple times because we can now tailor the individual steps of bone or tooth replacement through virtual planning, implants from the 3D printer, template-supported drilling procedures and real-time navigation," Dr Gellrich explained.

However, there is still one major drawback. Quality assurance costs a lot of money, but is not adequately rewarded. Not all hospitals have the infrastructure to perform computer-assisted surgery. The introduction and implementation of computer-assisted surgery often depends on individual enthusiasm for the techniques and, above all, on applications for third-party funding. Therefore, Dr. Gellrich sees a need for action on the part of healthcare systems. But he has high hopes, especially with regard to the next generation of young surgeons: “They are already digital natives”, adding that more openness to modern treatment approaches will translate into an increasing demand from the next generation to further expand the expertise they already have through new technologies.

References:
1. From 3D printers to patient-specific implants: What modern computer-assisted techniques make possible in oral and maxillofacial surgery - Professor Dr. med. dent. Nils-Claudius Gellrich; online press conference on the occasion of the 138th Congress of the German Society for Surgery (DGCH), Wednesday, April 7, 2021, 10:30 a.m. to 12:00 p.m. (Original Title: Von 3D-Druckern bis zu patientenspezifischen Implantaten: Was moderne computerassistierte Techniken in der Mund-, Kiefer- und Gesichtschirurgie möglich machen - Professor Dr. med. Dr. med. dent. Nils-Claudius Gellrich)
2. Press release: Facial surgery after severe accident or tumor: What modern, patient-specific 3D implants make possible; April 06, 2021. (Original Title: Pressemitteilung: Gesichts-OP nach schwerem Unfall oder Tumor: Was moderne, patientenspezifische 3-D-Implante möglich machen).

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