(Press-News.org) Following several years of research and collaboration, physicians and engineers at Johns Hopkins and Walter Reed National Military Medical Center say they have developed a computer platform that provides rapid, real-time feedback before and during facial transplant surgery, which may someday improve face-jaw-teeth alignment between donor and recipient.
Surgeons performed the first successful transplant of facial features, including the jaw and teeth, in 2008, mainly relying on visual judgment. Since then, approximately 30 facial transplants have been done worldwide, costing an estimated $250,000 to $500,000. These transplants have led to the improvement of patient survival and enhancement of physical appearances. However, current surgical methods often leave patients with some undesired residual deformities and abnormalities in function.
The new computer-assisted development should make it less likely to misalign the new set of bones, jaw and teeth, and prevent other reconstructive abnormalities for patients with severe craniofacial trauma, the researchers report.
Use of the new platform in mock surgeries performed on plastic and cadaveric human donor/recipient pairs is described in the journal Plastic and Reconstructive Surgery, published in August.
Called the computer-assisted planning and execution (CAPE) system, the platform is first used to help plan surgery once a donor has been identified for transplantation. Using information from CT scans, the donor's anatomy is matched to the recipient's anatomy in an effort to optimize form, or appearance, and function, such as chewing and breathing, according senior author Chad Gordon, D.O., an assistant professor of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine and co-director of the Multidisciplinary Adult Cranioplasty Center at Johns Hopkins.
The execution portion of the system's name refers to the technology used during surgery, which includes a novel feature known as real-time cephalometry (RTC), says Gordon. RTC provides the surgeon with objective measurements and angles related to ideal jaw-teeth positions, with instantaneous visual feedback in the operating room unlike ever before.
"Every time the donor's jaw-teeth segment moves during facial transplant inset, the computer recalculates its movements in comparison to the face transplant recipient, meaning the surgical team can have unprecedented visual data in achieving ideal alignment of the face, jaw and teeth," explains Gordon. His collaborators included faculty members and scientists at the Johns Hopkins University Whiting School of Engineering and Applied Physics Laboratory.
The preciseness of the technology will likely reduce the need for patients to undergo revision surgery and will help to improve outcomes in various areas, says Gordon.
Gordon and his colleagues have jointly filed for eight patents related to the system, which has various applications within the field of craniomaxillofacial surgery.
For the study, the team performed donor-to-recipient, Le Fort-based face-jaw-teeth transplantation on two plastic models and two human cadavers using the CAPE system.
Gordon says the current prototype system can assist face-jaw-teeth transplantation, known as Le Fort-based jaw surgery, and can help surgeons in all forms and types of craniofacial surgery, in both adults and children.
"CAPE and RTC can be adapted for use in other surgical disciplines, such as oral-maxillofacial surgery, head and neck surgery, and neurosurgery," adds co-author Mehran Armand, Ph.D., director of Biomechanical- and Image-Guided Surgical Systems, a collaborative laboratory between the Applied Physics Laboratory and Whiting School of Engineering. "In fact, they share principles with our biomechanical guidance system, which was previously developed for orthopaedic surgery through a grant funded by the National Institute of Biomedical Imaging and Bioengineering."
The team members at Walter Reed National Military Medical Center may find the system especially useful for treating victims of improvised explosive device blasts who have survived but are severely deformed and need reconstruction, according to Gerald Grant, service chief of the 3D Medical Applications Center at Walter Reed. "RTC will provide our team with a much-needed advantage when it comes to reconstructing wounded warriors with devastating maxillofacial or mandibular injuries, both for transplant surgery and for routine reconstruction," he says.
INFORMATION:
The research and development of the system was supported in part by numerous grants, including an American Society of Maxillofacial Surgeons' research award, an American Association of Plastic Surgeons' Academic Scholar Award, the Johns Hopkins' Institute for Clinical and Translational Research ATIP Award, internal research funds from the Applied Physics Laboratory and the Maryland Innovation Initiative award provided by TEDCO. The technology published here also received notable distinction from the Abell Foundation and won a Technology Innovation Award from TechConnect. The team says it hopes to obtain larger-scale research funding from the National Institutes of Health to help guide further development of the CAPE system, with the goal of launching a clinical trial within the next three to five years.
Article: Optimizing Hybrid Occlusion in Face-Jaw-Teeth Transplantation: A preliminary assessment of real-time cephalometry as part of the Computer-assisted Planning and Execution (CAPE) workstation for craniomaxillofacial surgery
Brown dwarfs are relatively cool, dim objects that are difficult to detect and hard to classify. They are too massive to be planets, yet possess some planetlike characteristics; they are too small to sustain hydrogen fusion reactions at their cores, a defining characteristic of stars, yet they have starlike attributes.
By observing a brown dwarf 20 light-years away using both radio and optical telescopes, a team led by Gregg Hallinan, assistant professor of astronomy at Caltech, has found another feature that makes these so-called failed stars more like supersized planets--they ...
CHAPEL HILL, NC - The stem cells in our gut divide so fast that they create a completely new population of epithelial cells every week. But this quick division is also why radiation and chemotherapy wreak havoc on the gastrointestinal systems of cancer patients - such therapies target rapidly dividing cells. Scientists at the UNC School of Medicine and the UNC Lineberger Comprehensive Cancer Center found that a rare type of stem cell is immune to radiation damage thanks to high levels of a gene called Sox9.
The discovery, which was made in mice and published in the journal ...
Washington, DC--The Endocrine Society today issued a Clinical Practice Guideline (CPG) on strategies for treating Cushing's syndrome, a condition caused by overexposure to the hormone cortisol.
The CPG, entitled "Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline," was published online and will appear in the August 2015 print issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society.
Cushing's syndrome occurs when a person has excess cortisol in the blood for an extended period, according ...
Enrolling in an insurance plan under the Affordable Care Act is only the first step for consumers to be actively engaged in their health care, according to a new analysis from RAND Corporation researchers.
To understand the issues facing consumers as well as the payers, providers and support organizations who work directly with them, RAND researchers conducted phone-based interviews with insurance companies, physician groups and community support nonprofit organizations. The analysis of the interviews shows more work is necessary to support consumers past the point of ...
Kindergarteners' social-emotional skills are a significant predictor of their future education, employment and criminal activity, among other outcomes, according to Penn State researchers.
In a study spanning nearly 20 years, kindergarten teachers were surveyed on their students' social competence. Once the kindergarteners reached their 20s, researchers followed up to see how the students were faring, socially and occupationally. Students demonstrating better prosocial behavior were more likely to have graduated college, to be gainfully employed and to not have been arrested ...
TORONTO, ON - People who have inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis, have twice the odds of having a generalized anxiety disorder at some point in their lives when compared to peers without IBD, according to a new study published by University of Toronto researchers.
"Patients with IBD face substantial chronic physical problems associated with the disease," said lead-author Professor Esme Fuller-Thomson, Sandra Rotman Endowed Chair at the University of Toronto's Factor-Inwentash Faculty of Social Work. "The additional burden of ...
Today the nonprofit Alliance for Aging Research released a white paper, Our Best Shot: Expanding Prevention through Vaccination in Older Adults, that provides a comprehensive overview of the factors that drive vaccination underutilization in seniors and offers recommendations on how industry, government, and health care experts can improve patient compliance.
Although influenza, pneumococcal, tetanus, and shingles vaccines are routinely recommended for older adults, are cost-effective, are covered to varying degrees by health insurance, and prevent conditions that have ...
The coalescence of two black holes -- a very violent and exotic event -- is one of the most sought-after observations of modern astronomy. But, as these mergers emit no light of any kind, finding such elusive events has been impossible so far.
Colliding black holes do, however, release a phenomenal amount of energy as gravitational waves. The first observatories capable of directly detecting these 'gravity signals' -- ripples in the fabric of spacetime first predicted by Albert Einstein 100 years ago -- will begin observing the universe later this year.
When the gravitational ...
Johns Hopkins researchers say their review of 128 medical case histories suggests that financial penalties imposed on Maryland hospitals based solely on the total number of patients who suffer blood clots in the lung or leg fail to account for clots that occur despite the consistent and proper use of the best preventive therapies.
"We have a big problem with current pay-for-performance systems based on 'numbers-only' total counts of clots, because even when hospitals do everything they can to prevent venous thromboembolism events, they are still being dinged for patients ...
Women who were socially well integrated had a lower risk for suicide in a new analysis of data from the Nurses' Health Study, according to an article published online by JAMA Psychiatry.
Suicide is among the top 10 leading causes of death among middle-age women in the United States. Most of the work in the field emphasizes the psychiatric, psychological or biological determinants of suicide.
Alexander C. Tsai, M.D., Ph.D., of Massachusetts General Hospital, Boston, and coauthors estimated the association between social integration and suicide using data from 72,607 ...