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Describes how the implementation of thromboembolic prophylaxis in patients undergoing oral and maxillofacial surgical procedures was audited. In 1997, four oral and maxillofacial units were asked about their practice of prophylaxis for thromboembolic disease (TED). Proformas were sent to each unit to assess 45 patients retrospectively. These patients were chosen at random from within defined groups of surgery. The audit was repeated in 1998, after presentation and discussion of initial findings. Of 117 patients at low risk of TED, 72 (62 per cent) and 50 (81 per cent) of 62 patients at moderate risk received prophylaxis. In the second run of the audit, there was a 7 per cent increase in the number of patients at moderate risk receiving prophylaxis. Patients admitted for trauma surgery were the most likely to have TED prophylaxis omitted. Concludes that there was an improvement between the first and second run of the audit, but some patients were still not being treated appropriately.

The purpose of this paper is to develop a workflow for design and fabrication of customized surgical guides (CSGs) for placement of the bidirectional extraoral distraction instruments (EDIs) in bilateral mandibular distraction osteogenesis (MDO) surgery to treat the bilateral temporomandibular joint ankylosis with zero mouth opening.

The comprehensive workflow consists of six steps: medical imaging; virtual surgical planning (VSP); computer aided design; rapid prototyping (RP); functional testing of CSGs and mock surgery; and clinical application. Fused deposition modeling, an RP process was used to fabricate CSGs in acrylonitrile butadiene styrene material. Finally, mandibular reconstruction with MDO was performed successfully using RP-assisted CSGs.

Design and development of CSGs prior to the actual MDO surgery improves accuracy, reduces operation time and decreases patient morbidity, hence improving the quality of surgery. Manufacturing of CSG is easy using RP to transfer VSP into the actual surgery.

This study describes an RP-assisted CSGs fabrication for exact finding of both; osteotomy site and drilling location to fix EDI’s pins accurately in the mandible; for accurate osteotomy and placement of the bidirectional EDIs in MDO surgery to achieve accurate distraction.

Head and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy. The use of a surgical treatment can lead to surgical infections that are a main theme in medicine. At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections.

The Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs. In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients).

The results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41%. Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone. Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin.

While the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics.

Employing the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs.

There is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies.

Additive manufactured (AM) skull models are increasingly used to plan complex surgical cases and design custom implants. The accuracy of such constructs depends on the standard tessellation language (STL) model, which is commonly obtained from computed tomography (CT) data. The aims of this study were to assess the image quality and the accuracy of STL models acquired using different CT scanners and acquisition parameters.

Images of three dry human skulls were acquired using two multi-detector row computed tomography (MDCT) scanners, a dual energy computed tomography (DECT) scanner and one cone beam computed tomography (CBCT) scanner. Different scanning protocols were used on each scanner. All images were ranked according to their image quality and converted into STL models. The STL models were compared to gold standard models.

Image quality differed between the MDCT, DECT and CBCT scanners. Images acquired using low-dose MDCT protocols were preferred over images acquired using routine protocols. All CT-based STL models demonstrated non-uniform geometrical deviations of up to +0.9 mm. The largest deviations were observed in CBCT-derived STL models.

While patient-specific AM constructs can be fabricated with great accuracy using AM technologies, their design is more challenging because it is dictated by the correctness of the STL model. Inaccurate STL models can lead to ill-fitting implants that can cause complications after surgery.

This paper suggests that CT imaging technologies and their acquisition parameters affect the accuracy of medical AM constructs.

Computer-aided design and additive manufacture (CAD/AM) technologies are sufficiently refined and meet the necessary regulatory requirements for routine incorporation into the medical field, with long-standing application in surgeries of the maxillofacial and craniofacial regions. They have resulted in better medical care for patients and faster, more accurate procedures. Despite ever-growing evidence about the advantages of computer-aided planning, CAD and AM in surgery, detailed reporting on critical design decisions that enable methodological replication and the development and establishment of guidelines to ensure safety are limited. This paper aims to present a novel application of CAD and AM to a single-stage resection and reconstruction of fibrous dysplasia in the zygoma and orbit.

It is reported in sufficient fidelity to permit methods replication and design guideline developments in future cases, wherever they occur in the world. The collaborative approach included engineers, designers, surgeons and prosthetists to design patient-specific cutting guides and a custom implant. An iterative design process was used, until the desired shape and function were achieved, for both of the devices. The surgery followed the CAD plan precisely and without problems. Immediate post-operative subjective clinical judgements were of an excellent result.

At 19 months post-op, a CT scan was undertaken to verify the clinical and technical outcomes. Dimensional analysis showed maximum deviation of 4.73 mm from the plan to the result, while CAD-Inspection showed that the deviations ranged between −0.1 and −0.8 mm and that the majority of deviations were located around −0.3 mm.

Improvements are suggested and conclusions drawn regarding the design decisions considered critical to a successful outcome for this type of procedure in the future.

The purpose of this paper is to demonstrate the route to digitize the customized mandible implants consisting of image acquisition, processing, implant design, fitting rehearsal and fabrication using fused deposition modeling and electron beam melting methodologies.

Recent advances in the field of rapid prototyping, reverse engineering, medical imaging and image processing have led to new heights in the medical applications of additive manufacturing (AM). AM has gained a lot of attention and interest during recent years because of its high potential in medical fields.

Produced mandible implants using casting, milling and machining are of standard sizes and shapes. As each person’s physique and anatomical bone structure are unique, these commercially produced standard implants are manually bent before surgery using trial and error methodology to custom fit the patient’s jaw. Any mismatch between the actual bone and the implant results in implant failure and psychological stress and pain to the patient.

The novelty in this paper is the construction of the customized mandibular implant from the computed tomography (CT) scan which includes surface reconstruction, implant design with validation and simulation of the mechanical behavior of the design implant using finite element analysis (FEA). There has been few research studies on the design and customization of the implants before surgery, but there had been hardly any study related to customized design implant and evaluating the biomechanical response on the newly designed implant using FEA. Though few studies are related to FEA on the reconstruction plates, but their paper lacks the implant design model and the reconstruction model. In this research study, an integrated framework is developed for the implant design, right from the CT scan of the patient including the softwares involved through out in the study and then performing the biomechanical study on the customized design implant to prove that the designed implant can withstand the biting and loading conditions. The proposed research methodology which includes the interactions between medical practitioners and the implant design engineers can be incorporated to any other reconstruction bone surgeries.

This study aims to assess the design, manufacturing and surgical implantation of three-dimensional (3D) customized implants, including surgical preoperative planning, surgery and postoperative results, for cranioplasty along with zygomatic and orbital floor implants using additive manufacturing (AM) technics for a 23-year-old female who suffered from severe craniomaxillofacial trauma.

The skull biomodel was produced in polyamide while implants were made of Ti-6Al-4V alloy by AM.

The method enabled perfectly fitting implants and anatomical conformance with the craniomaxillofacial defect, providing complete healing for the patient. Surgical planning using a customized 3D polyamide biomodel was effective. This proved to be a powerful tool for medical planning and manufacturing of customized implants, as complete healing and good craniofacial aesthetic results were observed.

Satisfactory surgical procedures, regarding surgery time reduction and good craniofacial aesthetic results, were achieved. Furthermore, the 3D titanium customized implants represented a favorable alternative for the repair of craniomaxillofacial defects.

Rapid prototype models are directly integrated into non‐engineering applications such as medicine. Medical models are used to plan complex procedures prior to surgery with potential to optimise patient treatment in the operating theatre. This paper presents results following a 12 month National Health Service Executive research project to assess the feasibility of using rapid prototype medical models. A total of 16 medical models were created. Nine anatomical sites were reconstructed from patient data acquired from five London hospitals. The purpose of the models is described and the commissioning surgeons as part of a questionnaire assessed their usefulness. Future developments are discussed and conclusions about the use of medical models are made.

This paper aims to illustrate a number of instances where RP and associated technology has been successfully used for medical applications.

A number of medical case studies are presented, illustrating different uses of RP technology. These studies have been analysed in terms of how the technology has been applied in order to solve related medical problems.

It was found that RP has been helpful in a number of ways to solve medical problems. However, the technology has numerous limitations that have been analysed in order to establish how the technology should develop in the future.

RP can help solve medical problems, but must evolve if it is to be used more widespread in this field.

This paper has shown a number of new applications for RP, providing a holistic understanding how the technology can solve medical problems. It also identifies a number of ways in which the technology can improve in order to better solve such problems.

The purpose of this paper is to design and development of a patient-specific implant for zygomatic area of a patient suffering from mucormycosis (fungal infection). The paper describes how integration of computer-aided design (CAD) and 3D printing can be successfully used for developing custom implants for the sites for which readymade optimal solutions are not available.

The CT scan data of the patient were used for the generation of a 3D model. The healthy side of skull was mirrored and copied on the infected part, which served as a base for designing the implant. The prototype of the implant was printed using fused deposition modelling before finally printing in Ti6Al4V alloy using direct metal laser sintering process.

The custom designed implant fitted well to the patient’s skull during surgery. Proper facial aesthetics were maintained post-surgery.

The work describes the application of CAD-based image processing software and additive manufacturing in the development of a custom implant for the sites for which no readymade optimal solution is available.