A cadaver based course focusing on Craniomaxillofacial reconstruction using pre-surgical computer aided planning as well as, intraoperative navigation. Lectures covering traumatic, neoplastic, and congenital deformities will be presented by experts from both the United States, Europe, and Asia.

Participants will be assigned a cadaveric skull and lower extremity. Presurgical planning sessions will allow the participants to perform virtual repair of both midface injuries and a segmental mandibulotomy with free flap reconstruction. Participants will then go into the cadaver lab and perform the pre-planned repair on their cadaveric specimen using intraoperative navigation for the midface and fibular free flap cutting guides for the mandibular reconstruction.

After completion of the repair, immediate postoperative CT scans will be performed. The post-surgical scanned data will be uploaded onto the planning stations to compare the planned repair with the actual postoperative result.

Statement of Need:

Stereotactic guidance for intracranial surgery dates back to the early 1900’s. Frameless surgical navigation systems were subsequently developed. These navigation systems increase surgical precision and are commonly used for neurosurgery and endoscopic sinus surgery.  Recent hardware/software advances have opened the door for computer aided surgery to be used for in maxillofacial reconstruction. Applications include complex congenital, post-traumatic, and post-oncologic restoration of facial symmetry; particularly when working around the orbit, naso-orbito-ethmoid, and zygomaticomaxillary complexes.

Computer aided maxillofacial surgery can be divided into two categories: pre-surgical “planning” and intra-operative surgical “navigation.” Pre-surgical planning software allows surgeons to import 2-dimensional computed tomography data and generate a precise 3-dimensional, virtual representation of the skull. The proposed surgical repair (including osteotomies and bone advancements/reconstruction) can then be performed in a virtual environment prior to the actual procedure. The virtual pre-surgical plan can then be imported into an intra-operative navigational system. Navigation is used to guide movement of bone segments and confirm the location of implants to improve surgical precision.

Intra-operative navigation is currently available at most US institutions, and pre-surgical planning software is becoming more available. There are many publications in the current literature describing the use of these techniques for maxillofacial reconstruction. Unfortunately there are few, if any, opportunities for residents and practicing surgeons to get hands-on experience. The proposed course will offer this hands-on training.

The course will be divided in two parts; a computer based pre-surgical planning “dry” lab, and a cadaver based intra-operative navigation “wet” lab. The dry lab will start with a series of didactic lectures (presented by distinguished, international, multidisciplinary faculty) reviewing pre-surgical planning terminology, available software packages, and finishing with a review of cutting edge planning techniques. Computer work stations will be provided to each participant (two per work station). Individual CT data sets from “pre-scanned” and “pre-injured” cadavers will be loaded onto each work station (i.e. left sided orbital fracture and a right sided zygoma fracture). The participants will then generate a virtual pre-surgical plan for their cadaver by mirroring the opposite, uninjured side to the contralateral injured side. This will be done in an interactive format whereby a sample pre-surgical plan is being generated on the main screen, and the participants will follow along in a step-by-step fashion with their individual cadaveric specimen. The faculty will circulate to give individual assistance to the participants.

After completion of the pre-sugical plan, each data set will be transferred to a corresponding wet lab work station to be used the following day. Each lab station will include: 1) The cadaver on which the individual pre-surgical plan was performed, 2) Surgical instrumentation, and  3) an intra-operative navigation system.  The participants will learn how to set up and register the navigation system on their cadaveric specimen. They will then reduce the left orbital and right zygomatico-maxillary complex fracture using their individual presurgical plan, while using the navigation system to confirm the bony reduction and guide implant placement. Once the surgical repair is complete, the heads will again be scanned using a portable scanner. The data will then be immediately uploaded onto computer work stations, allowing the participants to compare the planned repair with the actual repair.

Enrollment is open to practicing surgeons, fellows, and residents PGY 3 and above in Oral and Maxillofacial, Plastic Surgery, Otolaryngology, Facial Plastic and Reconstructive Surgery, Oculoplastic surgery, and other surgical specialties involved in stable internal fixation that have completed the Principles of Operative Treatment of Craniomaxillofacial Trauma and Reconstruction Course.