Pioneers in Modern Craniofacial Surgery: Assessing the Academic Impact of Drs. Joseph Gruss and Paul Manson.

BACKGROUND: The authors conducted this study to assess the impact that Drs. Joseph Gruss and Paul Manson have had on craniofacial surgery through their individual contributions and through their trainees. METHODS: This was a retrospective analysis of fellows trained by either Dr. Gruss or Dr. Manson. Demographic and bibliometric measures were recorded for each fellow. Demographic factors included years since completion of fellowship training, current practice of craniomaxillofacial surgery, academic practice, and academic leadership roles. Bibliometric measures included number of publications, number of citations, and h-index. To adjust for scholarly activity before fellowship training, only contributions published after fellowship training were included. RESULTS: Over a 39-year period, a total of 86 surgeons completed fellowship training with either of the two principal surgeons. The mean time since completion of training was 18.7 ± 11.4 years. Seventy-nine percent of surgeons had active practices in craniomaxillofacial surgery; 54 percent had academic practices. The mean number of publications was 26.4 ± 69.3, the mean number of citations was 582 ± 2406, and the average h-index was 6.7 ± 10.6. Among academic surgeons, the average h-index was 10.7 ± 13.1, 89 percent practiced in North America, 89 percent had active practices in craniomaxillofacial surgery, and nearly 50 percent had achieved a leadership role. CONCLUSIONS: Modern craniofacial reconstruction has evolved from principles used in trauma and correction of congenital differences. The extensive impact that Drs. Paul Manson and Joseph Gruss have had on the field, and plastic surgery at large, is evident through their primary contributions and the immense impact their trainees have had on the field.

Caracterización de programas de formación de especialistas en cirugía maxilofacial en Estados Unidos, Canadá y Chile / Postgraduate programs of maxillofacial surgery in United States, Canada and Chile

La cirugía maxilofacial es una especialidad quirúrgica que nace del trabajo mancomunado de dentistas y médicos cirujanos en el tratamiento de patologías de complejidad creciente. En el mundo actualmente existe diversidad en los requisitos de grado académico al ingreso, en la organización curricular y en el tipo de graduación al egreso de los programas de formación de esta especialidad. Debido a la necesidad de respaldo legal, ético y curricular en el quehacer médico complejo de esta especialidad y la tendencia mundial a desarrollar vías de doble graduación para responder a tal necesidad, se busca conocer la realidad actual de los programas de graduación de la especialidad en Estados Unidos, Canadá y Chile

Maxillofacial Surgery is a surgical specialty developed from mancommunated work of Dentists and Physicians in the treatment of pathologies of increasing complexity. In the world there is currently a diversity in the requirements of academic degree in income, in the curricular organization and in the type of graduation in the training program of this specialty. Need for legal, ethical and curricular support in the complex medical work of this specialty and the worldwide trend in the development of double graduation to respond to this need cause this study to know about potsgraduate programs of the specialty in the United States, Canada and Chile

A History of Orthognathic Surgery in North America.

This review highlights the contributions of American oral and maxillofacial surgeons to the field of orthognathic surgery. The present state of the art and science of orthognathic surgery is the harvest of yesterday's innovation and research. An improved understanding of the biological and surgical principles and the routine involvement of orthodontics have fueled widespread adoption of a coordinated approach to the treatment of dentofacial problems. Technologic advances in rigid internal fixation, virtual surgical planning with computer-aided manufacturing of occlusal splints and cutting guides, custom implants, and worldwide interest in the correction of dentofacial and craniofacial deformities have resulted in highly predictable, efficient, and safe treatment, which scarcely resembles the situation 70 years ago.

An innovative virtual reality training tool for orthognathic surgery.

Virtual reality (VR) surgery using Oculus Rift and Leap Motion devices is a multi-sensory, holistic surgical training experience. A multimedia combination including 360° videos, three-dimensional interaction, and stereoscopic videos in VR has been developed to enable trainees to experience a realistic surgery environment. The innovation allows trainees to interact with the individual components of the maxillofacial anatomy and apply surgical instruments while watching close-up stereoscopic three-dimensional videos of the surgery. In this study, a novel training tool for Le Fort I osteotomy based on immersive virtual reality (iVR) was developed and validated. Seven consultant oral and maxillofacial surgeons evaluated the application for face and content validity. Using a structured assessment process, the surgeons commented on the content of the developed training tool, its realism and usability, and the applicability of VR surgery for orthognathic surgical training. The results confirmed the clinical applicability of VR for delivering training in orthognathic surgery. Modifications were suggested to improve the user experience and interactions with the surgical instruments. This training tool is ready for testing with surgical trainees.

A predictive bone drilling force model for haptic rendering with experimental validation using fresh cadaveric bone.

PURPOSE: Bone drilling simulators with virtual and haptic feedback provide a safe, cost-effective and repeatable alternative to traditional surgical training methods. To develop such a simulator, accurate haptic rendering based on a force model is required to feedback bone drilling forces based on user input. Current predictive bone drilling force models based on bovine bones with various drilling conditions and parameters are not representative of the bone drilling process in bone surgery. The objective of this study was to provide a bone drilling force model for haptic rendering based on calibration and validation experiments in fresh cadaveric bones with different bone densities. METHODS: Using a commonly used drill bit geometry (2 mm diameter), feed rates (20-60 mm/min) and spindle speeds (4000-6000 rpm) in orthognathic surgeries, the bone drilling forces of specimens from two groups were measured and the calibration coefficients of the specific normal and frictional pressures were determined. RESULTS: The comparison of the predicted forces and the measured forces from validation experiments with a large range of feed rates and spindle speeds demonstrates that the proposed bone drilling forces can predict the trends and average forces well. CONCLUSION: The presented bone drilling force model can be used for haptic rendering in surgical simulators.

Demographics, training satisfaction, and career plans of Canadian oral and maxillofacial surgery residents.

The purpose of this study was to evaluate the demographics, training satisfaction, and career plans of Canadian oral and maxillofacial surgery (OMS) residents. A cross-sectional study was conducted using an anonymous online survey that was distributed via e-mail to all current Canadian OMS residents. The completion rate of this survey was 88.9%. Eighty percent of residents were satisfied with their surgical education overall. Residents were most satisfied with their training in the areas of facial trauma and orthognathic surgery. Satisfaction was lowest in the areas of facial cosmetic surgery, maxillofacial reconstructive surgery, cleft and craniofacial surgery, and dental implantology. A majority of residents, 78.1%, indicated that they would prefer to be trained in an MD-integrated OMS certificate program. Seventy-two percent of residents indicated that they would like to complete a fellowship following graduation. The most desirable career path was a combination of private practice and academic practice, with 75.0% of residents selecting this option. Overall, Canadian OMS residents were pleased with their training in the traditional scope of OMS, apart from dental implantology. Among the current generation of trainees, there appears to be a proclivity for a broader scope of practice, dual-degree training, and post-graduate fellowship training.

[Understanding of medical information provided during orthognathic surgery consultations]. / Compréhension de l'information médicale délivrée lors des consultations de chirurgie orthognathique.

INTRODUCTION: A prospective study was conducted from November 2012 to May 2013 to assess what patients had understood after their preoperative consultations for orthognathic surgery. We studied the impact of a written document created in the department, containing the information given during the consultation. MATERIALS AND METHODS: Fifty patients were asked to complete 2 questionnaires given to the patient the day before surgery. The first was used to assess what the patients had understood; it included 20 multiple-choice questions on information given during consultation and in the written document. For each item, the patient had to check what he thought to be the right answer. Each correct answer was graded at 1 and each incorrect answer or no answer was graded at 0. The maximum score was 20/20. The second was to assess the written document. Each item was graded from 1 to 10 (Likert-type scale). RESULTS AND CONCLUSION: Thirty-two patients answered both questionnaires. The average score for the first was 15.03/20 (P<0.05), significantly higher than the theoretical average set at 10 (P<0.05). The written document was found understandable (score 8.47/10) and information easy to find (score 7.28/10). The document provided answers to the patients' questions (score 7.50/10), using information given during consultation (score 7.56/10). DISCUSSION: The 2 consultations and the written document helped patients better understand orthognatic care and surgery.

The necessity to establish surgical orthodontic fellowship program for orthodontists.

INTRODUCTION: Medical field is developing very rapidly and is becoming more specialized. Orthodontics is of no exception. Thus, the purpose of this study was to evaluate the necessity of establishment of surgical orthodontic fellowship program for orthodontists in order to provide them with better insight. MATERIALS AND METHODS: A 10 multiple choice question survey was taken from 270 orthodontists who participated in the European Orthodontic Society Congress in Istanbul, 2011. The results were tabulated and analyzed. RESULTS: 52% of the respondents believed that the knowledge of treatment of orthognathic surgery patients can be significantly improved by adding a fellowship of orthognathic surgery after the residency program. CONCLUSION: Adding such program can be very constructive and will give better insight to orthodontists in regards to treatment of orthognathic patients.

Validação de constructo de tecnologia educativa para pacientes mediante aplicação da técnica Delphi / Validación de un constructo de tecnología educativa para pacientes mediante la aplicación de la técnica Delphi / Construct validation of educational technology for patients through the application of the Delphi technique

OBJETIVO: Descrever o processo de validação de uma tecnologia educativa para pacientes submetidos à cirurgia ortognática, mediante a aplicação da técnica Delphi. MÉTODOS: Participaram do estudo, dez juízes (quatro cirurgiões bucomaxilofaciais, duas enfermeiras, duas nutricionistas e duas fonoaudiólogas) que indicaram os assuntos a serem abordados no material destinado à primeira fase da técnica Delphi. Após a construção do material e a obtenção dos resultados da primeira fase, iniciou-se as segunda e terceira fases dessa técnica com validação da pertinência das informações contidas nessa tecnologia educativa. RESULTADOS: Na segunda rodada, obteve-se, pelo menos, 90,0% de concordância em todas as categorias. Na terceira, houve um aumento de 12% para o item conteúdo, melhora de 6,7% em linguagem, de 12,5% em ilustrações, de 3,3% no layout, de 10% em cultura, mantendo-se constante o item motivação. CONCLUSÃO: A técnica Delphi, pode ser uma importante ferramenta na construção e validação de tecnologias educativas.

OBJECTIVE: To describe the validation process of an educational technology for patients undergoing orthognathic surgery, through the application of the Delphi technique. METHODS: Participating in the study were ten experts (four maxillofacial surgeons, two nurses, two nutritionists and two speech therapists) who indicated the subjects to be covered in the material for the first phase of the Delphi technique. After constructing the material and obtaining the results of the first phase, the second and third phases of this technique were initiated with validation of the pertinence of the information contained in this educational technology. RESULTS: In the second round we obtained at least 90.0% agreement in all categories. In the third, the following improvements were noted: 12% for the content item, 6.7% for language, 12.5% for illustrations, 3.3% for layout, 10% for culture; the motivation item was unchaged. CONCLUSION: The Delphi technique can be an important tool in the construction and validation of educational technologies.

OBJETIVO: Describir el proceso de validación de una tecnología educativa para pacientes sometidos a cirugía ortognática, mediante la aplicación de la técnica Delphi. MÉTODOS: Participaron en el estudio, diez jueces (cuatro cirujanos bucomaxilofaciales, dos enfermeras, dos nutricionistas y dos fonoaudiólogas) que indicaron los asuntos a ser abordados en el material destinado a la primera fase de la técnica Delphi. Después de la construcción del material y la obtención de los resultados de la primera fase, se inició la segunda y tercera fases de esa técnica con validación de la pertinencia de las informaciones contenidas en esa tecnología educativa. RESULTADOS: En la segunda vuelta, se obtuvo, por lo menos, el 90,0% de concordancia en todas las categorías. En la tercera, hubo un aumento del 12% para el item contenido, mejora del 6,7% en lenguaje, del 12,5% en ilustraciones, del 3,3% en el esbozo, del 10% en cultura, manteniéndose constante el item motivación. CONCLUSIÓN: La técnica Delphi, puede ser una herramienta importante en la construcción y validación de tecnologías educativas.

Preliminary study of virtual orthognathic surgical simulation and training.

BACKGROUND AND OBJECTIVE: Virtual surgical simulation and training system offers a cost-effective and efficient alternative to traditional training and surgical planning. However, the algorithm for surgical simulation is sophisticated, and the requirement of computer software and hardware is high. The objective of this study was to explore the feasibility of tree-structure architectonic model in simplifying and realizing virtual orthognathic surgical simulation. METHODS: Four patients with skeletal malocclusions were enrolled in this study. Craniomaxillofacial computed tomography scan was obtained, and three-dimensional model was reconstructed using Simplant software. Maxillary Le Fort I osteotomy, bilateral sagittal split ramus osteotomy, vertical ramus osteotomy, and genioplasty were carried out on the three-dimensional model in advance. Tree-structure architectonic model was established in the sterolithography format. With stereoscopic glasses, using digital gloves, operators immersed in virtual environment and operated on "real" patients performing surgical simulation. RESULTS: Through establishing tree-structure architectonic model in advance, the complex algorithm for virtual osteotomy was simplified, and computational complexity was reduced. Three-dimensional model can be visualized from any viewing point. Operators were immersed in the virtual environment with a conspicuous sense of immersion. An obvious image and tactile feedback was perceived when touching and moving the bony segments. Virtual orthognathic surgical simulation and training were realized with real-time image and tactile perception feedback. CONCLUSIONS: Establishing tree-structure architectonic model in advance is an ideal alternative in implementing virtual orthognathic surgical simulation. Virtual surgical simulation and training were realized with a strong sense of immersion. Craniomaxillofacial three-dimensional virtual surgical simulation system can be used in orthognathic surgical planning, simulation, and operation training.

Haptic model fabrication for undergraduate and postgraduate teaching.

Three series of cone-beam computed tomography (CBCT) patient data sets were obtained. These data were exported into DICOM and MIMICS (Materialise's Interactive Medical Image Control System; Materialise, Leuven, Belgium) and were imported for differentiation of various tissues (bone, teeth, and nerve). After transferring the data to an additive manufacturing machine, three-dimensional (3D) haptic models were fabricated using clear and opaque materials. These models were integrated into phantom heads normally used for education in undergraduate dental education. 3D prototype CBCT-based haptic patient models can be used in undergraduate and postgraduate education. Students can simulate routine standard oral surgical procedures with supervision under 'dry conditions'. Residents can simulate advanced and complex cases before performing the real operation.