arXiv subjects

Franck Boutault

Publications and source records attributed to Franck Boutault.

15 recordsLinked to original sources

arXiv2007

Computer aided planning and navigation for orbito-zygomatic reconstruction

This paper suggests a full protocol of Computer Aided Surgery as previously recommended in literature addressing the challenging task of primary or secondary reconstruction of orbito-zygomatic dislocation. First, on a specifically developed planning software, the best zygoma reduction and orbital boundaries reconstruction to achieve skeletal symmetry are determined. This treatment plan is then transferred to the 3D Navigation Systems within the operating room. After patient's anatomy registration to his preoperative CT scan data, the navigation system allows zygomatic guiding to its planned reduced location and bone orbital volume restoration control. The feasibility of this technique was checked in 3 patients with major orbito-zygomatic deformities. Preliminary clinical results are presented.

physics.med-ph↗

arXiv2007

Intra-operative quantification of the surgical gesture in orbital surgery: Application to the proptosis reduction

Proptosis is characterized by a protrusion of the eyeball due to an increase of the orbital tissue volume. To recover a normal eyeball positioning, the most frequent surgical technique (BROD technique) consists in the osteotomy of orbital walls combined with a loading on the eyeball to initiate tissue decompression. This paper proposed an experimental method to quantify the intra-operative clinical gesture in proptosis reduction, and the pilot study concerned one clinical case. The eyeball's backward displacement was measured by an optical 3D localizer and the load applied by the surgeon was simultaneously measured by a custom-made force gauge. Quasi-static stiffness of the intra-orbital content was evaluated. The average values for the whole experiment was 16 N (SD: 3 N) for the force exerted by the surgeon and 9 mm (SD: 4 mm) for the eyeball backward displacement. The averaged quasi-static stiffness of the orbital content was evaluated to 2.4 N/mm (SD: 1.2) and showed a global decrease of 45% post-operatively.

physics.med-ph↗

arXiv2006

Maxillofacial computer aided surgery: a 5 years experience and future

This paper gives a review of the experience provided by our group in terms of computer aided maxillo-facial surgery.

physics.med-ph↗

arXiv2006

A 3D Finite Element evaluation of the exophthalmia reduction

This paper presents a first evaluation of the feasibility of Finite Element modelling of the orbital decompression, in the context of exophthalmia. First simulations are carried out with data extracted from a patient TDM exam. Results seem to qualitatively validate the feasibility of the simulations, with a Finite Element analysis that converges and provides a backward movement of the ocular globe associated with displacements of the fat tissues through the sinuses. This FE model can help a surgeon for the planning of the exophthalmia reduction, and especially for the position and the size of the decompression hole. To get an estimation of the fat tissues volume affected by the surgery, an analytical model seems to provide quicker results for an equivalent efficiency.

physics.med-ph↗

arXiv2006

Computer aided planning for orthognatic surgery

A computer aided maxillofacial sequence is presented, applied to orthognatic surgery. It consists of 5 main stages: data acquisition and integration, surgical planning, surgical simulation, and per operative assistance. The planning and simulation steps are then addressed in a way that is clinically relevant. First concepts toward a 3D cephalometry are presented for a morphological analysis, surgical planning, and bone and soft tissue simulation. The aesthetic surgical outcomes of bone repositioning are studied with a biomechanical Finite Element soft tissue model.

physics.med-ph↗

arXiv2006

Evaluating soft tissue simulation in maxillofacial surgery using pre and post-operative CT scan

One of the most important issue in soft tissue modeling is to assess the quality of the simulations. A validation protocol is presented based on two CT scans of the patient acquired before and after cranio-maxillofacial surgery. The actual bones repositioning realized during the intervention are accurately measured and reproduced. A evaluation of the soft tissue deformation is then computed using a finite element model of the face. The simulations are therefore compared, qualitatively and quantitatively, with the actual outcome of the surgery. This protocol enable to rigorously evaluate different modeling methods, and to assess the clinical relevance of soft tissue simulation in maxillofacial surgery.

physics.med-ph↗

arXiv2006

A stiffness sensor to help in the diagnosis and the surgery of orbital pathologies

physics.med-ph↗

arXiv2006

Computer-aided planning for zygomatic bone reconstruction in maxillofacial traumatology

An optimal planning procedure has been proposed to define the target position of the zygomatic bone following a fracture of the mid-face skeleton. The protocol has been successfully tested on healthy subjects, and ensures the global symmetry of the face could be obtained after the reconstruction surgery. Now that the planning procedure is available, the next step of this project will be to develop an intra-operative guiding system to help the surgeon to follow the planning. This procedure will mainly rely on the intra-operative registration of the zygomatic bone fragment, and the design of specific surgical ancillaries for cranio-maxillofacial surgery.

physics.med-ph↗

arXiv2006

Biomechanics applied to computer-aided diagnosis: examples of orbital and maxillofacial surgeries

This paper introduces the methodology proposed by our group to model the biological soft tissues deformations and to couple these models with Computer-Assisted Surgical (CAS) applications. After designing CAS protocols that mainly focused on bony structures, the Computer Aided Medical Imaging group of Laboratory TIMC (CNRS, France) now tries to take into account the behaviour of soft tissues in the CAS context. For this, a methodology, originally published under the name of the Mesh-Matching method, has been proposed to elaborate patient specific models. Starting from an elaborate manually-built "generic" Finite Element (FE) model of a given anatomical structure, models adapted to the geometries of each new patient ("patient specific" FE models) are automatically generated through a non-linear elastic registration algorithm. This paper presents the general methodology of the Mesh-Matching method and illustrates this process with two clinical applications, namely the orbital and the maxillofacial computer-assisted surgeries.

physics.med-ph↗

arXiv2006

A finite element study of the influence of the osteotomy surface on the backward displacement during exophthalmia reduction

Exophthalmia is characterized by a protrusion of the eyeball. The most frequent surgery consists in an osteotomy of the orbit walls to increase the orbital volume and to retrieve a normal eye position. Only a few clinical obser-vations have estimated the relationship between the eyeball backward dis-placement and the decompressed fat tissue volume. This paper presents a method to determine the relationship between the eyeball backward displace-ment and the osteotomy surface made by the surgeon, in order to improve ex-ophthalmia reduction planning. A poroelastic finite element model involving morphology, material properties of orbital components, and surgical gesture is proposed to perform this study on 12 patients. As a result, the osteotomy sur-face seems to have a non-linear influence on the backward displacement. More-over, the FE model permits to give a first estimation of an average law linking those two parameters. This law may be helpful in a surgical planning frame-work.

physics.med-ph↗

arXiv2006

Comparison of linear and non-linear soft tissue models with post-operative CT scan in maxillofacial surgery

A Finite Element model of the face soft tissue is proposed to simulate the morphological outcomes of maxillofacial surgery. Three modelling options are implemented: a linear elastic model with small and large deformation hypothesis, and an hyperelastic Mooney-Rivlin model. An evaluation procedure based on a qualitative and quantitative comparison of the simulations with a post-operative CT scan is detailed. It is then applied to one clinical case to evaluate the differences between the three models, and with the actual patient morphology. First results shows in particular that for a "simple" clinical procedure where stress is less than 20%, a linear model seams sufficient for a correct modelling.

physics.med-ph↗

arXiv2006

Models for Planning and Simulation in Computer Assisted Orthognatic Surgery

Two aspects required to establish a planning in orthognatic surgery are addressed in this paper. First, a 3D cephalometric analysis, which is clini-cally essential for the therapeutic decision. Then, an original method to build a biomechanical model of patient face soft tissue, which provides evaluation of the aesthetic outcomes of an intervention. Both points are developed within a clinical application context for computer aided maxillofacial surgery.

physics.med-ph↗

arXiv2006

Simulation of the Exophthalmia Reduction using a Finite Element Model of the Orbital Soft Tissues

This paper proposes a computer-assisted system for the surgical treatment of exophthalmia. This treatment is classically characterized by a de-compression of the orbit, by the mean of an orbital walls osteotomy. The plan-ning of this osteotomy consists in defining the size and the location of the de-compression hole. A biomechanical model of the orbital soft tissues and its in-teractions with the walls are provided here, in order to help surgeons in the definition of the osteotomy planning. The model is defined by a generic Finite Element poro-elastic mesh of the orbit. This generic model is automatically adapted to the morphologies of four patients, extracted from TDM exams. Four different FE models are then generated and used to simulate osteotomies in the maxillary or ethmoid sinuses regions. Heterogeneous results are observed, with different backwards movements of the ocular globe according to the size and/or the location of the hole.

physics.med-ph↗

arXiv2006

Prediction of tissue decompression in orbital surgery

Objective: A method to predict the relationships between decompressed volume of orbital soft tissues, backward displacement of globe after osteotomy, and force exerted by the surgeon, was proposed to improve surgery planning in exophthalmia reduction. Design: A geometric model and a poroelastic finite element model were developed, based on Computed Tomography scan data. Background: The exophthalmia is characterised by a protrusion of the eyeball. Surgery consists in an osteotomy of the orbit walls to decompress the orbital content. A few clinical observations ruling on an almost linear relationship between globe backward displacement and tissue decompressed volume are described in the literature. Methods: Fast prediction of decompressed volume is derived from the geometric model: a sphere in interaction with a cone. Besides, a poroelastic Finite Element model involving morphology, material properties of orbital components and surgical gesture was implemented. Results: The geometric model provided a better decompression volume estimation than the Finite Element model. Besides, the Finite Element model permitted to quantify the backward displacement, the surgical gesture and the stiffness of the orbital content. Conclusions: The preliminary results obtained for one patient, in accordance with the clinical literature, were relatively satisfying. An efficient aid for location and size of osteotomies was derived and seemed to be able to help in the surgery planning. Relevance: To our knowledge, this paper concerns the first biomechanical study of exophthalmia reduction. The approach permitted to improve the treatment of orbitopathy and can be used in a clinical setting.

physics.med-ph↗

arXiv2006

Computer assisted planning and orbital surgery: patient-related prediction of osteotomy size in proptosis reduction

BACKGROUND: Proptosis is characterized by a protrusion of the eyeball due to an increase of the orbital tissue volume. To recover a normal eyeball positioning, the most frequent surgical technique consists in the osteotomy of orbital walls combined with the manual loading on the eyeball. Only a rough clinical rule is currently available for the surgeons but it is useless for this technique. The first biomechanical model dealing with proptosis reduction, validated in one patient, has been previously proposed by the authors. METHODS: This paper proposes a rule improving the pre-operative planning of the osteotomy size in proptosis reduction. Patient-related poroelastic FE models combined with sensitivity studies were used to propose two clinical rules to improve the pre-operative planning of proptosis reduction. This poroelastic model was run on 12 patients. Sensitivity studies permitted to establish relationships between the osteotoemy size, the patient-related orbital volume, the decompressed tissue volume and the eyeball backward displacement. FINDINGS: The eyeball displacement and the osteotomy size were non-linearly related: an exponential rule has been proposed. The patient-related orbital volume showed a significant influence: a bi-quadratic analytical equation liking the osteotomy size, the orbital volume and the targeted eyeball protrusion has been established. INTERPRETATION: Two process rules derived from patient-related biomechanical FE models have been proposed for the proptosis reduction planning. The implementation of the process rules into a clinical setting is easy since only a sagittal radiography is required. The osteotomy size can be monitored using optical guided instruments.

physics.med-ph↗