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Cranial reference mount

Inactive Publication Date: 2017-01-05
THE JOHN HOPKINS UNIV SCHOOL OF MEDICINE
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Benefits of technology

The patent describes a surgical guide assembly for attaching a bone to another bone or soft tissue. The assembly includes a body with an opening and an arm extending from it. There is a joint with an outer and inner ring that moves to change the angle between the central axes of the rings. A screw is used to secure the assembly to the bone. The technical effect of this invention is to provide a precise and secure guide for surgical procedures that allows for precise bone cuts and joint formation.

Problems solved by technology

Facial transplantation represents one of the most complicated scenarios in craniomaxillofacial surgery due to skeletal, aesthetic, and dental discrepancies between donor and recipient.
Two broad approaches to computer-assisted surgery (CAS) have gained popularity:1) pre-operative computer surgical planning and the use of three-dimensional computer manufactured surgical guides (3D CAD / CAM) to cut and reposition bone and soft tissue, and2) utilizing intraoperative feedback relative to preoperative imaging for the surgeon to provide more objective data on what is happening beyond the “eyeball test.” However, none are meant for real-time placement feedback in areas where guide placement is more challenging, such as the three-dimensional facial skeleton.
Also, there are no single platforms built to provide BOTH planning AND navigation—with seemless integration.
Additionally, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate problems associated with the increased complexity of this particular procedure.
Furthermore, there are currently no validated methods for optimizing outcomes related to facial (e.g., soft tissue), skeletal (e.g., hard tissue), and occlusal (e.g., dental) inconsistencies in the setting of donor-to-recipient anthropometric mismatch—a major hurdle to achieving this specialty's full potential.
However, such a system uses standard off-the-shelf vendor systems and does not include necessary features to mitigate the increased complexity of this particular procedure.
Additionally, known CAS paradigms for craniomaxillofacial surgery provide little capacity for intraoperative plan updates.

Method used

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Examples

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example 1

[0075]Live transplant surgeries (n=2) between four size-mismatched swine investigated whether or not an embodiment could actually assist a surgical team in planning and executing a desired surgical plan. As shown in FIGS. 9A-9B, the first live surgery confirmed the proposed utility of overcoming soft and hard tissue discrepancies related to function and aesthetics. The final occlusal plane within the first recipient was ideal and consistent with the virtual plan as seen on lateral cephalogram as shown in FIG. 10C. Pre-operative functional predictions of donor-to-recipient occlusion were realized based on cephalometric analyses as shown in FIG. 9C performed both before and after surgery. Soft tissue inconsistencies of the larger-to-smaller swine scenario were also reduced following the predicted movements of face, jaw and teeth as shown in FIG. 10D.

[0076]The second live surgery showed improved success as compared to its predecessor due to surgeon familiarity and technology modificati...

example 2

[0080]Female and male donor heads (n=2), double-jaw, Le Fort III-based alloflaps were harvested using handheld osteotomes, a reciprocating saw, and a fine vibrating reciprocating saw. Both osteocutaneous alloflaps were harvested using a double-jaw, Le Fort III-based design (a craniomaxillofacial disjunction), with preservation of the pterygoid plates, incorporating all of the midfacial skeleton, complete anterior mandible with dentition, and overlying soft tissue components necessary for ideal reconstruction.

[0081]Prior to transplantation, both scenarios were completed virtually given the gender-specific challenges to allow custom guide fabrication as shown in panels A-H of FIG. 12. Once assimilated, the donor orthognathic two-jaw units were placed into external maxilla-mandibular fixation (MMF) using screw-fixated cutting guides to retain occlusal relationships during the mock transplants as shown in panels A-D of FIG. 13.

[0082]As shown in FIGS. 13, 14A-14B, an embodiment of a cutt...

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Abstract

A surgical guide assembly includes a body having an opening formed at least partially therethrough. An arm extends from the body. A joint is positioned at least partially in the arm. The joint includes an outer ring and an inner ring. The inner ring is configured to move with respect to the outer ring such that an angle between a central longitudinal axis through the inner ring varies with respect to a central longitudinal axis through the outer ring.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS[0001]This application claims priority from U.S. Provisional Patent Application Ser. Nos. 61 / 910,204, filed Nov. 29, 2013; 61 / 940,196, filed Feb. 14, 2014; and 62 / 049,866, filed Sep. 12, 2014, each of which is hereby incorporated by reference in its entirety.GOVERNMENT SUPPORT STATEMENT[0002]This invention was made with government support under NCATS Grant No. UL1TR000424-06 awarded by the National Institutes of Health. The government has certain rights in the invention.FIELD OF THE INVENTION[0003]This invention relates generally to the field of surgery, particularly craniomaxillofacial surgery, and specifically to the field of computer-assisted craniomaxillofacial surgery and all related orthognathic, neurosurgical and head / face / neck surgical procedures and associated methods, tools, and systems.BACKGROUND OF THE INVENTION[0004]Facial transplantation represents one of the most complicated scenarios in craniomaxillofacial surgery due to skeleta...

Claims

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Application Information

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IPC IPC(8): A61B17/15A61B34/20A61B17/80A61B17/16G16H20/40G16H30/40G16H50/50
CPCA61B17/15A61B17/8085A61B34/20A61B17/1695A61B17/176A61B2034/2055A61B2034/105A61B2034/108G16H50/50A61B17/1739Y02A90/10G16H30/40G16H20/40A61B34/10A61B2034/2051A61F2/2803A61B2034/2065
Inventor WOLFE, KEVINGORDON, CHADMURPHY, RYANARMAND, MEHRAN
Owner THE JOHN HOPKINS UNIV SCHOOL OF MEDICINE