BCD uses computers for anatomical reconstruction

Anatomical reconstruction has always required the utmost artistry and skill. These days the computer is a new ally in the quest for perfection.

Suzanne Verma, assistant professor and anaplastologist in the Texas A&M Health Science Center Baylor College of Dentistry Department of Oral and Maxillofacial Surgery, now uses technology as the canvas for her scientific artistry.

Anaplastology – the art and science of restoring a malformed or missing part of the human body through artificial means – is being transformed by advances in digital technology. From presurgical planning with medical and dental specialists through the delivery of a finished prosthesis, advanced technology is enhancing outcomes.

“We can use radiographic data to virtually create a 3D model of our patients, allowing us to preoperatively plan where to place an implant, plan the surgical approach for removing a tumor or use the data to create a physical model of the missing anatomy,” Verma says.

Computer-assisted image-guided surgery is one valuable tool that Verma and the oral and maxillofacial surgery team are applying to craniofacial reconstruction. This navigational surgery—nicknamed by insiders as “GPS in the OR”—provides real-time three-dimensional information during a procedure.  Radiographic data previously collected from the patient can be fused together in advance and used to plan a surgical approach such as implant placement.  When in surgery, the patient is registered in the virtual world, and surgeons can touch the patient with a navigated instrument or “tracking wand” and see precisely where they are in real time and whether they are on target with the preoperative plan.

This technology also gives them flexibility to resort to a predetermined Plan B when Plan A is deemed less than ideal during surgery. By allowing for repositioning during surgery, image-guided navigation eliminates the need for a physical surgical guide and can enhance clinical efficiency and improve treatment outcomes.

Take the case of a patient who wants to replace a missing ear. The patient benefits from Verma’s artistry in creating a new prosthetic ear out of silicone to perfectly match the size, shape and color of the other natural ear. To attach this silicone prosthetic ear, bone-anchored implants are needed for retention; they should be positioned beneath the thickest parts of the prosthetic ear in order to be concealed and function ideally. Teamwork between the surgeon and the anaplastologist is essential as always for optimal outcomes.

“Before the digital age, I would have the patient come in for an appointment, spend hours in the lab to sculpt the new ear out of wax, have the patient come back to try it on, then decide implant locations, which I would mark on an acrylic surgical guide I provided to the surgeon,” says Verma. “All of this was just the presurgical aspect of my anaplastology work.

“Now all I need for preoperative planning is a CT scan or MRI of the patient’s head that meets certain precise quality guidelines,” continues Verma. “Using specialized computer software, I can virtually separate the soft tissue from the skull, take the image of the good ear and mirror it onto the side of the skull with the defect; something we can only do with virtual software.

“While this helps determine ideal implant placement from a prosthetic and esthetic perspective, I can also measure bone depth and quantity; essential criteria for implant success,” she adds.

Four to six months following surgery, after the implants are fully integrated with the bone and the soft tissue is healed, the patient returns for a series of appointments with Verma, who uses a combination of art, science and digital technology to create a prototype and mold for the patient’s silicone ear. This allows near-perfect symmetry and saves both Verma and the patient time.

At this point, the anaplastologist’s hand skills and artistry take center stage. Verma still spends up to a week in the clinic and lab creating the perfect ear by pigmenting silicone to perfectly match the patient’s skin tone, pigmentation and vascularization.

The scope of technological advancements in Verma’s field is far-reaching. She is involved on an international level with a multidisciplinary group called Advanced Digital Technology in Head and Neck Reconstruction, which she serves as a member of its scientific advisory board.

“We meet every three years, and it’s amazing to hear how interdisciplinary craniofacial teams around the world are applying new technology to patient care,” Verma says.

Verma collaborates on navigational surgery with departmental faculty members such as Drs. Gil Triplett, Bob Schow and Marianela Gonzalez; former chief residents Drs. Brian Stone and Michael Ding, now in private practice; and medical and dental professionals at Baylor University Medical Center, Children’s Medical Center and Medical City Dallas Hospital.

International foundations such as the LEAP Foundation have paid travel and medical costs to send underprivileged international patients to Verma for care.