Progress in Three-Dimensional Imaging at the Texas Craniofacial Center

Abstract

Three-dimensional imagery via the use of sophisticated computer graphics has been highly touted by the media and others as a new technology which will revolutionize traditional approaches to surgery [1, 2], and to craniomaxillofacial surgery in particular. However, such new technology obviously does not in and of itself perform surgery or improve the quality of surgery per se. The question we must ask, however, is: Is computer-assisted three-dimensional reconstruction of benefit to the surgeon in enhancing his diagnostic acumen and improving his assessment and planning of the proposed surgery, thereby increasing surgical efficiency? Possible additional beneficial uses of computer-assisted three-dimensional imaging could be the ability to document the results of surgery and provide long-term postoperative follow-up. Furthermore, three-dimensional imaging could be of benefit in a teaching environment, in that it would provide medical students, residents, and fellows with a graphic, life-like image of the underlying bony pathology in patients with craniomaxillofacial disorders. To evaluate these possible uses of three-dimensional computer imaging, we at the Texas Craniofacial Center have examined over 300 cases of craniomaxillofacial deformities in which over 350 three-dimensional CT reconstructions were performed over the past 2 years. The age of the patients studied ranged from 1 day to 56 years, with infants and children constituting the majority of our patient population. Because of the nature of our referral system, congenital deformities accounted for approximately three-quarters of the craniomaxillofacial deformities studied, the remainder being divided between acquired defects and tumors (Table 1). The most common congenital deformity studied was craniosynostosis, which constituted almost one-half of the congenital defects encountered. Some other congenital deformities studied were facial clefts, hemifacial microsomia, hypertelorism, Treacher Collins syndrome, and encephaloceles (Table 2). The vast majority of acquired defects were secondary to trauma, with the remainder being due to infection, exorbitism and other miscellaneous defects (Table 3). Tumors encountered were fibrous dysplasia, orbital hemangiomas, and neurofibromatosis (Table 4).