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The University Hospital for Craniomaxillofacial and Oral
Surgery at the General Hospital in Vienna has been engaged
in computer-assisted surgery since the middle of the 1990s.
Through transmission of operations, in connection with interactive
televised consultations, we have applied and evaluated many
possible options for solving a variety of surgical problems.
We have carried out over 50 operating room transmissions,
including the transmission of the world’s first a computer-assisted
arthroscopy of the temporomandibular joint.
Arthroscopy
The University Hospital for Craniomaxillofacial
and Oral Surgery at the Vienna General Hospital performed the world’s first computer-assisted
athroscopy of the temporomandibular joint.
Publications: Wagner A, Undt G, Watzinger F, Wanschitz F,
Schicho K, Yerit K, Kermer C, Birkfellner W, Ewers R: "Principles
of computer-assisted arthroscopy of the temporomandibular
joint with optoelectronic tracking technology"; Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2001, 92(1): 30-37
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Computer-assisted arthroscopy of the temporomandibur joint: Both active and passive optical tools have been used
successfully. Computer assistance technology is also a great
advantage for medical students and doctors in training.
The positions of the arthroscope
and craniotome as well as of the patient are recorded constantly
by optoelectronic tracking technology. The sensors can be
designed in different ways and attached to the right places.
User the
surface of MedScanIITM (Artma): Using computer-tomographic
images, the paths can be exactly planned in relation to the
patient’s anatomy. The targeted point is marked yellow,
the actual position of the tip of the arthroscope is
marked red. The arthroscopic live video is integrated in the
MedScanII program surface and can be combined with the exact information of
the computer-assisted surgery.
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Axiography
With the new axiographic software (developed
in cooperation with Artma), axiographic examinations of the temporomandibular joint are much
quicker and less complicated than with the conventional axiograph. Not only does this method save time and money, it is also
much more pleasant for the patient. For the first time it
is possible to depict the graphs three-dimensionally in a chosen perspective. For
diagnostic purposes (e.g. the comparison of the pre- and postoperative
course or to observe the development of a pathology over a
longer period of time), various graphs can be layered on top
of each other. The newly developed optoelectronic system (Wagner
A, Schicho K, Seemann R et al.) requires only one light-weight-sensor
for the maxillary and the mandibular row of teeth each to
carry out a valid axiography. The infrared
digitizer records the movements, the software module calculates
the graphs and draws them
three-dimensionally.
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Computer-assisted implantology
Computer-assisted surgery is
already a routine in the field of dental implantology. Through
televised consultation via the internet, highly competent
specialists from distant hospitals can be involved in planning
the implants. Through the navigation the plan can be precisely and safely implemented.
Software: Virtual Implant NavigatorTM (Artma, Vienna)
Distraction Osteogenesis
The
operative correction of genetic deformations of the cranium
can be better planned with the use of navigation technology.
The operation is simulated
on a precise stereolithographic model, made
from computer tomographic data. Sensors transfer the positions
of some parts of the skull to the navigation system where
they are saved. As shown in the example,
the parameters for setting the temporarily implanted distractor
can be determined before the operation. Software: MedScanIITM
(Artma, Vienna)
Xenolith
removal
The removal of a small xenolith,
which was difficult to locate, was achieved with help of the
navigation technology. (Stryker - Navigation system)
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Computer-
assisted surgery
The University Hospital for Craniomaxillofacial
and Oral Surgery at the General Hospital in Vienna has been
engaged in computer- assisted surgery since the middle of
the 1990s. Through transmission of operations, in connection
with interactive televised consultations, we have applied
and evaluated many possible options for solving a variety
of problems. We have carried out a total of 50 of these operating
room transmissions (including the preclinical test
runs much more than 100 transmissions), including the transmission
of the world’s first computer-assisted arthroscopy of
the temporomandibular joint.
See: ‘Wagner A, Undt G,
Schicho K, Wanschitz F, Watzinger F, Murakami K, Ewers R.
Interactive Stereotaxic Teleassistance of Remote Experts During
Arthroscopic Procedures’. Arthroscopy; published 12/
2002
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Recent
Publications
‘ Wagner A, Ploder O, Enislidis
G, Truppe M, Ewers R. Virtual image guided navigation in tumor
surgery--technical innovation’. J Craniomaxillofac Surg.
1995 Oct;23(5):271-273.
‘Schicho
K., Ewers R. Telekonsultation und 3D-Visualisierung in der
computerunterstützten Implantologie: Der aktuelle Entwicklungsstand’;
Implantologie Journal 5/2001, S.86-88.
‘Wagner A, Ploder O, Enislidis
G, Truppe M, Ewers R. Image-guided surgery’. Int J Oral
Maxillofac Surg. 1996 Apr;25(2):147-51.
‘ Wagner A, Rasse M, Millesi
W, Ewers R. Virtual reality for orthognathic surgery: the
augmented reality environment concept’. J Oral Maxillofac
Surg. 1997 May;55(5):456-62; discussion 462-3.
‘Wagner A, Millesi W, Watzinger
F, Truppe M, Rasse M, Enislidis G, Kermer C, Ewers R.
Clinical experience with interactive teleconsultation and
teleassistance in craniomaxillofacial surgical procedures’.
J Oral Maxillofac Surg. 1999 Dec;57(12):1413-8.
‘Wagner A, Undt G, Watzinger
F, Wanschitz F, Schicho K, Yerit K, Kermer C, Birkfellner
W, Ewers R. Principles of computer-assisted arthroscopy of
the temporomandibular joint with optoelectronic tracking technology’.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001 Jul;92(1):30-7
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"Wagner A, Wanschitz F, Birkfellner W, Zauza K, Watzinger
F, Schicho K, Kainberger F, Czerny C, Bergmann H, Ewers R.
Computer-Aided Placement of Endosseous Oral Implants in Patients
after Ablative Tumor Surgery: Assessment of Accuracy. Clin
Oral Implants Res. 2003 Jun;14(3):340-8.
" Wagner A, Schicho
K, Birkfellner W, Figl M, Seemann R, König F, Ewers R. Quantitative Analysis
of Factors Affecting Intraoperative Precision and Stability of Optoelectronic
and Electromagnetic Tracking-Systems. Medical Physics 2002 May;29(5):905-12
" Wagner A, Undt G, Schicho K, Wanschitz F, Watzinger
F, Murakami K, Czerny C, Ewers R. Interactive stereotaxic
teleassistance of remote experts during arthroscopic procedures.
Arthroscopy 2002;18(9):1034-9.
" Watzinger F, Birkfellner W, Wanschitz F,
Ziya F, Wagner A, Kremser J, Kainberger F, Huber K, Bergmann H, Ewers R. Placement
of Endosteal Implants in the Zygoma after Maxillectomy: A Cadaver Study Using
Surgical Navigation. Plast Reconstr Surg. 2001 Mar;107(3):659-667.
" Wanschitz F, Birkfellner W, Figl M, Patruta S, Wagner
A, Watzinger F, Yerit K, Schicho K, Hanel R, Kainberger F,
Imhof H, Bergmann H, Ewers R. Computer-enhanced stereoscopic
vision in a head-mounted display for oral implant surgery.
Clin Oral Implants Res. 2002 Dec;13(6):610-6.
"Ewers R, Schicho K, Seemann R, Reichwein A, Figl M,
Wagner A. Computer aided navigation in dental implantology:
7 years of clinical experience. Journal of Oral and Maxillofacial
Surgery; accepted for publication.
"Wagner A, Seemann R, Schicho K, Ewers R, Piehslinger
E. A comparative analysis of optical and conventional axiography
for the analysis of temporomandibular joint movements. J Prosthet
Dent. 2003 Nov;90(5):503-9.
"Wagner A, Schicho K, Kainberger F, Birkfellner W, Glaser
C, Grampp S, Ewers R. Quantification and Clinical Relevance
of Head Motion During Computed Tomography. Invest Radiol.
2003;38(11):733-741.
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