University of Basel

Faculty of
Medicine

Research Group Mueller AA | Facial & Cranial Anomalies

Technological development

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  1. Lingens L, Gözcü B, Schnabel T, Lill Y, Benitez BK, Nalabothu P, Mueller AA, Gross M. and Solenthaler B. Image-Based 3D Reconstruction of Cleft Lip and Palate Using a Learned Shape Prior. In International Workshop on Applications of Medical AI (pp. 94-103). 2023 Cham: Springer Nature Switzerland. https://people.inf.ethz.ch/~sobarbar/paper/Lingens23.pdf
     
  2. Schnabel TN, Gözcü B, Gotardo P, Lingens L, Dorda D, Vetterli F, Emhemmed A, Nalabothu P, Lill Y, Benitez BK,Mueller AA, Gross M, Solenthaler B. Automated and data-driven plate computation for presurgical cleft lip and palate treatment. Int J Comput Assist Radiol Surg. 2023 Apr 2. doi: 10.1007/s11548-023-02858-6

    Here we present an algorithm to automatically design passive pre-surgical plates for infants born with cleft palates. The pipeline is based on deep-learning methods to automatically place landmarks on intraoral scans and subsequently design individualized plates. The resulting 3D file can be 3D-printed to be used by patients after minimal manual post-processing. 
     
  3. Ureel M, Augello M, Holzinger D, Wilken T, Berg BI, Zeilhofer HF, Millesi G, Juergens P, Mueller AA. Cold Ablation Robot-Guided Laser Osteotome (CARLO®): From Bench to Bedside. J. Clin. Med. 2021, 10(3), 450; https://doi.org/10.3390/jcm10030450 

    We present here our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO®), a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools. A patient underwent bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO® device. The linear part of the Le Fort I osteotomy was performed autonomously by the device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images. The CARLO® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications. The CARLO® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. 

     
  4. Holzinger D, Ureel M, Wilken T, Mueller AA, Schicho K, Milles G, Juergens P. First-in-man application of a cold ablation robot guided laser osteotome in midface osteotomies. J Cranio-Maxillofac Surg. Volume 49, Issue 7, July 2021, Pages 531-537;
     https://doi.org/10.1016/j.jcms.2021.01.007

    In this report we describe the effective and successful routine use of Cold ablation robot-guided laser osteotomy CARLO® (AOT Advanced Osteotomy Tools, Basle, Switzerland) in an actual clinical setting. CARLO® is an integrated system, functionally comprising: an Er:YAG laser source, intended to perform osteotomies using cold laser ablation, a robot arm that controls the position of the laser source, an optical tracking device that provides a continuous and accurate measurement of the position of the laser source and of reference elements attached to instruments or bones, a navigation system (software) that is able to read preoperatively defined planned osteotomies, and – under the control of a surgeon – performs the planned osteotomies. It is a promising technical innovation that has the potential to set new standards for accuracy and safety in orthognathic surgery. 
     
  5. Nalabothu P, Verna C, Benitez BK, Dalstra M, Mueller AA. Load Transfer during Magnetic Mucoperiosteal Distraction in Newborns with Complete Unilateral and Bilateral Orofacial Clefts: A Three-Dimensional Finite Element Analysis. Appl. Sci. 2020;10(21):7728.
     https://doi.org/10.3390/app10217728

    The primary correction of congenital complete cleft lip and palate (CLP) is challenging due to inherent lack of palatal tissue and small extent of the palatal shelves at birth. We have determined whether the intrinsic structural soft and hard tissue deficiency can be ameliorated before surgical repair using the principles of periosteal distraction by means of magnetic traction. Two three-dimensional maxillary finite element models were created from computed tomography slice data using dedicated image analysis software. The findings suggest that in newborns with CLP, periosteal distraction by means of a magnetic attraction force can promote the generation of soft and hard tissues along the cleft edges and rectify the tissue deficiency associated with the malformation.
    (Freiwillige Akademische Gesellschaft (FAG))

     
  6. Nalabothu P, Verna C, Steineck M, Mueller AA, Dalstra M. The biomechanical evaluation of magnetic forces to drive osteogenesis in newborn ’ s with cleft lip and palate. J Mater Sci: Mater Med 31, 79 (2020). doi.org/10.1007/s10856-020-06421-6

    This study examined the potential for dental magnets to act as a driving force for osteogenesis in the palate of newborns with a unilateral cleft lip and palate. We quantified the stresses and strains induced by magnetic forces in the palate of a newborn with a unilateral cleft lip and palate (UCLP) to verify whether the loading could reach the threshold necessary to simulate the periosteal loading necessary for bone formation. A mimick set up for a palatal distraction device was used to obtain the force/distance relationship. Analsis with a 3D finite element model of the palate of a newborn affected by unilateral cleft lip and palate showed that the implant-like set up is able to exceed the 1,500 μstrain limit needed to induce periosteal tissued modelling.
    (Freiwillige Akademische Gesellschaft (FAG))

     
  7. Nalabothu P, Benitez BK, Dalstra M, Verna C, Mueller AA. Three-Dimensional Morphological Changes of the True Cleft under Passive Presurgical Orthopaedics in Unilateral Cleft Lip and Palate: A Retrospective Cohort Study. J Clin Med. 2020;9(4):962.
     https://doi.org/10.3390/jcm9040962

    Using a new analysis method based on three-dimenstional standardized reproducible landmarks, we have quantified the morphological changes in the palatal cleft and true cleft areas induced by passive plate therapy. We emphasize the importance of reproducibility and reliability of the anatomical points to establish a valid measuring method.
    (Freiwillige Akademische Gesellschaft (FAG), Basel, Switzerland)

     
  8. Can Esad. Erstellung eines digitalen Diagnoseregisters und Erfassung der dreidimensionalen Ausgangsbefunde für die elektronische Patientenakte bei Lippen-, Kiefer- und Gaumenspalten am Behandlungszentrum des Universitätsspital Basels. 2019. Doctorate Dental Medicine, Esad Can, University of Basel. Supervised-student-publication by Mueller AA.

     
  9. Beiglboeck F, Thieringer FM, Scherrer G, Mueller AA. 3D-printing for orthopedic treatment of infants with cleft lips and palate deformities. Int J Oral Maxillofac Surg. 2019;48:5. https://doi.org/10.1016/j.ijom.2019.03.583

    Since its introduction by McNeil in 1954, infant orthopedic treatment of cleft lip and palate deformities has undergone a development into various directions. Various plate designs enable different improvements of cleft morphology and oral function to be achieved and their timing of the application might be restricted either to before lip surgery or extend for several years. Today 3D printing is assuming an indispensable role in the toolbox of surgery and dentistry. We present here a stepwise workflow using on-the-spot medical 3D-printing which renders as simple, fast and cost-effective to build infant orthopedic plates.

     
  10. Berg B-I, Mueller AA, Augello M, Berg S, Jaquiéry C. Imaging in Patients with Bisphosphonate-Associated Osteonecrosis of the Jaws (MRONJ). Dent J. 2016;4(3):29. https://doi.org/10.3390/dj4030029

    Bisphosphonate-associated osteonecrosis of the jaws (MRONJ/BP-ONJ/BRONJ) is a commonly encountered disease. During recent decades, there has been major advances in diagnostics. When MRONJ is suspected, a thorough clinical examination and radiological imaging are essential. In this paper we present the latest clinical update on the imaging options in regard to MRONJ: X-ray/Panoramic Radiograph, Cone Beam Computed Tomography (CBCT) and Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Nuclear Imaging, Fluorescence-Guided Bone Resection. The choice of image modality depends not only on the surgeon’s/practitioner’s preference, but also on the availability of imaging modalities. A three-dimensional imaging modality is desirable, and in severe cases necessary, for extended resections and planning of reconstruction.

     
  11. Vajgel A, Santos TDS, Camargo IB, De Oliveira DM, Laureano Filho JR, De Holanda Vasconcellos JR, Lima Jr. SM, Pereira Filho VA, Mueller AA and Juergens P. Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: Results of a multicentre study. J Cranio-Maxillofacial Surg. 2015;43(1):34-42. https://doi.org/10.1016/j.jcms.2014.10.006

    This multicentre study aimed to investigate long-term subsequent radiographic and functional results after the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach. We show that Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results, additionally with the advantages of the absent visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture.

     

  12. Mueller AA, Neue Verfahren zur Wiederherstellung kiefer-gesichtschirurgischer Defekte, insbesondere bei Lippen-Kiefer-Gaumenspalten und nach Tumorresektionen. 2015, Postdoctoral Thesis (Habilitation), University of Basel, Faculty of Medicine. https://edoc.unibas.ch/80509/


     
  13. Mueller, AA. Complementing surgical with biomedical and engineering methods to evolve lip and nose reconstruction. 2013, Doctoral Thesis, University of Basel, Faculty of Medicine. http://edoc.unibas.ch/diss/DissB_10955

     
  14. Mueller AA, Schumann D, Reddy RR, Schwenzer-Zimmerer K, Mueller-Gerbl M, Zeilhofer HF, Sailer HF, Reddy SG. Intraoperative vascular anatomy, arterial blood flow velocity, and microcirculation in unilateral and bilateral cleft lip repair. Plast Reconstr Surg. 2012;130(5):1120-1130. doi:10.1097/PRS.0b013e318267d4fb

    Cleft lip repair techniques differ mainly in the design of the skin incisions, how the muscle portions are reconstructed, and how the nasal framework is repositioned. The vascular anatomy has remained largely unaddressed in current surgical techniques. Since normal blood supply is a precondition for development and growth, it would be of clinical interest to determine whether cleft anatomy leads to a change in the blood supply before or after surgery. To improve our understanding of the blood circulation in cleft lip, we assessed both the arterial vascular flow and the microcirculation before, at the end and late after cleft lip repair, and in a healthy control group. Compare to the normal cadaver dissections, there appears to be no intrinsic circulatory deficit in unilateral and bilateral cleft lip–cleft palate patients.
    (Swiss National Science Foundation, European Association for Craniomaxillofacial Surgery)

     
  15. Mueller AA, Paysan P, Schumacher R, Zeilhofer H-F, Berg-Boerner B-I,Maurer J, Vetter T, Schkommodau E, Juergens P, Schwenzer-Zimmererl K. Missing facial parts computed by a morphable model and transferred directly to a polyamide laser-sintered prosthesis: An innovation study. Br J Oral Maxillofac Surg. 2011;49(8):e67-e71. https://doi.org/10.1016/j.bjoms.2011.02.00

    Mirroring of missing facial parts and rapid prototyping of templates have become widely used in the manufacture of prostheses. However, mirroring is not applicable for central facial defects, and the manufacture of a template still requires labour-intensive transformation into the final facial prosthesis. We have explored innovative techniques to meet these remaining challenges. We used a morphable model of a face for the reconstruction of missing facial parts that did not have mirror images, and skin-coloured polyamide laser sintering to directly manufacture the prosthesis.
    (Swiss National Science Foundation)

     
  16. Schwenzer-Zimmerer K, Boerner BI, Schwenzer NF, Mueller AA, Juergens P, Ringenbach A, Schkommodau E and Zeilhofer HF. Facial acquisition by dynamic optical tracked laser imaging: a new approach. J Plast Reconstr Aesthetic Surg. 2009;62(9):1181-1186. https://doi.org/10.1016/j.bjps.2007.11.080

    Three-dimensional capture of the surface of soft tissue is a desirable support for documentation and therapy planning in plastic and reconstructive surgery concerning the complex anatomy of the face, particularly cleft lip and palate (CLP). Different scanning systems are used for capturing facial surfaces. This study aimed to assess the suitability of a radical new approach first used in automotive industries that employs a mobile, flexible handheld laser scanner with simultaneous registration by optical tracking for surgical procedures on the human face in operating theatre. With this scanning system, even complex areas with undercuts could be reproduced completely and precisely with an accuracy in the sub-millimetre range.
    (Suisse National Center of Competence in Research (SNF), ‘Computer Aided and Image Guided Medical Interventions (Co-Me))

     
  17. Juergens P, Kim H, Kunz C, Beinemann J, Mueller AA, Schwenzer-Zimmerer K, Zeilhofer HF. Intraoperative three-dimensional real-time navigation in orthognathic surgery. Int J Oral Maxillofac Surg. 2009;38:5(474) 
    https://doi.org/10.1016/j.ijom.2009.03.276

    Accurate preoperative planning of corrective surgery of deformities in the facial skeleton is essential for successful surgical treatment. Virtual three-dimensional (3D) models of the facial soft tissue and the underlying bony structures generated from computed tomography (CT) scans are used to perform relocation planning and soft tissue prediction. A navigation system consisting of a laptop computer linked to a POLARIS optical tracking system with passive markers and the software based on the MARVIN platform was used. The innovated 3D guidance interface enables the surgeons to reach their planned surgical goals in an intuitive way. The developed workflow was implemented in the clinical routine. The navigation system has been validated for the use in orthognathic surgery.

     
  18. Schwenzer-Zimmerer K, Boerner B-I, Mueller AA, Jürgens P, Ringenbach A, Schkommodau E. T-Scan: First Experiences with Acquisition of Cleft Morphology. Adv Med Eng. Published online 2007:458-463. doi.org/10.1007/978-3-540-68764-1_77

    Throughout the last years the three dimensional capturing of body surfaces became more and more important. For capturing facial surfaces, different commercial systems are available. However, all these conventional devices have shadowing effects. These effects can avoided by the use of a hand-held laser scanner with simultaneous registration. The T-Scan, developed and used for industrial purposes is such a tracked scanning device. We assessed the suitability of this scanner, and acquired data sets with an accuracy of less than a millimetre.
     

 

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