THERE’S A FIRST FOR EVERYTHING IN PLASTIC SURGERY Continual Change and Evolvement in the Aesthetic Industry

Dr. Eric J. Stelnicki, M.D. is the first craniofacial surgeon to use Virtual Surgical Planning (VSP Orthognathics) in the state of Florida for treatment of complex jaw deformities related to craniofacial disorders.

By: Elizabeth C. Fassler

Dr. Stelnicki performed jaw surgery with Virtual Surgical Planning (VSP) for the second time near the end of December at Joe DiMaggio Children’s Hospital. This is the first Craniofacial Center that has used VSP Orthognathics (Virtual Surgical Planning) computer-generated modeling plates. It is a more precise, anatomically based surgical simulation method.

VSP provides data in order to accurately plan surgery in a computerized, digital atmosphere, with customized 3D printed surgical tools and guides. Then takes both of the VSP knowledge and surgical tools to the physical surgical operation with the results of advanced outcomes.

Craniofacial Microsomia (CFM) describes a vast array of abnormalities that affect the skull’s development before birth. Individuals with this possess a facial anatomy of reduced growth, resulting in various degrees of craniofacial asymmetry that only progresses over time. Those diagnosed with CFM have differences in size and shape between the right and left sides of the face. Most cases have abnormalities on both sides of the face where one side generally differs from the other. Others that are diagnosed with this have abnormalities only on one side of the face. 

The facial features and traits usually include one, underdeveloped side of the jaw (maxillary or mandibular hypoplasia) that may cause dental problems, eating and speech complications and in some cases of severe mandibular hypoplasia, difficulties in breathing. Other abnormalities caused by craniofacial microsomia are the effectiveness of one or both ears. This can include the possibility in possessing the growth of skin tags, microtia or anotia or a closed ear canal. These abnormalities can result in the loss of hearing. The occurrence of eye problems in craniofacial microsomia are less prevalent, but those affected by this abnormality tend to have microphthalmia or other problems that result in vision loss. People with craniofacial microsomia can also have abnormalities in other regions of the body, which include deformed bones of the vertebrae, kidneys with an unusual shape and heart defects.

The diagnosis is estimated to occur around 1of 3,600-5,600 newborns (Farina, Valladares, Torrealba, Nuñez, & Uribe, 2015). Although for reasons that are unclear or not yet

understood, craniofacial microsomia occurs more in males than females. CFM is very broad in classifying an array of craniofacial malformation conditions. It is also uncertain what genes are involved in this disorder, but is caused from complications in the development of the embryo structures called the branchial and visceral arches, also known as the first and second pharyngeal arches. Moreover, it is not biologically inherited (U.S. National Library of Medicine, 2016).

The diagnosis for the second jaw surgery, performed on a 20-year-old male patient was congenital deformity of the face, and Hemifacial Microsomia on the right with asymmetry to the maxilla and mandible. The right appeared hypoplastic relative to the left. The was more asymmetry included in the lateral wall, right orbit, right zygomatic arch and right external auditory canal.

Dr. Stelnicki clarifies that this is the "second surgery of its kind in the state Florida for patients with Craniofacial Microsomia where we will be correcting the deformity of the jaw…we are using the computer to reshape the face, taking a crooked face and making it straight."

Mike Applegate from Kls Martin works exclusively with Dr. Stelnicki in procedures such as these, using Virtual Surgical Planning, and is also present during the actual surgery. Applegate describes his part as "basically taking a CT Scan of the patient and through a virtual surgical webinar we are able to design exactly what movements we want to make to the maxilla, mandible and bone anatomy. We can do a soft tissue coverage to see what it’s going to look like post-op, which is very accurate. And that is something we have been kind of incorporating to Orthognathic surgery as a whole…taking titanium alloy plates

that…used to be a stock plate…a surgeon had to bend specific to the anatomy, and we are now printing them. Now, what was taken on the virtual surgical webinar, is now completely replicated, every single time in the O.R. with these custom plates." Dr. Stelnicki’s first patient that received this treatment a few months prior was diagnosed with left-sided craniofacial microsomia with combined maxillary and mandibular hypoplasia. In short, the treatment for this surgery is based on skeletal correction. Before her surgical performance, Dr. Stelnicki participated in extensive pre-operative planning and modeling. The operation was performed with LeFort-I osteotomy, bilateral sagittal split osteotomy, nasal endoscopy and internal fixation of both osteotomies. VSP Orthognathics (the computerized modeled plan and computerized custom modeling) was used for the staging and creation of the two separate custom oral splints for her procedure. 

Furthermore, this same patient created a documentary titled Double Jaw Surgery: Journey From an Asymmetrical Faced Girl, before undergoing her surgery. 

In keeping a positive state-of-mind, she states in her video that "…As teenagers, we tend to pick at our flaws…and as a 16-year-old, I have never judged my asymmetrical face…In the 6th grade I noticed my smile was crooked on my ID picture. My mom thought I was being a typical teen by judging my face…Until an ENT found out I had tinnitus. ‘There’s something wrong with your face,’ he commented…I was diagnosed with a malocclusion class 3 cross bite. Little did I know then that in two years I would have a new face. I’ll miss my crooked smile…People ask "...‘Are you nervous?’ No not really. July 23, 2016 will be the date I’ll never forget."

In conclusion, the Atlantic Center of Aesthetic and Reconstructive Surgery are the only craniofacial surgeons who’ve performed this type of surgery in the state of Florida today, using "state-of-the art, computerized planning and intra-operative computer optimization to treat very complex deformities." Furthermore, Dr. Stelnicki emphasizes that he’s "very proud" of the Atlantic Center on being "the pioneers of the state offering this type of surgical direction."

REFERENCES

Craniofacial Microsomia. (2016). U.S. National Library of Medicine. Retrieved from https://ghr.nlm.nih.gov/condition/craniofacial-microsomia 

Farina R., Valladares S., Torrealba R., Nuñez M., & Uribe F. (2015). Orthognathic Surgery in Craniofacial Microsomia: Treatment Algorithm. Plastic Reconstr Surg, 3(1), e294. 

VSP Orthognathics. (2016). 3D Systems Healthcare. Retrieved from http://www.med-icalmodeling.com/solutions-for-surgeons/vsp-technology/vsp-orthognathics