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• W2321110244 abstract "Sir: There are various obstacles to be overcome in total auricular reconstruction, such as the decision regarding ear position, creation of the skin envelope, handling of remnants, fabrication of a three-dimensional framework, perspective view for multistage operations, and others. The construction of a maximum relief framework is the most difficult of these problems. Preoperative rehearsal performed with an accurate costal cartilage model would therefore be advantageous for surgeons. In this study, we established a system for three-dimensional modeling of costal cartilage from preoperative computed tomographic data with reverse-engineering techniques.1 Costal cartilage modeling was performed for two cases. Using 64-slice multidetector-row computed tomographic scanning, axial slices at 1.0-mm intervals were used for modeling. Segmentation and volume rendering was performed with MIMICS 13.1 (Materialise Interactive Medical Image Control System; Materialise, Leuven, Belgium). Because the computed tomographic value of costal cartilage is close to that of the surrounding tissues, automatic segmentation such as skin and bone2,3 is not possible. Therefore, in axial slices, segmentation was performed manually. These data were converted to stereolithographic data. Which costal cartilage should be output was decided based on the three-dimensional data. In case 1, fifth, sixth, seventh, and eighth cartilages on the right side were output; and in case 2, sixth, seventh, eighth, and ninth cartilages on the right side were output with Kezlex (Ono & Co., Ltd., Tokyo, Japan).4 Right sixth, seventh, and eighth cartilage was harvested in both cases. The patients in case 1 and 2 were 9 and 14 years of age, respectively. The models were made from acrylic polyurethane, which allowed handling like real costal cartilage. Preoperative framework construction was performed with these models (Fig. 1).Fig. 1.: Preoperative framework construction was performed with sixth, seventh, and eighth cartilages in patient 1.The precision of modeling is the most important point for our purpose. Therefore, verification of accuracy was performed during surgery. The length, thickness, and shape of the established models were perfectly consistent with the actual cartilage (Fig. 2).Fig. 2.: Verification of the model in patient 1 was performed during surgery.Our model can be bent, cut, and sculpted like real costal cartilage. Therefore, simulation of framework fabrication, which is close to the real situation, is possible. The accuracy of modeling is the most important point in this type of simulation. In particular, for preoperative planning, the shape of the connection between cartilage and the length of the eighth or ninth costal cartilage are very important.5 Therefore, during the operation, we compared our model with harvested costal cartilage, and confirmed that our models were very precise. In addition to preoperative framework construction, this model would be useful for various purposes, depending on the surgeon's level of expertise. To minimize the amount of sacrificed cartilage, this model can be used to determine where cartilage can be preserved preoperatively. New types of framework can also be tested before actual application to patients. This model will also be useful for educational purposes and to allow residents to practice the procedures. In addition to microtia, the techniques used for digital modeling of costal cartilage can also be applied to other simulations, such as that of the pectus excavatum. ACKNOWLEDGMENTS This work was supported in part by a Grant-in-Aid for Young Scientists provided by the Japanese government (Category B: 21791751) and Keio University Grant-in-Aid for Encouragement of Young Medical Scientists. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this article. Junpei Miyamoto, M.D., Ph.D. Department of Plastic and Reconstructive Surgery School of Medicine Keio University Tokyo, Japan Shimpei Miyamoto, M.D., Ph.D. Division of Plastic and Reconstructive Surgery National Cancer Center Hospital East Chiba, Japan Tomohisa Nagasao, M.D., Ph.D. Department of Plastic and Reconstructive Surgery School of Medicine Keio University Tokyo, Japan Shogo Kasai, M.D. Department of Plastic and Reconstructive Surgery Sano Kousei General Hospital Tochigi, Japan Kazuo Kishi, M.D., Ph.D. Department of Plastic and Reconstructive Surgery School of Medicine Keio University Tokyo, Japan" @default.
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• W2321110244 date "2011-07-01" @default.
• W2321110244 modified "2023-10-12" @default.
• W2321110244 title "Preoperative Modeling of Costal Cartilage for the Auricular Reconstruction of Microtia" @default.
• W2321110244 cites W2024753108 @default.
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• W2321110244 doi "https://doi.org/10.1097/prs.0b013e31821744eb" @default.
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