Ewers Rolf, Schicho Kurt, Wagner Arne, Undt Gerhard, Seemann Rudolf, Figl Michael, Truppe Michael
University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical School, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
J Oral Maxillofac Surg. 2005 Oct;63(10):1447-54. doi: 10.1016/j.joms.2005.06.020.
In this work the experiences from 50 telemedically supported treatments in craniomaxillofacial surgery are summarized and different setups for their technical realization are described. Furthermore, for the first time the innovative UMTS (universal mobile telecommunication system) is applied for the transmission of arthroscopic videos of the temporomandibular joint and other craniomaxillofacial structures.
The combination of computer-assisted navigation technology in augmented reality environments with telecommunication is used for execution of interactive stereotaxic teleconsultation. Furthermore, treatments without navigation are telemedically supported. This study is composed of 4 technical system configurations: 1) integrated services digital network (ISDN)-based videoconferencing without remote control of the navigation computer; 2) transmission control protocol/internet protocol (TCP/IP)-based interactive teleconsultation via bundled ISDN lines (including remote control of the navigation computer); 3) TCP/IP-based interactive teleconsultation via network; 4) combination of TCP/IP-connection and ISDN-based videoconferencing. The telemedically supported treatments are: orbitozygomatic osteotomies, positioning of the mandibular condyle in orthognathic surgery, insertion of implants, positioning of the maxilla in orthognathic surgery, distraction osteogenesis, arthroscopies of the temporomandibular joint, and operation simulations on stereolithographic models. The surgical interventions are evaluated on a 5-level system performance scale from the technical point of view. In a separate trial 20 videosequences of arthroscopies of the temporomandibular joint are transmitted via UMTS cellular phones and independently evaluated by 3 experts (ie, a total of 60 streamings) to investigate feasibility of this technology in the field of craniomaxillofacial surgery.
In the years from 1996 to 2002 a total of 50 treatments were telemedically supported. All intraoperative applications were successfully finished; 48 of 60 UMTS transmissions were finished without any interruptions in constant quality, slight interruptions were observed in 8 tests, and a complete breakdown was observed during 4 streamings that required a restart of the transmission. Resolution was sufficient to diagnose even tiny anatomic structures inside the temporomandibular joint, but orientation was hardly recognizable.
In many applications telecommunication technology can contribute to a quality improvement in cranio- and maxillofacial surgery because of the global availability of specialized knowledge. The required technical expenditure for teleconsultation crucially depends on the infrastructure that is already available at the clinic and the remote site. UMTS is a promising technology with the potential to be valuable in numerous craniomaxillofacial applications.
本文总结了50例颅颌面外科远程医疗支持治疗的经验，并描述了其技术实现的不同设置。此外，首次将创新的通用移动通信系统（UMTS）应用于颞下颌关节及其他颅颌面结构的关节镜视频传输。
将增强现实环境中的计算机辅助导航技术与电信技术相结合，用于执行交互式立体定向远程会诊。此外，无导航的治疗也得到了远程医疗支持。本研究由4种技术系统配置组成：1）基于综合业务数字网（ISDN）的视频会议，无需对导航计算机进行远程控制；2）通过捆绑的ISDN线路基于传输控制协议/互联网协议（TCP/IP）的交互式远程会诊（包括对导航计算机的远程控制）；3）通过网络基于TCP/IP的交互式远程会诊；4）TCP/IP连接与基于ISDN的视频会议相结合。远程医疗支持的治疗包括：眶颧截骨术、正颌外科中下颌髁突的定位、植入物植入、正颌外科中上颌骨的定位、牵张成骨、颞下颌关节镜检查以及在立体光刻模型上的手术模拟。从技术角度在一个5级系统性能量表上对手术干预进行评估。在一项单独试验中，通过UMTS手机传输了20个颞下颌关节镜检查的视频序列，并由3名专家独立评估（即总共60次传输），以研究该技术在颅颌面外科领域的可行性。
在1996年至2002年期间，共有50例治疗得到了远程医疗支持。所有术中应用均成功完成；60次UMTS传输中有48次在质量恒定的情况下无任何中断完成，8次测试中观察到轻微中断，4次传输过程中出现完全故障，需要重新启动传输。分辨率足以诊断颞下颌关节内即使是微小的解剖结构，但方位几乎无法辨认。
在许多应用中，由于专业知识的全球可获取性，电信技术有助于提高颅颌面外科的质量。远程会诊所需的技术投入关键取决于诊所和远程站点已有的基础设施。UMTS是一项有前途的技术，在众多颅颌面应用中具有潜在价值。
