Damak Yarığı Cerrahi Eğitiminde Yenilikçi ve Yerli Bir Ürün: Anatomik ve Modifiye Damak Yarığı Cerrahi Eğitim Modeli

Year 2023, Volume: 56 Issue: 2, 109 - 116, 30.09.2023

Murat Kara , Burçin Gül , Deniz Yanılmaz , Özge Akbulut , İnci Gökalan Kara , Fatma Figen Özgür

https://doi.org/10.20492/aeahtd.1293861

Abstract

Amaç
Damak yarığı cerrahisi hastanın küçük yaşına bağlı dar ağız açıklığı, dokuların küçük olması ve öngörülemeyen sonuçlar nedeniyle zorludur. Bu nedenlerden dolayı damak yarığı cerrahisi gerçekleştiren merkez ve cerrah sayısında yetersizlik söz konudur. Bu noktada çalışmamızın amacı damak yarığı cerrahi eğitiminde kullanılacak etkin, pratik, ulaşılabilir, yüksek gerçeklikli ve uygun maliyetli bir damak yarığı cerrahi eğitim modelinin üretimini sağlayarak etkinliğinin ortaya konmasıdır.
Gereç ve Yöntem
Model üretiminde kalıp olarak dokuz aylık damak yarıklı bebeklerin tomografi ve manyetik rezonans görüntüleri kullanılmıştır. Üç boyutlu modelleme ve basım aşamalarından sonra üretilen silikon bazlı yüksek gerçeklikli ve anatomik modeller cerrahlar tarafından görünüm, dokunma, bistüri (kesme), tutma, traksiyon ve dikiş hissiyatları pratik olarak değerlendirilmiştir. Takiben, mühendis ekibi tarafından laboratuvar testleri ile dokuların gerçekliği (yırtılma ve gerim kuvveti) test edilmiştir. Modellerin revizyonları sonrası düzenlenen cerrahi eğitim kursunda modelin etkinliği kayıt altına alınmıştır.
Bulgular
Dört yarık tipinde anatomik ve gerçekçi dört cerrahi eğitim modeli elde edilmiştir. Çalışmaya dahil olmayan tarafsız ve alanlarında uzman hakemlerin standardize değerlendirme formları kullanarak yaptıkları değerlendirmede modeller görünüm, anatomi ve cerrahi açıdan yeterli ölçüde gerçekçi olduğu, modelin anatomik yapısının literatürde tanımlanmış cerrahi tekniklerin gerçekleştirilmesine uygun olduğu ve cerrahi eğitimde etkin bir şekilde kullanılabileceği sonucuna varmışlarıdır. Kurs verilerinin analizinde ise, katılımcıların tamamında model cerrahisi ile rahat bir ortamda yapılan cerrahinin teorik bilginin pekiştirilmesi, pratik eğitim artması ile kendilerine olan cerrahi güveni belirgin bir şekilde arttırmıştır.
Sonuç
Damak yarığı cerrahi eğitiminde etkin, ulaşılabilir, yüksek gerçeklikli ve anatomik bir damak yarığı cerrahi eğitim modeli üretilerek etkinliği ortaya konmuştur.

Keywords

Cerrahi eğitim, cerrahi model, Damak yarığı

Supporting Institution

TÜBİTAK ve TİKA

Project Number

TÜBİTAK 1005 projesi, 120S341

Thanks

Çalışmamız Türkiye Bilimsel ve Teknik Araştırma Kurumu (TÜBİTAK) 1005 projesi (Proje No: 120S341) kapsamında desteklenmiş olup, modelin üretimi ile ilgili finansman TÜBİTAK tarafından karşılanmıştır. Ayrıca modelin araştıma görevlilerine yönelik bir eğitim faaliyetinde kullanımı Türk İşbirliği ve Koordinasyon Ajansı (TİKA) tarafından desteklenmiştir. Bu bağlamda çalışmamıza sağladıkları katkı nedeniyle TÜBİTAK ve TİKA’ya teşekkür ederiz.

An Innovative and Domestic Product in Cleft Palate Surgical Education: An Anatomical and Modified Cleft Palate Surgical Training Model

Abstract

Aim
The surgical treatment of cleft palate is difficult due to the young age of the patients causing narrow mouth opening, small tissues, and unpredictable results. For these reasons, there is an insufficient number of centers and surgeons performing cleft palate surgery. At this point, the aim of our study is to produce an effective, practical, accessible, highly realistic, and cost-effective cleft palate surgical training model and to demonstrate its effectiveness.
Material and Methods
In model production, tomography and magnetic resonance images of nine-month-old babies with cleft palate were used as templates. Silicone-based high-fidelity and anatomical models produced after three-dimensional modeling and printing stages were evaluated practically by surgeons for their appearance, touch, scalpel (cutting), holding, traction, and suture sensations. Subsequently, the realistic features of the tissues (tear and tensile strength) were tested by laboratory tests by the engineering team. The effectiveness of the model was recorded in the surgical training course held after the revisions of the models.
Results
Four anatomical and realistic surgical training models in four cleft types were obtained. In the evaluation made by the neutral and expert referees, who were not included in the study, they concluded that the models were realistic enough in terms of appearance, anatomy, and surgery, and the anatomical structure of the model was suitable for performing the surgical techniques defined in the literature and could be used effectively in surgical training. In the analysis of the course data, the consolidation of the theoretical knowledge of the surgery performed in a comfortable environment with model surgery and the increase in practical training significantly increased the surgical confidence in all of the participants.
Conclusion
An effective, accessible, highly realistic, and anatomical cleft palate surgical training model has been produced and its effectiveness has been demonstrated in cleft palate surgical training.

Keywords

Surgical training, surgical model, cleft palate

Project Number

TÜBİTAK 1005 projesi, 120S341

References

• 1. Fan D, Wu S, Liu L, et al. Prevalence of non-syndromic orofacial clefts: based on 15,094,978 Chinese perinatal infants. Oncotarget. Mar 2 2018;9(17):13981-13990. doi:10.18632/oncotarget.24238
• 2. Raghavan U, Vijayadev V, Rao D, et al. Postoperative Management of Cleft Lip and Palate Surgery. Facial Plast Surg. Dec 2018;34(6):605-611. doi:10.1055/s-0038-1676381
• 3. Hardwicke JT, Landini G, Richard BM. Fistula incidence after primary cleft palate repair: a systematic review of the literature. Plast Reconstr Surg. Oct 2014;134(4):618e-27e. doi:10.1097/prs.0000000000000548
• 4. Cohen SR, Kalinowski J, LaRossa D, et al. Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg. Jun 1991;87(6):1041-7.
• 5. Kummer AW, Clark SL, Redle EE, et al. Current practice in assessing and reporting speech outcomes of cleft palate and velopharyngeal surgery: a survey of cleft palate/craniofacial professionals. Cleft Palate Craniofac J. Mar 2012;49(2):146-52. doi:10.1597/10-285
• 6. Rohrich RJ, Love EJ, Byrd HS, Johns DF. Optimal timing of cleft palate closure. Plast Reconstr Surg. Aug 2000;106(2):413-21; quiz 422; discussion 423-5. doi:10.1097/00006534-200008000-00026
• 7. Timbang MR, Gharb BB, Rampazzo A, et al. A systematic review comparing Furlow double-opposing Z-plasty and straight-line intravelar veloplasty methods of cleft palate repair. Plast Reconstr Surg. Nov 2014;134(5):1014-22. doi:10.1097/prs.0000000000000637
• 8. Podolsky DJ, Fisher DM, Wong KW, et al. Evaluation and Implementation of a High-Fidelity Cleft Palate Simulator. Plast Reconstr Surg. Jan 2017;139(1):85e-96e. doi:10.1097/prs.0000000000002923
• 9. Williams WN, Seagle MB, Pegoraro-Krook MI, et al. Prospective clinical trial comparing outcome measures between Furlow and von Langenbeck Palatoplasties for UCLP. Ann Plast Surg. Feb 2011;66(2):154-63. doi:10.1097/SAP.0b013e3181d60763
• 10. Kantar RS, Esenlik E, Al Abyad OS, et al. The First Hybrid International Educational Comprehensive Cleft Care Workshop. Cleft Palate Craniofac J. May 9 2022:10556656221097820. doi:10.1177/10556656221097820
• 11. Kantar RS, Ramly EP, Almas F, et al. Sustainable Cleft Care Through Education: The First Simulation-Based Comprehensive Workshop in the Middle East and North Africa Region. Cleft Palate Craniofac J. Jul 2019;56(6):735-743. doi:10.1177/1055665618810574
• 12. Nagy K, Mommaerts MY. Advanced s(t)imulator for cleft palate repair techniques. Cleft Palate Craniofac J. Jan 2009;46(1):1-5. doi:10.1597/08-004.1
• 13. Senturk S. The simplest cleft palate simulator. J Craniofac Surg. May 2013;24(3):1056. doi:10.1097/SCS.0b013e31828f2679
• 14. Vadodaria S, Watkin N, Thiessen F, et al. The first cleft palate simulator. Plast Reconstr Surg. Jul 2007;120(1):259-61. doi:10.1097/01.prs.0000264394.27150.0d
• 15. Gunther E, Wisser JR, Cohen MA, et al. Palatoplasty: Furlow's double reversing Z-plasty versus intravelar veloplasty. Cleft Palate Craniofac J. Nov 1998;35(6):546-9. doi:10.1597/1545-1569_1998_035_0546_pfsdrz_2.3.co_2
• 16. Frizziero L, Santi GM, Leon-Cardenas C, et al. In-House, Fast FDM Prototyping of a Custom Cutting Guide for a Lower-Risk Pediatric Femoral Osteotomy. Bioengineering (Basel). May 26 2021;8(6)doi:10.3390/bioengineering8060071
• 17. Liu Z, Wang Y, Wu B, et al. A critical review of fused deposition modeling 3D printing technology in manufacturing polylactic acid parts. The International Journal of Advanced Manufacturing Technology. 2019;102(9):2877-2889. .
• 18. Podolsky DJ, Fisher DM, Wong Riff KWY, et al. Infant Robotic Cleft Palate Surgery: A Feasibility Assessment Using a Realistic Cleft Palate Simulator. Plast Reconstr Surg. Feb 2017;139(2):455e-465e. doi:10.1097/prs.0000000000003010
• 19. Cheng H, Podolsky DJ, Fisher DM, et al. Teaching Palatoplasty Using a High-Fidelity Cleft Palate Simulator. Plast Reconstr Surg. Jan 2018;141(1):91e-98e. doi:10.1097/prs.0000000000003957
• 20. Katzel EB, Basile P, Koltz PF, et al. Current surgical practices in cleft care: cleft palate repair techniques and postoperative care. Plast Reconstr Surg. Sep 2009;124(3):899-906. doi:10.1097/PRS.0b013e3181b03824
• 21. Owusu JA, Liu M, Sidman JD, et al. Resource utilization in primary repair of cleft palate. Laryngoscope. Mar 2013;123(3):787-92. doi:10.1002/lary.23661
• 22. von Ungern-Sternberg BS, Boda K, Chambers NA, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet. Sep 4 2010;376(9743):773-83. doi:10.1016/s0140-6736(10)61193-2
• 23. Basta MN, Fiadjoe JE, Woo AS, et al. Predicting Adverse Perioperative Events in Patients Undergoing Primary Cleft Palate Repair. Cleft Palate Craniofac J. Apr 2018;55(4):574-581. doi:10.1177/1055665617744065
• 24. Antony AK, Sloan GM. Airway obstruction following palatoplasty: analysis of 247 consecutive operations. Cleft Palate Craniofac J. Mar 2002;39(2):145-8. doi:10.1597/1545-1569_2002_039_0145_aofpao_2.0.co_2
• 25. Jackson O, Basta M, Sonnad S, et al. Perioperative risk factors for adverse airway events in patients undergoing cleft palate repair. Cleft Palate Craniofac J. May 2013;50(3):330-6. doi:10.1597/12-134
• 26. Ghanem A, Podolsky DJ, Fisher DM, et al. Economy of Hand Motion During Cleft Palate Surgery Using a High-Fidelity Cleft Palate Simulator. Cleft Palate Craniofac J. Apr 2019;56(4):432-437. doi:10.1177/1055665618793768
• 27. Jung S, Lo LJ. Dissection in the Pyramidal Space for Effective Relief of Tension in Cleft Palate Repair. Ann Plast Surg. Jan 2020;84(1S Suppl 1):S54-s59. doi:10.1097/sap.0000000000002169
• 28. Rossell-Perry P. Flap Necrosis after Palatoplasty in Patients with Cleft Palate. Biomed Res Int. 2015;2015:516375. doi:10.1155/2015/516375