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Detecting the pterygomaxillary disjunction using an instrumented hammer: A cadaveric study.
Manon Bas Dit Nugues1, Giuseppe Rosi2, Charles Henri Flouzat-Lachaniette3
1CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, 61, Avenue du Général de Gaulle, 94010 Créteil Cedex, France.
Clinical Biomechanics (Bristol, Avon)
|December 18, 2025
Summary
A new vibroacoustic system using an instrumented hammer accurately detects pterygomaxillary disjunction during maxillofacial surgery, improving patient safety by reducing reliance on surgeon proprioception.
Area of Science:
- Biomedical Engineering
- Surgical Technology
- Maxillofacial Surgery
Background:
- Pterygomaxillary disjunction is crucial in maxillofacial surgery to separate the jaw from the skull.
- Current methods rely on surgeon proprioception to confirm disjunction, risking complications.
- Objective feedback is needed to enhance surgical precision and safety.
Purpose of the Study:
- To validate a novel vibroacoustic setup for detecting pterygomaxillary disjunction.
- To assess the efficacy of an instrumented hammer with a force sensor in real-time surgical feedback.
- To develop a reliable system for intraoperative decision support.
Main Methods:
- An instrumented hammer with a force sensor was utilized to record impact signals during fourteen osteotomies.
- A Support Vector Machine classification algorithm, incorporating a cost matrix, was developed using signal indicators.
- The algorithm classified impacts into pre- and post-disjunction states, minimizing Negative Likelihood Ratio for optimal performance.
Main Results:
- The vibroacoustic system achieved 96% accuracy in distinguishing impacts before and after pterygoid plate osteotomy.
- The instrumented hammer successfully detected the disjunction with a minimal delay of two impacts.
- The developed algorithm demonstrated high reliability in identifying the critical surgical event.
Conclusions:
- The validated vibroacoustic system shows significant potential for intraoperative guidance.
- This technology can lead to the development of a decision support system for pterygomaxillary disjunction.
- Enhanced feedback during surgery promises to improve outcomes and reduce complications.
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