SPECIAL TOPIC A Web-Based, Integrated Simulation System for Craniofacial Surgical Planning Stephen A. Schendel, M.D., D.D.S. Kevin Montgomery, Ph.D. Palo Alto, Calif. Background: Advances in computing over the last 10 years have rapidly improved imaging and simulation in health care. Implementation of three-dimensional pro- tocols and image fusion techniques are moving diagnosis, treatment planning, and teaching to a next-generation paradigm. In addition, decreasing cost and increasing availability make generalized use of these techniques possible. Methods: In this article, the authors present a Web-based, integrated simulation system for craniofacial surgical planning and treatment. Image fusion technology was utilized to create a realistic virtual image that can be manipulated in real time. The resultant data can then be shared over the Internet by distantly located prac- titioners. Results: Initial use of this system proved to be beneficial from a planning standpoint and to be accurate as to the reliability of landmark identification. Additional case studies are needed to further document the results of actual surgical simulation. Conclusion: This technology presents significant advantages in surgical planning and education, both of which can improve patient safety and outcomes. (Plast. Reconstr. Surg. 123: 1099, 2009.) A lthough a number of systems have been developed over the past three decades for computer-based surgical planning, 1–20 most have not enjoyed widespread adoption and use clinically beyond academic publications. This lim- ited use is directly related to the cost of the system and limited availability on the one hand and the difficulty of use on the other. Systems that are not realistic enough and real-time based inhibit clini- cians from taking the time to master the system, as initial use is learning intensive. In addition, the sys- tems are frequently not user friendly for clinicians. Computing advancements in the last 10 years have rapidly improved imaging and simulation in the health care field. The adoption of three-di- mensional imaging protocols and the power of the Internet are moving diagnosis, treatment plan- ning, outcome evaluation, and teaching to the next-generation paradigm. Image fusion combin- ing computed tomography/cone beam computed tomography, magnetic resonance imaging, and surface image scans enables the generation of a patient-specific electronic model in the real world, which magnifies the potential for truly patient- centric care. Lastly, these systems can be Web-based, which both increases availability and decreases cost. The virtual patient can then be studied and treat- ment protocols developed. Improved results in surgery with the use of vir- tual reality may be obtained secondary to improved precision and reduced complications. Computer- based surgical simulation also has proven benefit in teaching and the acquisition of surgical skills and their objective evaluation. A Web-based vir- tual reality system allows the interaction of multi- ple users at a distance and immediate dissemina- tion of application. Correctly planning and accurately predicting surgical outcome is paramount in facial surgery. Gossett et al. 21 have outlined a threefold purpose for computer-simulated predictions: (1) guide the treatment to the desired result, (2) give the patient a reasonable preview of the outcome, and (3) serve as a communication tool between specialists, such as orthodontist and surgeon. It is easy to see that this can be expanded to include other pro- fessionals involved in patient care. Traditionally, the visual treatment objective has been done by manual creation of simulated treatment tracings based on cephalometric radiographs. The first From the Division of Plastic Surgery, Stanford University. Received for publication March 15, 2008; accepted June 18, 2008. Copyright ©2009 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e318199f653 Disclosure: The authors are consultants for 3dMD, which makes a surface scanner. www.PRSJournal.com 1099