The Virtual Surgical Management of Facial Fibrous Dysplasia.

PURPOSE: Fibrous dysplasia (FD) is a benign condition, which is characterized by the replacement of normal bone with fibrous tissue and the deposition of woven bone in an irregular manner. Surgical resection, careful corrective osteotomies as debulking, and recontouring procedures are frequently performed, but can be complicated by postoperative regrowth of the lesion. The main aim of this study was to introduce a computer-guided technique for a predetermined technique of bone contouring of craniofacial FD involving the facial bones. METHODS: This case report was conducted on an 18-year-old girl complaining of unilateral craniofacial dysplasia. Upon clinical examination and radiographic examination, a customized computer-generated bone contouring guide was designed using virtual surgical software for accurate contouring of excess bone in the cranial vault and frontal bone. This guide was virtually designed after importing the multislice computerized tomography scans into the virtual surgical planning software. It was generated based on the mirroring option of the unaffected normal side along the median sagittal plane. In the surgery, the guide was seated in place and 5 mm implant drills were inserted through the guide depth holes. Bone removal was made using surgical burs connecting the guiding depth holes. RESULTS: At the end of the follow-up, the patient showed acceptance of her external appearance with no signs of infection or dehiscence. CONCLUSION: This patient-specific cutting guide shows a promising solution for preplanned bone removal in cases with unilateral craniofacial FD.

Delayed complex fronto-zygomatico-orbital reconstruction using patient specific 3D printed implants; A report of three complex cases - A short communication.

PURPOSE: To demonstrate use of patient specific implants (PSIs) in the reconstruction of significant facial skeletal defects. Polyamide 12 implants were used to achieve good symmetric results with great projection and contours and minimal morbidity, all of which would not be predictably achievable with other reconstructive options. METHODS: Using a retrospective study design, three patients who had significant facial skeletal defects affecting the zygomaticomaxillary complex, frontal bone and also having an orbital component were used as subjects. The cases reported in this article were managed during the period from June 2015 to May 2016 with a minimum of 5 years follow up for all three cases. Outcomes were evaluated radiographically by overlapping postoperative x-rays with the virtual plan and also clinically using a virtual analogue scale (VAS). RESULTS: For the three patients, VAS assessment for patient satisfaction yielded promising results with the first case reporting an 8, with 10 being most satisfied. For the second patient, the VAS was 7.5 and for the third patient it was 8.5. Radiographically, the difference in transverse projection on all four points did not exceed 2.48 mm. When assessing antero-posterior projection accuracy, there was an average deviation of 0.68 mm at the infraorbital rim and 0.86 mm at the zygomaticofrontal point. CONCLUSION: This article aims to point out the significant advantages of the use of polyamide 12 PSIs for the major facial skeletal reconstructions regarding symmetry, anatomical contours, minimal morbidity and decreased costs. A larger number of patients is needed in future studies.

Reconstruction of Cranial Bone Defects Using Polyamide 12 Patient-Specific Implant: Long Term Follow Up.

ABSTRACT: The main objective of this study was to evaluate the use of patient-specific polyamide 12 implants in cranial bone defect reconstruction.Ten patients who underwent prior decompression craniectomy were selected for the current study. Skull scanning by computerized tomography was performed and used to make virtual planning of the implants to be transformed into physical implant using selective laser sintering. Cranioplasty was performed through coronal surgical approach where cranial implants were fixated using 2.0-mm mini-screws, and plates. Patients follow-up was from 12 to 36 months. Glasgow Outcome Score recorded 1 (good recovery) for all patients. Patient and surgeon satisfaction for the esthetic outcome were measured using visual analog scale as mean of 10 ± 0 and 9 ± 1, respectively. Cranial symmetry index was calculated as mean score of 98% ± 1%, indicating highly accurate symmetry, and preoperative virtual planning and postoperative outcome were compared for accuracy analysis with a mean difference of 0.3197 ± 0.1649, which indicates high accuracy.Polyamide12 cranial implants seem to offer a promising option to cranial bone reconstruction with patient-specific implants. This study ensures proper cosmetic and clinical outcome.

Accuracy of patient-specific temporal implants using PEKK.

The main aim of this study was to evaluate the accuracy of immediate CAD/CAM reconstruction of the temporal hollowing following temporalis muscle surgery, using a patient-specific implant (PSI) PEKK model. This case series included ten patients who underwent maxillofacial reconstruction using temporalis muscle flap (TMF). The study involved the preoperative planning and fabrication of the temporal implant using virtual surgical planning software. The planning was based on multislice CT scans, from which DICOM files were used to fabricate a 3D model of the temporalis muscle using polyetherketoneketone (PEKK). The patients were followed up for 12 months, to check for any signs of infection or mobilization, and to assess accuracy. At the end of the follow-up period, all the patients showed acceptance of the external appearance, with no signs of infection or rejection. These customized implants were measured and compared with their original 3D preoperative planning using a point-based analysis. This revealed a mean difference (±SD) of 0.0373 (±0.3036) mm and a median difference (Q1 to Q3) of 0.0809 (-0.2108 to 0.2769) mm. The study demonstrated that a highly accurate duplication of PSIs can be achieved using this template-molding workflow. The use of PEKK PSIs resulted in uneventful healing and esthetic acceptance by the patients and, therefore, is a relevant treatment option when temporal hollowing has to be corrected.