Postoperative Management of Zygomatic Arch Fractures: In-House Rapid Prototyping System for the Manufacture of Protective Facial Shields.

Zygomatic fractures account for 10% to 15% of all facial fractures. The surgical management of isolated zygomatic arch fractures usually requires open reduction treatment without fixation through an intraoral access. Therefore, the main problem in the non-fixed treatment of zygomatic arch fractures is related to the difficulty in obtaining a stable reduction for a period long enough to guarantee the physiological bone healing process. We propose an innovative "in-house" rapid prototyping (RP) protocol for the 3D-zygoma mask manufacture of a patient-specific protective device to apply after zygomatic arch fracture reduction. Our study includes 16 consecutive patients who underwent surgical open reduction for an isolated zygoma fracture without fixation between January 2017 and February 2018. The patients received regular postoperative checks at weeks 1 and 2. Before the device was removed, a multiple choice questionnaire was administered to measure the degree of wearability of the mask. The estimated cost of the production is around &OV0556;5 per case and the construction time is around 90 minutes. Based on the encouraging results, obtained in our experience, we hope that other studies can be conducted to confirm our procedure and improve its functionality in the field of facial trauma.

Low-cost, self-made CAD/CAM-guiding system for mandibular reconstruction.

Facial symmetry, as well as function, remains the big challenge for surgeons who attempt mandibular reconstruction. Nowadays several studies recommend the use of computer aided surgery (CAS) and CAD/CAM technology to guide mandibular segmental osteotomies and reconstruction using free fibula flap. Although these systems have radically changed the way of doing mandibular reconstructive surgery, they are expensive and require extended periods of time for prototypation. This may be an important limitation in case of malignant neoplasms which require short-term treatment. The aim of our study is to investigate the reliability and efficiency of a protocol to obtain cutting guides produced in a "homemade" way. This study includes four consecutive patients who underwent a segmental mandibulectomy and fibula osteo-cutaneous free flap reconstruction for oral squamous cell carcinoma between January and September 2016. The CAD/CAM system algorithm proposed was based on the use of free open source software for digital planning and 3D layer plastic deposition printer. A cost of about 3 Euro for each case was estimated. An average mean distance between 3D preoperative and postoperative mesh points of 1.631 mm and a standard deviation of 5.496 mm has been demonstrated by 3D volume overlay analysis. Overlapping results with much shorter prototyping time was required with the in-house procedure described as compared to the available commercial system. In conclusion, we expect that this technique will reduce operative time and cost however further study and large series are needed to confirm our results and better define the applicability in everyday surgical practice.