Applications of Computer Technology in Complex Craniofacial Reconstruction

Abstract

Background: To demonstrate our use of advanced 3-dimensional (3D) computer technology in the analysis, virtual surgical planning (VSP), 3D modeling (3DM), and treatment of complex congenital and acquired craniofacial deformities.

Methods: We present a series of craniofacial defects treated at a tertiary craniofacial referral center utilizing state-of-the-art 3D computer technology. All patients treated at our center using computer-assisted VSP, prefabricated custom-designed 3DMs, and/or 3D printed custom implants (3DPCI) in the reconstruction of craniofacial defects were included in this analysis.

Results: We describe the use of 3D computer technology to precisely analyze, plan, and reconstruct 31 craniofacial deformities/syndromes caused by: Pierre-Robin (7), Treacher Collins (5), Apert's (2), Pfeiffer (2), Crouzon (1) Syndromes, craniosynostosis (6), hemifacial microsomia (2), micrognathia (2), multiple facial clefts (1), and trauma (3). In select cases where the available bone was insufficient for skeletal reconstruction, 3DPCIs were fabricated using 3D printing. We used VSP in 30, 3DMs in all 31, distraction osteogenesis in 16, and 3DPCIs in 13 cases. Utilizing these technologies, the above complex craniofacial defects were corrected without significant complications and with excellent aesthetic results.

Conclusion: Modern 3D technology allows the surgeon to better analyze complex craniofacial deformities, precisely plan surgical correction with computer simulation of results, customize osteotomies, plan distractions, and print 3DPCI, as needed. The use of advanced 3D computer technology can be applied safely and potentially improve aesthetic and functional outcomes after complex craniofacial reconstruction. These techniques warrant further study and may be reproducible in various centers of care.

Fig. 1.

Computer-assisted VSP and 3D models were used to plan placement of distractors and vector in this case of right unilateral coronal craniosynostosis. Notice almost complete normalization of the right forehead, orbit, and nose after distraction.

Fig. 2.

Accuracy and symmetry can be achieved with the aid of a customized cutting guide, vector analysis, and virtual planning of screw hole placement in a case of mandibular distraction for severe Pierre Robin Sequence with severe airway obstruction.

Fig. 3.

3D modeling was indispensable in these complex congenital craniofacial disorders. Seen here is a complex facial cleft that required 4-stage surgical repair in which both bony and soft-tissue 3D models were fabricated to simulate the surgical approach.

Fig. 4.

This is a severe case of Apert syndrome (kleeblattschädel) that used 3D models to plan anterior reconstruction and distraction.

Fig. 5.

Shown is a complex posttraumatic facial deformity with enophthalmos and vertical orbital dystopia. Virtual surgical simulation and 3D models were used in the reconstructive planning. Custom printed implants that were used are shown.

Fig. 6.

This patient with Treacher Collins syndrome exhibits characteristic malar deficiency. VSP with custom designed and printed implants played a big role in this zygomatic-orbital reconstruction.