Patient-Specific Implants in Maxillofacial Reconstruction - A Case Report

Abstract

Rationale: The successful utilisation of three dimensional (3D) techniques in engineering a titanium patient specific implant (PSI) for a patient who underwent hemimaxillectomy following post COVID mucormycosis infection.

Patient concerns: Issues related to problems associated with resection following mucormycosis, such as occlusal function, aesthetics and facial asymmetry.

Diagnosis: The patient affected by mucormycosis was left with Aramany class 1 and Cordeiro type II sub total maxillectomy defect.

Treatment: The patient was operated for mucormycosis followed by reconstruction with patient specific implant.

Outcome: Positive clinical outcomes, including improved facial symmetry, function and psychological well being with immediate replacement of the teeth, the benefits of which far outweigh the traditional approach.

Take away lessons: The advances in the use of PSI by integration of 3D printing and computer aided design computer aided manufacturing (CAD-CAM) technology for extensive and challenging defects in the maxillofacial region have been highlighted in this case report.

Keywords: Case report; occlusion; patient-specific implants; prosthetic rehabilitation; reconstructive surgery.

Figure 1

Painless, progressively non-healing wound involving the right maxillary region and osteolytic lesion in the right maxilla causing break in the continuity of the floor of nasal fossa, maxillary sinus and right palatal bone

Figure 2

Pre-operative extra-oral clinical appearance demonstrating facial asymmetry, flattening of the nasolabial fold and asymmetrical lip line and pre-reconstructive intra-oral defect

Figure 3

Outlines and extent of defect extending from the infraorbital region superiorly, tooth 22 anteriorly and involving the nasal floor

Figure 4

Planning of the patient-specific implant extending from the zygomatic arch bilaterally and includes occlusal studs and provision for hardware fixation

Figure 5

Fabricated patient-specific implant on the patient’s anatomic model with provision for hardware fixation and occlusal studs demonstrating the fit of the patient-specific implant

Figure 6

Intraoperative fixation of the patient-specific implant and intraoperative suturing done following fixation of the patient-specific implant

Figure 7

The final Prosthesis and 9-month post-operative follow-up demonstrating facial symmetry, even smile line and improvement of the nasolabial fold

Figure 8

Post operative orthopantomogram (OPG) showing fixation of patient specific implant with rigid fixation screws along with the prosthetic components